Skin Cancer

Skin cancer is one of the most common cancers in the world.  Skin cancer is an abnormal growth of skin cells most often occurring on skin exposed to the sun.  However, skin cancer can also develop on areas of your skin not generally exposed to sunlight.

There are three main forms of skin cancer:

• Basal cell carcinoma 
• Squamous cell carcinoma
• Melanoma

The most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma.  Also referred to as ‘non-melanoma skin cancer’, they affect approximately 147,000 people in the UK each year.

Melanoma is the most dangerous form of skin cancer and is not as common as basal cell or squamous cell carcinomas. Early diagnosis and treatment is key; if left untreated or diagnosed too late, melanomas are more likely to spread to other organs as well as the skin, making it harder to treat and increasing the risk of death from skin cancer.

Checking your skin for changes and talking with your doctor if you notice anything suspicious can help identify cancer at the earliest stages giving you the chance of recovery.  You can help reduce your risk of skin cancer by reducing or avoiding exposure to ultraviolet (UV) radiation.

Symptoms of Skin Cancer

Skin cancer is typically a section or spot of skin that does not heal.  If you scratch your knee, it will usually heal within a month, however skin cancer will not.  The most common warning sign of skin cancer is an irregularity on the skin, characteristically a new growth, or a change in an existing growth or mole.

Skin cancer develops predominantly on areas of skin frequently exposed to the sun, such as the scalp, face, lips, ears, neck, chest, arms, hands, and legs.  However, it can also occur on areas that barely see sunlight — your palms, beneath your fingernails or toenails, and genital area.

Basal cell carcinoma signs and symptoms may appear as:

• A small, smooth, pearly or waxy bump 
• A flat, pink/red or brown coloured scar-like lesion
• A scabbing or bleeding that heals and then returns

Squamous cell carcinoma signs and symptoms may appear as:

• A solid, red nodule 
• A flat, rough, scaly lesion that can itch, bleed, and become crusty on the surface

Both basal cell and squamous cell cancers largely occur on areas of the skin frequently exposed to the sun such as your neck, face, ears and hands but can occur anywhere.

Melanoma can occur anywhere on your body, in normal skin or in an existing mole that becomes cancerous.  Melanoma mainly develops on the face or the trunk of affected men.  In affected women, this type of cancer most often occurs on the lower legs.  Melanoma can occur on skin not exposed to the sun, in both men and women.

Skin cancer affects people of all skin tones.  If melanoma occurs in people with dark skin tones, it is more likely to develop in areas not usually exposed to the sun, such as the palms of the hands, soles of the feet and finger nails.

Melanoma symptoms may appear as:

• A large brown patch with darker speckles
• A painful lesion that itches or has a burning sensation
• A mole that changes in size, colour, texture or that bleeds

Following the ABCDE rules will help you know what signs to look out for:

Asymmetry

Unequal and uneven shape.

Border

Uneven or irregularly shaped edges.

Colour

Different shades of black, brown or tan. Or, as it grows, red, blue or white.

Diameter

Larger than 6mm or your average pencil eraser.

Evolution

Any change, enlarging, shape, colour, size or symptom such as crusting, bleeding or itching.

Signs and Symptoms of Less Common Skin Cancers

Kaposi Sarcoma

This rare form of skin cancer occurs in the skin’s blood vessels and forms red or purple patches on the skin.  Kaposi sarcoma generally develops in people with weakened immune systems, such as people with AIDS, or in people taking medications that subdues their natural immunity, such as people who have undergone organ transplants.

Merkel Cell Carcinoma

Merkel cell carcinoma causes solid, shiny nodules that develop on or just underneath the skin and in hair follicles. Merkel cell carcinoma is most frequently found on the head, neck and trunk.

Sebaceous Gland Carcinoma

This rare and aggressive cancer develops in the oil glands in the skin.  They usually emerge as hard, painless nodules that can develop anywhere, but most commonly on the eyelid, where they are frequently mistaken for other eyelid problems.

Book an appointment with your doctor if you notice any changes to your skin that cause you concern.  Not all changes to the skin are caused by skin cancer.  Your doctor will examine your skin changes to try and determine a cause.

Causes of Skin Cancer

Except in rare cases, most skin cancers come from DNA mutations caused by ultraviolet light affecting cells.  Many of these early cancers seem to be controlled by natural immune investigation.

Causes of non-melanoma skin cancer causes

Over-exposure to ultraviolet (UV) light is the prime cause of non-melanoma skin cancer.  UV light originates from the sun as well as from tanning beds and sunlamps.

Other factors that can increase your risk of developing non-melanoma skin cancer includes:

• Previous non-melanoma skin cancer
• Family history of skin cancer
• Pale skin that burns easily
• A large number of freckles and moles
• Taking medication that suppresses the immune system
• A medical condition that represses your immune system

Melanoma skin cancer causes

Melanoma is caused by skin cells that start to develop abnormally.  Over-exposure to ultraviolet (UV) light from the sun and sunbeds is believed to cause most melanomas.  The type of sun exposure that causes melanomas is abrupt, intense exposure such as while on holiday or getting sunburnt.

Other factors that can increase your risk of developing melanoma include:

• Having lots of moles or freckles 
• Having a condition or taking medication that suppresses your immune system 
• Having easily burnt, pale skin
• Previous skin cancer diagnosis
• Blonde or red hair
• Previous exposure to radiation
• A family history of melanoma

Cells Involved in Skin Cancer

Skin cancer begins in the top layer of your skin, the epidermis.  The epidermis is a thin layer that offers a protective cover of skin cells that your body constantly sheds.  The epidermis contains three main types of cells:

• Squamous cells sit just under the outer surface and work as the skin’s inner lining.
• Basal cells produce new skin cells and sit beneath the squamous cells.
• Melanocytes, which produce melanin (the pigment that gives skin its colour) are located in the lower portion of your epidermis.  Melanocytes create more melanin when are in the sun to help protect the deeper layers of your skin.

The type of cancer you have and the treatment options available depend on where the skin cancer began.

Diagnosis

To diagnose skin cancer, your doctor will examine your skin and remove a sample of skin for testing (a biopsy).  If your doctor determines you have skin cancer, they will likely carry out additional tests to conclude the stage of the skin cancer.

Additional investigations may include imaging tests to inspect the nearby lymph nodes for signs of cancer or a procedure to remove a nearby lymph node and test it for signs of cancer (sentinel lymph node biopsy).  In some cases, a biopsy alone can remove all the cancer tissue and no further treatment is needed.  A biopsy is typically performed using local anesthetic to numb the area, so you will not feel any pain.  You will undergo further tests if there is a concern that the cancer may have spread into other organs, bones or your blood.

The skin cancers stage will help determine which treatment option will be most effective.

Skin Cancer Staging

Staging is a way of describing the size of the cancer and how much it has grown.  When a cancer is first diagnosed, your doctor will perform tests to check how large the cancer is, if it has spread to surrounding tissues or other parts of the body.  Cancer staging can sometimes include the grade of cancer, describing how similar a cancer cell is to a normal cell.

T (tumour): This refers to the tumour’s size, location and how deep it has grown into the skin.

N (node): This defines whether or not cancer cells have spread to nearby lymph nodes, or the channels joining the lymph nodes.

M (metastasis): This refers to whether the cancer cells have spread to further organs.

Different types of staging structures are used for different types of cancer.  Below is an example of one common method of staging:

Stage 0

Indicates that the cancer has not spread and is still in situ.

Stage I

The cancer is minor and has not spread anywhere else.

Stage II

The cancer has developed, but has not spread.

Stage III

The cancer is larger and may have spread to the nearby tissues and/or lymph nodes.

Stage IV

The cancer has spread to at least one other organ- referred to as ‘secondary’ or ‘metastatic’ cancer.

The grade of a cancer is determined by how the cells look like under a microscope.  Typically, a lower grade specifies a slower-growing cancer and a higher grade specifies a faster-growing one.  Below is an example of the grading system used:

Grade I

Cancer cells resemble regular cells and are not growing quickly.

Grade II

Cancer cells do not resemble normal cells and are growing quicker than normal cells.

Grade III

Cancer cells appear abnormal and may grow or spread more aggressively

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

Treatment

Surgery is the main treatment for melanoma and non-melanoma skin cancer, although it may depend on your individual situation.

When helping you decide on your private skin cancer treatment, your doctor and healthcare team will consider:

• The type of cancer you have 
• The stage of your cancer 
• Your general health

Your treatment team will suggest the option that they think is best for you, but the final decision is yours.

In the case of non-melanoma skin cancer, non-surgical treatments such as freezing (cryotherapy) and radiotherapy can be used in certain circumstances.  Treatment for non-melanoma skin cancer is successful in 9 out of 10 patients. 

Treatment options for melanoma and non-melanoma skin cancer may include:

• Radiotherapy 
• Chemotherapy 
• Surgery
• Immunotherapy
• Cryotherapy
• Photodynamic therapy (PDT)
• Electrochemotherapy

Outlook

It is important to seek medical attention if you notice skin abnormalities in order to obtain an early diagnosis.  Examine your skin for new growths, changes, freckles, bumps and birthmarks.  Take care in the sun, wear sun cream, avoid tanning beds and wear protective clothing.

If you have been diagnosed with skin cancer, knowing what to expect and making a plan for how to proceed can help make this worrying time easier.

Need Help?

Private skin cancer treatment is available at One Ashford Hospital in Kent with a leading Consultant Dermatologist and we can book you in for a consultation, usually within 48 hours.  

One Ashford Hospital is ideally located for patients in Ashford, Maidstone, Dover, Canterbury, Folkestone and all nearby areas.  To book an appointment, call the hospital direct on 01233 364 022 or email here.