Skin Cancers

There are three common types of skin cancers:

• Basal cell carcinoma
• Squamous cell carcinoma
• Malignant melanoma

Basal cell carcinoma (BCC)

Basal cell carcinoma also called the ‘rodent ulcer’ is the most common form of skin cancer. It usually occurs in sun exposed areas like the head, neck and legs. Individuals, especially fair skinned, with sun exposure like those who have worked outdoor or lived in warmer climates are more prone. It grows slowly over many months to years and can invade underlying tissues especially if neglected but spread (metastasis) is extremely rare. Once excised, there is no need for follow up in most individuals.

It presents in many forms such as

1. A scabby crusty area that bleeds from time to time and fails to heal.
2. A shiny nodule crossed by small blood vessels particularly at the edges.
3. A scaly, red flat mark.
4. A lesion with a pearly white rim and a central crater which if left for years can ‘gnaw away’ at the skin eventually causing an ulcer.

Treatment

BCCs can be cured by completely removing them surgically in most patients. Difficulties may arise, when they have been neglected or are located in awkward areas like around the nose and eyes. Surgical removal is the preferred treatment as it provides a specimen for the pathologist to confirm the diagnosis. Margin controlled surgery using Mohs micrographic surgery and frozen section controlled excision may be indicated especially for the difficult BCCs. Following removal it is possible to close the wound directly in many situations, sometimes however, reconstruction with skin grafts, local flaps or more complex reconstruction may be required.

Other methods of treatment include, radiotherapy, cryotherapy, photodynamic therapy, curettage and cautery.  It is sometimes more appropriate to use topical creams as treatment.  This will be discussed with you, along with the other options, at your consultation.

Squamous cell carcinoma (SCC)

The Squamous cell carcinoma is the second most common form of skin cancer.  It usually occurs in sun exposed areas like the head, neck and legs.  Individuals, especially fair skinned, with sun exposure like those who have worked outdoor or lived in warmer climates are more prone. It grows over many months and can invade underlying tissues especially if neglected. Less commonly, it can spread to lymph glands in the adjoining area. Distant spread is rare. Therefore there is a need for regular follow up appointments for many patients as well as self-examination.  This will hopefully help to detect any early recurrence or continuing spread.

SCC’s initially present as skin coloured lumps that grow in the surface layers of the skin. If untreated, these break though the skin to form ulcers with raised and everted edges. These may develop scabs or crusts. It may also present as the keratin horn.

The most common form of treatment is surgical excision, which provides a specimen for histologic diagnosis. Reconstruction with skin grafts, local flaps or more complex reconstruction may be required.

Radiotherapy may be indicated in some individuals in combination with surgery or alone.

Other forms of treatment include curettage and cautery, cryotherapy, photodynamic therapy.  Laser treatment may rarely be indicated in special circumstances.

Will further treatment be required on a long term basis?

You may need to be followed up after your treatment for 6 months to two years.

Malignant melanoma

A malignant melanoma is a cancer of the pigmented cells of the skin called melanocytes. These cells grow abnormally and produce a new mole or change in a pre-existing mole. Changes in the size, colour, shape or sensation of a mole or growth may be the first sign of a malignant melanoma.  However, a malignant melanoma can present with no symptoms.

The following factors can predispose to malignant melanomas;

1. Sun-exposure.
2. Fair skin.
3. Some familial tendency to develop malignant melanoma and have many abnormal moles.

Diagnosis

Malignant melanomas tend to be moles that have a characteristic appearance. They are usually larger than 6mm in diameter, have an irregular edge, variable pigmentation and tend to have some dark brown or black pigment. The majority of patients will have noticed recent growth in the mole or the development of a new mole. Unfortunately, a few of these moles will have no pigment or colour in them, thereby masquerading as other lesions and delaying diagnosis.

Treatment
Once suspected, an urgent excision biopsy is carried out under local anaesthetic as a day-case procedure to confirm the diagnosis.

If this confirms melanoma, further excision surgery will be necessary. Also Sentinel Lymph Node Biopsy may be an option depending on the thickness of the melanoma.

Reconstruction with a skin flap, a skin graft or more complex reconstruction may be required.

Follow up

Most patients will have a regular check-up every few months, for three to five years. Patients with very early melanoma may be discharged from clinic sooner.  Scans may also be necessary based on the thickness of the melanoma.

Prognosis

Early non-invasive melanoma is rarely life threatening and has an excellent prognosis. Complete cure is often possible with skin surgery. Invasive melanoma can sometimes spread to the lymph glands or elsewhere. The risk of spread depends on the depth of invasion of the abnormal pigment cells in the skin.  You will be advised about the risk, based on research studies that have been carried out.

How can I help reduce the risk of skin cancers?

• Do practice sun awareness!
• Do stay out of the sun when you can
• Do keep yourself covered up with a wide brimmed hat, long-sleeved shirt or blouse and long trousers when you go in the sun.
• Do wear a high protection factor sunscreen on exposed skin any time you go outdoors, even on overcast days.
• Remember that winter sun, on a skiing holiday for instance, may contain just as much of the damaging ultraviolet light as summer sun. Many companies now make skin moisturizers with a factor SpF 30 or above and you may want to use one of these as part of your daily routine.
• Do check out any lesions of concern with your doctor or specialist.
• Do not procrastinate.
• Do not use sun beds.
• Vitamin D supplementation may be beneficial as its level may become suboptimal with sun protection.