Q: What is Skin Cancer?
A: All cancers are caused by damage to the DNA inside cells. Skin cancer happens when the DNA inside skin cells is damaged, resulting in a malignant growth. There are different types of skin cancer with varying risks of malignancy and therefore varying potential to spread. Skin cancers generally develop in the outermost layer of the skin so a tumour can usually be seen. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma. They each arise from different types of skin cells and have characteristic appearances as a result.
Q: What does skin cancer look like?
A: There are a variety of different skin cancer signs. These include changes in the skin that do not heal, ulcerating in the skin, thickening of the skin, bleeding, discoloured skin, and changes in existing moles, such as development of irregular or jagged edges, changes in shape or enlargement in size.
Q: What causes Skin Cancer?
A: Ultraviolet exposure is the primary cause of skin cancer. People with fair skin, a tendency to freckling and sunburn are more at risk, as are those with a family history of skin cancer (especially melanoma). In addition to natural UV exposure, ageing itself is a risk. Artificial ultraviolet exposure with sunbeds has been shown to increase the risk of melanoma and prematurely ages the skin. Other factors include smoking tobacco, HPV infections (more related to squamous cell carcinoma), and some genetic syndromes (congenital melanocytic nevi syndrome). Chronic non-healing wounds pose a long-term risk for developing Squamous Carcinoma.
Q: What Types of skin cancer are there?
A: The three main types that are most common are Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma. There are other types that are rare, such as Merkel Cell Carcinoma, Kaposi Sarcoma, Cutaneous T-Cell Lymphoma, Sebaceous Gland Carcinoma and Dermatofibrosarcoma Protuberans.
Q: What is malignant melanoma?
A: Malignant melanoma occurs when there is damage to the DNA of the melanocyte cell resulting in a malignant growth. It can arise in a pre-existing mole or appear out of the blue in what appears to be a new mole. Warning signs of malignant melanoma include change in the size, shape, colour or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding. Unfortunately, a few melanomas are pink, red or fleshy in colour; these are called amelanotic melanomas and tend to be more aggressive.
Q: What is basal cell carcinoma?
A: Basal cell carcinoma is often mistaken for a sore that does not heal and usually presents itself as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. Sometimes small blood vessels can be seen within the tumour. Crusting and bleeding in the centre of the tumour often develops. This form of skin cancer is the least deadly as it tends to only stay growing where it started and not spread anywhere else, so with proper treatment can be completely eliminated.
Q: What is squamous cell carcinoma?
A: Squamous Cell Carcinoma (SCC) is the second most common skin cancer. Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped, and when they grow very rapidly a sub-type of Squamous Carcinoma called a keratoacanthoma may be the diagnosis. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass, and has a small chance of spreading to lymph nodes and other organs.
Q: What are the signs of skin cancer?
A: There are a variety of different skin cancer signs. These include changes in the skin that do not heal, ulcerating in the skin, discoloured skin, and changes in existing moles such as jagged edges to the mole and enlargement of the mole. Symptoms such as pain and bleeding are late features and therefore it is a mistake to think that if it is not hurting or bleeding it must be alright.
Q: What factor sunscreen should I use?
A: The paler your skin, the more protection you will need from ultraviolet radiation to prevent sunburn. Scientists classify skin into seven different types according to the response to sunburn by ultraviolet radiation. People with type 1 and 2 burn easily, tan only slightly and have a high cancer risk – generally Celtic, redhead or very fair people. They should always use a minimum SPF of 30 with a 4-star UVA rating during the summer. In between are skin types 3 and 4 with a moderate to low cancer risk, encompassing the vast majority of Europeans, Mediterraneans and paler-skinned Asians. They should use an SPF 30 with 4 stars if they are worried about developing wrinkles and sunspots, and if not, an SPF 15 with 4 stars. Skin types 5-7 are predominantly dark Asians and Africans, who have a very low cancer risk and rarely burn (black skin naturally contains the equivalent of SPF 10 against UV exposure). They should use an SPF 15 with 4 stars if they’re worried about skin ageing; if not it would be alright to go out unprotected.
Q: Do you need different factors in different parts of the world?
A: The sun’s rays are strongest at the equator, and UV radiation also increases with altitude – a 4 per cent increase with every 1,000 feet you ascend, which is why you should be especially careful to protect your skin when skiing and climbing. So look at your map carefully before you travel. Note how near you are to the equator, and also your altitude.
Q: How is skin cancer treated?
A: Generally, skin cancers are treated by surgical removal. There may need to be further treatment depending upon the stage of the disease. With Squamous and Basal Cell carcinomas, this is usually just to make sure a good margin of healthy tissue has been removed (usually at the first treatment) to prevent recurrence at the original site. Sometimes to ensure completeness of surgical excision either in awkward sites (eg near the eye) or when there has been a recurrence particularly of a BCC, then a technique known as “Moh’s Micrographically controlled surgery” may be employed. In Melanoma, the assessment of the original malignant mole down the microscope will dictate the further treatment, which may just involve a modest further excision of the skin, or referral for more detailed “staging” examinations such as “Sentinel Lymph node biopsy”. There are some medical treatments for skin cancers, such as very superficial Basal Cell Carcinomas, and pre-malignant conditions, such as Bowen’s disease and Actinic Keratoses. These medical treatments include topical creams (5 FluroUracil, Imiquamod, Solaraze), Cryotherapy (freezing with sprayed liquid Nitrogen) or Photodynamic Therapy (light activation of a topical cream absorbed by the lesion to maximise the concentration of the effect)
Q: How common is skin cancer?
A: In 2008 in the UK, 11,767 new cases of malignant melanoma were diagnosed and more than 98,800 non-melanoma skin cancers were registered. In 2009 in the UK, 2,633 people in the UK died from skin cancer – around 2,081 from malignant melanoma and 552 from non-melanoma skin cancer.
Q: What are the survival rates for skin cancer?
A: Survival depends on the type of cancer and the stage of the cancer. Generally, Basal Cell Carcinomas once removed completely as confirmed down the microscope are “cured”. Squamous Carcinomas also rarely spread to the local lymph nodes, but a small proportion can do so careful follow up for a short while may be recommended. Melanomas are potentially problematic and can recur depending upon the initial stage at first diagnosis. Thin melanomas (less than 0.76mm) are associated with an excellent prognosis (of the order of 95% 5-year survival), but thicker melanomas can be associated with lymph node involvement at the time of diagnosis (often only detected by Sentinel Lymph Node Biopsy) or microscopic disease spilling over into the rest of the body in the thickest of lesions seen. More detailed discussion is outside the scope of this information sheet.
Q: What is the Sentinel Node Biopsy?
A: Sentinel Lymph Node biopsy is becoming more commonly used in the staging of malignant melanoma. It is when the surgeon, at the time of completing the surgical removal of a biopsy proven malignant melanoma, arranges to visualise the path taken by the lymphatic system which drains the area that the melanoma came from. The lymphatics are fine tubes with straw coloured juice which can contain tiny cancer cells which will then get trapped in the lymph node at the top of the chain of fine lymphatic vessels. By a combination of imaging with a short acting low dose radioactive tracer and a blue dye injected at the site of the original melanoma, it is possible to identify this “Sentinel Node” and then have it sampled to check for microscopic disease.
Q: Is skin cancer treated with radiotherapy?
A: It is not usual to use Radiotherapy as a first line of treatment, but in certain circumstances it may be appropriate to consider it. This can be for Basal Cell Carcinomas which are either at cosmetically awkward sites or where there is uncertainty about the complete removal surgically and further surgery is considered potentially mutilating. Sometimes SCCs may also be considered for Radiotherapy for similar reasons. It is unusual to offer radiotherapy in the initial treatment of melanoma, but it probably has its place in more advanced disease.
Q: Is skin cancer treated with chemotherapy?
A: Most skin cancers are treated by surgery alone. It is very unlikely that chemotherapy will be recommended. There are some studies, especially in Melanoma, where different types of agents to try and reduce the risk of melanoma recurrence are being studied, but these are part of well-constructed clinical trials of treatments.
Q: Do sunbeds cause skin cancer?
A: Recent evidence suggests that sun beds are very harmful and are a significant skin cancer risk factor.