Skin Cancer Q&A

Three of our leading skin cancer specialists answer some of your most commonly asked questions on skin cancer, including signs and symptoms, the most common places for skin cancer to appear, early diagnosis, and effective treatment options – of which there are many.

• Dr Andrew Birnie is a consultant dermatologist and dermatological surgeon at The Chaucer Hospital
• Dr Robert Herd is a consultant dermatologist at Ross Hall Hospital
• Dr Sandeep Varma is a consultant dermatologist at The Park Hospital

What is skin cancer?

Dr Andrew Birnie: Skin cancer is the most common form of cancer in the world. It is typically divided into two main types, which are melanoma and non-melanoma skin cancer (NMSC).

Melanomas are derived from melanocytes. These are the cells that produce melanin, which is why they are often deeply pigmented. These are typically the most dangerous skin cancer, though if caught early, the majority do not require further treatment after being removed.

There are a number of types of NMSC, but the two most common are squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). SCCs often grow quickly and a small proportion can spread. BCCs are the most common form of skin cancer but, if treated appropriately, they almost never spread.

Dr Robert Herd: Skin cancer can be divided into melanoma and non-melanoma skin cancer. The most serious type is melanoma. If not treated early, it can spread and cause more serious disease. Basal cell carcinoma is the most common type of cancer and can usually be treated easily if identified early by surgical excision. Squamous cell carcinoma is also a non-melanoma skin cancer and only rarely spreads.

Dr Sandeep Varma: Skin cancer is the name given to any cancer that arises from a structure of your skin. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

What are the most common skin cancer symptoms?

Dr Andrew Birnie: Skin cancers will usually be noticed as a new or changing lesion on your skin, or a wound that never heals. Skin cancers are not always symptomatic, though some areas where skin cancer is present can be tender to the touch.

Dr Robert Herd: Skin cancer appears as a new or changing blemish on your skin. Melanoma is usually brown or black in colour and can be quite irregular in outline and in colour. It can occur on any part of the skin but is most common on the legs of women and the backs of men.

Dr Sandeep Varma: Basal cell carcinoma can bleed then scab, then bleed then scab. Often the lesion looks like it will heal, only for the scab to come off in the shower, on the towel, or on your pillow.

Signs of skin cancer on your back

Dr Robert Herd: Keep an eye out for moles on your back that have irregular borders, an uneven colour, are larger than the size of a pencil eraser (6mm or more), or have changed in shape, size, or colour over time.

Watch for the development of new growths on your back that do not heal, or go away, or persist for several weeks or months.

Non-melanoma skin cancer most commonly occurs on the head and neck, which are areas most exposed to the sun. Its appearance can vary from being a smooth or scaly lump to a flat, scarred looking patch.

Is skin cancer painful?

Dr Sandeep Varma: Squamous cell carcinoma grows like a lump often and can sometimes cause pain, but it can also be a symptomless growing lesion.

Melanoma can be surprisingly symptomless and usually presents as a new mole that grows or a pre-existing mole that changes in size, shape and/or colour.

Who is most at risk of skin cancer?

Dr Andrew Birnie: People with fair skin and those who have had a lot of UV exposure.

The lighter your skin the greater the risk, so those people who have skin that burns and never tans in the sun are at most risk. There is still some debate as to exactly how UV light is involved in the development of skin cancer, but it is thought that intense periods of sun exposure and burning episodes are the biggest contributor to the development of melanoma. Cumulative UV exposure plays an important role in SCCs.

Typically, skin cancer affects older people, but melanoma is one of the most common cancers in adolescents and young adults. Increasingly, I am seeing people in their 20s and 30s with BCCs who have used sunbeds.

Dr Robert Herd: The risk factors for all the common skin cancers are skin type and sun exposure. Those with pale skin and those who have had a lot of sun exposure are most at risk. The main risk factors for melanoma are pale skin type, many moles, a history of sun burns and use of sun beds. The pattern of sun exposure that leads to basal cell carcinoma is total sun exposure up to a certain threshold. For squamous cell carcinoma it's total cumulative sun exposure.

Dr Sandeep Varma: Fair-skinned individuals with skin that burns easily and tans poorly. Those who have experienced a lot of sun exposure through holidays, work, hobbies, or leisure. Those who have used sun beds or experienced blistering sunburn. Those with lots of moles or freckles. Family history can be important, too.

Is there a genetic element to skin cancer risk?

Dr Andrew Birnie: Yes, there is definitely a genetic link. Someone with an immediate family member (parent or sibling) who has had a melanoma is probably twice as likely to develop a melanoma than one with no family history.

There are some genetic conditions in which affected individuals develop large number of skin cancers. Fortunately, these are very rare, but if a relative has had a number of BCCs it may well increase an individual's risk of developing one, too.

Dr Robert Herd: A family history of sun exposure gives a small increased risk of skin cancer. It is therefore sensible that these individuals should avoid sun exposure.

Dr Sandeep Varma: People with a family member who has had skin cancer should take extra precaution by keeping a check on their skin for any new moles that grow or change quickly. Be alert for any lumps that grow unusually or bleed or scab. Use sunscreens if they burn and a broad brimmed hat and long-sleeved clothing. The sun should also be avoided between 11am and 3pm.

How is skin cancer detected?

Dr Andrew Birnie: If someone spots a new or changing lesion, then they should see their GP. Unless they are confident it is benign, the GP will refer the patient to the local skin cancer clinic or dermatologist. The specialist will then see the patient, take a history, and examine them. With melanomas, your dermatologist will be looking for asymmetry, an irregular border and variable colours. They may also use a device called a dermatoscope to look more closely at it.

If your specialist suspects cancer, then they will often remove the whole lesion and send it for pathology, though with BCCs and SCCs a biopsy may be taken first to help determine the right form of treatment.

Dr Robert Herd: Skin cancer is detected by seeing a lesion on the skin that is either new or changing. This should then be examined by a doctor, and if skin cancer is suspected, they should be referred to a dermatologist or other specialist. The specialist will then either reassure the patient or perform a biopsy to identify the precise diagnosis.

Dr Sandeep Varma: A history and clinical examination are usually enough to diagnose skin cancer. A dermatoscopy is extremely useful, but if there is any doubt then a biopsy can help with the diagnosis.

What is the most common treatment for skin cancer?

Dr Andrew Birnie: In most cases for melanoma the appropriate treatment is a wide excision (the removal of the mole or affected area of skin). Certain medication may be an alternative treatment.

BCCs and SCCs are typically excised, sometimes with a more advanced technique called Mohs micrographic surgery, but they can also be treated with radiotherapy.

Dr Sandeep Varma: There are many options, surgical and non-surgical and these depend on the type of skin cancer you have. Most skin cancers can be treated under local anaesthetic, meaning you will be awake during the procedure, but the area being operated on will be numbed so you don’t feel any pain. There are various medications that can be an alternative appropriate treatment.

Skin cancer treatments

Radiation therapy is often used for skin cancers that are not easily treated with surgery or when surgery is not an option.

Some early-stage skin cancers can be treated with topical medications applied directly to the skin, such as creams or gels. These medications may include chemotherapy creams, immune response modifiers, or photodynamic therapy.

Cryotherapy involves freezing the cancer cells with liquid nitrogen. It's commonly used for precancerous skin conditions and small, early skin cancers.

Electrodesiccation and curettage involves scraping away the cancerous tissue with a curette (a sharp instrument) and then using an electric needle to destroy any remaining cancer cells. It's often used for superficial skin cancers.

Targeted therapy and immunotherapy are newer treatments that target specific molecules involved in cancer growth or stimulate the immune system to fight cancer. They are mainly used for advanced or metastatic skin cancers.

Systemic chemotherapy, which involves taking medication by mouth or through a vein, may be used for advanced cases of skin cancer that have spread to other parts of your body. However, it is less commonly used for skin cancer than some other cancers.

Getting treatment with Circle Health Group

There you have it – everything you need to know about skin cancer through the eyes of dedicated experts.

At Circle Health Group we offer many treatment options for skin cancer, including surgery.

If you want to know more about our treatment options, book your appointment online today or call a member of our team directly.