Skin cancer is the most common cancer of all types in humans, and its incidence is on the increase
This is due to a combination of factors, including people in the UK having more recreational sunshine due to foreign holidays and use of sunbeds. The government passed the Sunbeds Regulation Act in May 2010. This bans under 18 year olds from using sunbeds.
Risk factors for skin cancer include
- High and prolonged sun exposure
- Skin types I-II (fair skin, blue eyes, blonde or red hair, freckles)
- Sunburn in childhood
- Use of sunbeds
- Family history
- Genetic predisposition
- Transplant or immunosuppressed patients
There are several types of skin cancer
Roughly they can be divided between:
- Non-melanoma skin cancer (NMSC). These cancers don’t arise from melanocytes (pigment producing skin cells).
- Melanoma, arising from melanocytes.
Non-melanoma skin cancer
Basal Cell Carcinoma (BCC)
These are the most common types of skin cancer (75%).
Estimates in the UK are around 100,000 cases per year. This is likely to be an underestimate, as not all of them are recorded.
BCCs often grow very slowly and can go unnoticed for some time as they don’t give any symptoms. When they get larger, they can sometimes bleed or scab. They can also ulcerate (commonly known as rodent ulcer).
They often present like a new sore or skin lesion that doesn’t heal up.
They appear on sun exposed areas, and they are more common with increasing age. However, dermatologists are now seeing BCCs in younger people, illustrating the increasing trend.
This cancer very rarely spreads anywhere else in the body (they don’t metastasize). However, they can cause local destruction of deeper structures, and if they are ignored and grow to a large size can require very involved and potentially mutilating surgery.
There are a variety of treatments for BCCs, depending on the type and size. These include creams, freezing (cryotherapy), PDT (photodynamic therapy), surgery and radiotherapy.
Squamous cell carcinoma (SCC)
These types of cancers are less common (ratio 4-6 BCCs per SCC).
They are more aggressive, and often grow faster and look more alarming than BCCs.
They can appear on areas of sun damaged skin after some physical trauma. They can also spread to other organs (metastasize) and be potentially fatal. SCCs on the ears and lips are more likely to metastasize.
To have the best prognosis, SCCs must be diagnosed and treated promptly. Treatment with commonly involve surgery but radiotherapy can also be used on some occasions.
Malignant Melanoma is the deadliest form of skin cancer. However, if diagnosed and treated in its early stages, the prognosis is very good.
Melanomas arise on pre-existing moles from pigment producing cells called melanocytes. However, around half of cases will appear as a new mole (we call that de novo).
The main warning signs that a pigmented lesion could be a melanoma are a change in size, shape or colour on a new or existing mole. It looks out of character from the rest of your moles (we call this the ugly duckling sign).
Melanomas often don’t produce any symptoms until they are advanced.
Treatment for melanoma always includes surgery. This gives the best chance of a cure. Surveillance is necessary to detect recurrence after treatment.
In the event of the melanoma having already spread, there are now several types of immunotherapy available that can effectively prolong survival and maintain quality of life. Different treatments can be use depending on the genetic markers of the tumour.
The South West of England has one of the highest incidences of skin cancer in the UK. This is partly due to the weather, but also people’s occupations and hobbies tend to be more outdoors. There is also a higher proportion of elderly people retiring to this part of the country. For more information and statistics on skin cancer in the SW, please check the Skin Cancer Hub website.
In the UK, there are very good guidelines about how patients with skin cancers should be managed. NICE Improving Outcomes Guidelines for people with skin tumours including Melanoma. These are implemented in all NHS cancer treatment centres, so this remains the best setting for your skin cancer to be treated.
Glasgow Melanoma 7 point checklist
- Change in size
- Irregular shape
- Irregular colour
- Diameter over 7mm
- Change in sensation
Melanoma ABCDE rule
- A Asymetry
- B Border irregularity
- C Colour variation
- D Diameter over 6mm
- E Evolving (enlarging, changing)
One major feature or more, or 2 minor features or more are concerning