Skin Cancer

Skin cancer is the uncontrolled growth of abnormal skin cells that form into a mass of cancer cells.

Most cases of skin cancer are caused by overexposure to ultraviolet (UV) light from the sun and also tanning beds and sunlamps.

Although we do not know why certain cells become cancerous, risk factors have been identified for skin cancer. These include fair skin, red or blond hair, blue eyes, several freckles, previously damaged skin from sunburn or radiation, a large number of moles particularly those 5mm or more or irregularly shaped, precancerous skin lesions, age, a family or personal history of skin cancer, excessive sun exposure and living in sunny or high-altitude climates, a weakened immune system, and exposure to certain substances such as arsenic.

The diagnosis of skin cancer normally begins with a skin cancer screening which is a visual examination of your skin by a doctor or skin specialist (dermatologist) or plastic surgeon. They may take a biopsy to determine the type of skin cancer you have and whether it might spread to other parts of your body. Further tests may be required to check if cancer has spread to your lymph nodes or another part of your body.

Skin cancer is usually divided into melanoma and non-melanoma cancer. 

• Non-melanoma – the most common types are:
  • Basal cell carcinomas (BCC) – is by far the most common skin cancer. BCC starts in the basal cells at the bottom of your epidermis. It occurs most often on skin areas that are exposed to the sun such as your head and neck. It grows slowly not usually spreading to other parts of your body. Most BCC’s are treated successfully.
  • Squamous cell carcinomas (SCC) – is the second most common type of skin cancer in the UK. SCC is a cancer of the cells in the outer layer of your skin. It is usually slow-growing and only spreads to other parts of your body if left untreated for a long time unless it is a more aggressive type. Most SCC’s can be completely cured.
• Malignant melanoma - the less common but most serious type of skin cancer that can grow quickly and needs to be treated early. It can start in a mole or normal skin that creates a new, abnormal mole, in skin cells called melanocytes that are mainly in the top layer of your skin.

Skin cancer symptoms are different for melanoma and non-melanoma skin cancer.

Symptoms of non-melanoma skin cancers:

Non-melanoma skin cancer most often develops on areas of skin that are regularly exposed to the sun, such as your face, ears, shoulders, upper chest and back, and hands.

The first sign of basal cell carcinomas and squamous cell carcinomas is usually the appearance of a red and firm lump that may turn into an ulcer or a discoloured and scaly skin patch that does not heal within a few weeks and slowly progresses over time.

More specifically, a basal cell carcinoma usually appears as a small and pearly lump with a waxy appearance that slowly gets bigger, may become crusty, bleed, or develop into a painless ulcer. It can also look like a red, scaly patch with some brown or black pigment within.

A squamous cell carcinoma appears as a firm pink lump with a crusted and scaly surface that may feel tender, bleed sometimes, and develop into an ulcer.

Symptoms of melanoma skin cancers:

Melanoma skin cancers can appear anywhere on your body but are less common in areas that are protected from sun exposure.

The most common melanoma skin cancer symptoms are a change in an existing mole or the development of a new pigmented or unusual-looking mole-like growth on your skin.

Most melanoma moles have an irregular shape and are more than one colour. They may be larger than normal and itchy or bleed.

You should keep an eye on suspected melanoma moles. They gradually change shape, size or colour and need treatment as soon as possible.

Skin cancer treatment is based on the type of cancer you have.

Non-melanoma skin cancer treatment

Minor surgery is the main treatment for non-melanoma skin cancer. It removes the cancerous tumour and some of the surrounding healthy skin. Mohs surgery removes and examines the cancer layer by layer until no abnormal cells remain.

Other treatments are available for non-melanoma skin cancer and will be recommended based on the type, size, and location of your non-melanoma skin cancer and your personal preferences. These include:

• Cryotherapy – freezes small skin cancers with liquid nitrogen.
• Curettage and electrodessication (C and E) - removes the surface of small skin cancers with a scraping curet instrument and then sears the base of the cancer with an electric needle.
• Anti-cancer creams - prescription creams or ointments treat small skin cancers.
• Radiotherapy - high-energy beams kill cancer cells. Sometimes used after surgery if there is an increased risk of cancer returning or for people who can't undergo surgery.
• Laser therapy – an intense beam of light destroys cancer growths for superficial skin cancers.
• Photodynamic therapy (PDT) - a combination of photosensitising drugs and light treatment that destroys small superficial skin cancers.

Non-melanoma skin cancer treatment is usually successful as these types of cancer rarely spread to other parts of your body, unlike most other types of cancer.

Melanoma skin cancer treatment

Treatment for your melanoma will depend on the size, stage and location of your cancer, your overall health, and your personal preferences.

If melanoma is diagnosed at an early stage, surgery is the main treatment to remove the cancer and sometimes a border of the normal surrounding skin and is usually successful.

If melanoma has spread beyond your skin your treatment options may include:

• Lymph node removal surgery – removes the affected nodes if the melanoma has spread to your nearby lymph nodes.
• Targeted therapy - medicines target specific genetic changes in the melanoma, such as BRAF inhibitors, or medicines boost your body's immune responses to the melanoma.
• Radiotherapy - high-powered energy beams kill your melanoma cancer and may be directed to your lymph nodes if it has spread to them.
• Chemotherapy – drugs used to kill your melanoma cancer cells.

Unfortunately, once your melanoma has been removed, there is a chance it may return especially if your cancer was advanced or widespread. You may be offered regular check-ups to monitor your health and you will also be told how to examine your skin and lymph nodes to check for the return of melanoma.