What is skin cancer?
Skin cancer is caused by a change in skin cells that allows them to grow abnormally causing a tumour. It occurs when there is damage to the genetic material (DNA) within skin cells which is often caused by exposure to UV radiation (sunlight exposure). It is the commonest type of cancer in the UK and although it is often seen in older individuals it can also affect adults from a young age. It is very important to detect skin cancer early as it can be treated effectively without serious consequences to general health if it is removed at an early stage.
What types of skin cancer are there?
There are 2 main types of skin cancer: Melanoma and Non-Melanoma skin cancer
Melanoma skin cancer is a dangerous type of cancer as it has the potential to spread internally to other parts of the body from the skin. It is caused by a cancerous change in the pigment cells in the skin known as melanocytes. The incidence of melanoma continues to rise worldwide and in the UK around 16200 cases are diagnosed each year. It is the 5th commonest type of cancer. Melanomas can develop within moles however most (>80%) arise independently of a mole. They can appear anywhere on the body but most commonly arise on the legs, trunk, arms and face.
Non-melanoma skin cancer
Non-melanoma skin cancers are much more common than melanoma with over 152000 cases per year in the UK. Fortunately, they are usually less serious than melanoma skin cancer. The 2 main types are basal cell carcinoma and squamous cell carcinoma. They tend to occur on sun exposed sites on the body, particularly on the face, scalp, neck and ears. Basal cell carcinomas are the commonest type accounting for 75% of non-melanoma skin cancers. They are slow growing and usually remain localised to the skin. If left for long periods of time however they can cause ulceration in addition to significant destruction of the skin and underlying structures making it more difficult to remove them. Squamous cell carcinomas can be more serious as they occasionally move to other parts of the body. They tend to grow rapidly and are often painful.
What should I look out for?
You should get urgent advice if you notice a new pigmented lesion on the skin, particularly if it looks different from your other moles. Dermatologists look out for the “ugly duckling” sign- the mole that looks ugly and different from the rest of the persons other moles. You should also seek medical advice if you notice a change in colour, shape or size in a mole. Persistent itching or bleeding in a skin lesion can also be a sign of something concerning.
The ABCDE checklist is a helpful tool to assess for worrying signs that might indicate you have a melanoma.
A: Asymmetry- one half of a mole does not match the other
B: Irregular border- such as blurring, notches
C: Multiple colours- melanomas are often brown or black but can also have shades of blue, grey and red within them. Over time different colours can develop within a melanoma.
D: Diameter- melanomas are often larger than a standard mole (>5mm diameter)
E: Evolving- changing in size, shape or colour
This is useful as a guide but not all skin lesions with some of these features are cancerous and not all melanomas follow these rules! If you are not sure you should seek expert medical advice.
Basal cell carcinomas usually present as a skin coloured, pink or pearly white lump sometimes with visible small blood vessels on their surface. They are usually painless, grow slowly with time and can bleed or scab over. There is also a superficial type of basal cell carcinoma that can appear as a red scaly patch of skin. Squamous cell carcinomas are usually firm, pink, scaly lumps, sometimes with a spiky horn arising from the top. They are often painful/ tender and can bleed easily.
Am I at risk of getting skin cancer?
Several factors contribute to an individual’s risk of getting skin cancer. Environmental exposure to ultraviolet (UV) radiation is one of the most important (and preventable!) causes of skin cancer. If you work outdoors, have had a lot of sunny holidays, or lived overseas and if you have had multiple sunburn episodes (particularly blistering) then your risk is higher. Sunburn in childhood is thought to be a significant risk factor for getting skin cancer in later life. There is also evidence that the use of sunbeds can increase the risk of skin cancer. Genetic factors are also important for determining your risk particularly if you are fair skinned and freckly, are unable to tan easily, have lots of moles (more than 50) and have a family history of melanoma. Individuals whose immune system is suppressed by disease or medication are also at higher risk. For example, guidelines state that organ transplant recipients on medication to suppress their immune system should have an annual check of their skin.
What can I do to reduce my risks of getting skin cancer?
Being outdoors is an enjoyable and important part of everyday life, however excessive exposure to the sun can be dangerous. Even if you have already had a lot of sun exposure there is strong evidence to show that limiting UV exposure can still reduce your risks! Being careful in the sun, particularly in sunny conditions with a high UV index, by avoiding exposure during the middle part of the day, wearing protective clothing where possible and using a good sunblock will all limit the risks. It is advisable to use a broad-spectrum sunblock that protects against both UVA and UVB rays. This should be a minimum of a Factor 30 and needs to be applied in good quantity (a “shot glass full” is sufficient for a single application for an average sized adult in a swimming costume) and regularly. The protective barrier chemicals in most sunscreens break down in direct sunlight and so they need to be reapplied every couple of hours. Avoiding the use of sunbeds is also recommended.
Being aware of your skin and moles and performing monthly skin checks can also help to pick up early changes that can be treated. For individuals who are at higher risk of skin cancer, mole mapping can be a very helpful tool to assist patients and Dermatologists. Mole mapping uses digital imaging technology to provide detailed images of moles over the body that make it easier to detect changes in moles at an early stage.
What should I do if I’m worried about something on my skin?
It is essential that you seek medical advice if you notice something worrying on your skin as quickly as possible. Skin cancer is treatable if it is caught at an early stage.
What can I expect if I come in for a check of a suspicious skin lesion?
The doctor will ask you some questions relating to the area of concern such as how long it has been there, any symptoms and if it has changed. They will also assess your risk of skin cancer by asking about your previous sun exposure, if you have had previous skin cancers, family history and your background medical history. They will then examine the lesion closely including with a type of magnifying glass known as a dermatoscope. A dermatoscope is able to provide the doctor with a 10x magnified view of the lesion but also reveals structures that cannot be seen with the naked eye and provide vital information on the likelihood of whether something is benign (non-cancerous) or malignant (cancerous). You will usually also be offered a full body skin check. This is advisable as it allows the doctor to compare the mole or skin lesion with other moles on the body- moles that look different to others in an individual person are more concerning. It also helps to make sure that there are no other concerning skin lesions that you may not have otherwise noticed.
What happens if the skin lesion is worrying?
If the doctor thinks that the skin lesion looks worrying, then they will advise a biopsy. Different types of biopsy may be offered depending on the appearance, size and the type of growth that is seen. Skin biopsies are performed under a local anaesthetic and are usually quick and straightforward. The biopsy enables the skin lesion to be examined in detail under the microscope by an expert pathologist who can confirm what the type of growth is and enable the doctor to advise you on the best possible treatment required. In many cases the biopsy will fully remove the lesion of concern and no further treatment is required.
If the skin lesion is not thought to be worrying in appearance but is causing problems due to symptoms such as itching, catching on clothing or is of cosmetic concern then the doctor can also discuss optimal ways with you for removing the lesion.
What happens if I am diagnosed with skin cancer?
The doctor will spend time to explain the diagnosis to you and discuss if any further investigation or treatment is required. At OneWelbeck all of our patients who are diagnosed with a serious type of skin cancer such as melanoma are supported by a multidisciplinary group (known as a multidisciplinary team or MDT) of top experts in skin cancer including dermatologists, specialist dermatological surgeons, plastic surgeons, histopathologists and oncologists. This ensures that all patients receive the best possible treatment, by the best type of doctor according to their individual case and needs. Your follow up will also be tailored to ensure the best possible outcome.