Skin cancer

Skin cancers can be broadly divided into two groups:

• Melanoma (originating from melanocytes which make up moles and give our skin colour)
• Non-melanoma skin cancer (originating from other cells which make up the skin layers).

Melanoma occurs as a result of a cancerous change to the melanocytes, which are the cells responsible for producing pigment in the skin. For this reason, they are commonly brown or black in colour, but can, in fact, be red, pink or skin coloured.

Although they may arise within an existing mole (which is made up of benign melanocytes), approximately 70% arise as a completely new lesion on the skin. They may look somewhat similar to a mole but are often described as an “ugly duckling” because of a somewhat atypical appearance.

Most melanomas occur in areas that have been exposed to the sun at some stage and are therefore most common on the trunk in men and lower legs in women. It is uncommon but possible to develop melanoma in unexposed sites such as palms and soles, or mucosal (mouth, genitals) sites. Risk of melanoma can increase with painful sunburns as a child, fair skin and chronic sun exposure.

Early detection and removal of a melanoma result in a very high cure rate but occasionally more aggressive or long-standing lesions can spread (metastasise) beyond the skin to lymph nodes or internal organs. The depth of a melanoma at the time of excision is most closely associated with risk of spread. Early detection and diagnosis of melanoma are associated with a greater chance of survival.

Non-melanoma skin cancers are much more common than melanoma and rarely spread beyond the skin. They occur due to cancerous change in the cells of the epidermis (top layer of the skin). Most non-melanoma skin cancers can be treated with a simple surgical procedure but some cases may require more extensive surgery or radiotherapy. Pre-cancerous change in this layer of the skin results in a spectrum of sun damaged lesions known as actinic (or solar) keratosis and Bowen’s disease which may be treated using less invasive options such as cryotherapy, photodynamic therapy or topical cream options.

The most common forms of NMSC are:

• Basal cell carcinoma (BCC) the most common type of skin cancer (75% of all skin cancers). Develops from the basal (bottom) layer of the epidermis and very rarely spreads beyond the skin. BCCs can, however, cause damage by infiltrating local structures such as nerves and blood vessels and therefore may cause problems if left untreated. BCCs can vary in appearance but are typically pink, red or brown and may have a pearly appearance if stretched. They often scab or bleed slightly and may intermittently seem to “heal”.
• Squamous cell carcinoma (SCC) develops from the squamous cells of the epidermis. SCC has a small risk of spread, most commonly to lymph nodes and therefore early treatment is desirable. SCCS are typically skin coloured and may appear as a small lump or ulcerated area of the skin. They are often tender to touch or squeeze. Rapidly growing or painful lesions on the head and neck have the highest risk of spread.
• Keratoacanthoma (KA) has a similar origin to an SCC and may appear as a rapidly growing tender lump with a crusted centre. Fortunately, these lesions have a very low risk of spread but usually need to be surgically excised to fully rule out a rapidly growing SCC.

Treatment options for NMSC will depend on the size, location and nature of lesion but may include cryotherapy, curettage and cautery, photodynamic therapy, topical immunotherapy (imiquimod) and surgical excision. Early detection and treatment are helpful. Individual patients factors and preferences are also taken into account.

• Bowen’s disease (also known SCC in-situ) is a superficial form of SCC. It is confined to the epidermis but has small risk of progressing to an SCC by invading into the deeper layers of the skin.
• Actinic keratoses (also known as solar keratoses) are precancerous growths associated with sun-related skin damage. They have a small risk of transforming into SCCs over time. Overall, they serve as risk markers for the future development of skin cancer.

• Fair skin, blue/green eyes and fair hair
• Inability to tan
• Painful sunburn as a child
• Chronic (long-term) sun exposure
• Outdoor occupations
• Family history

Cancerous lesions, by definition, have cells that are growing and changing. For this reason, most skin cancers usually grow, evolve or change in some way over time. This might show a change in colour, size, shape, margins, tenderness, itch scabbing or bleed, but in some cases, it may be very slow and therefore may not be obvious. Benign lesions are usually much more stable in appearance.

Some people will describe a “sixth sense” about a particular spot but cannot specify the exact nature of their concern. All concerning lesions should be checked by an experienced practitioner to confirm a diagnosis.

Your dermatologist will discuss your overall risk of skin cancer and your personal need for regular skin checks. All adults, however, should monitor their own skin on a regular basis. As a general guide, a 3-monthly self-skin check is warranted.

• Become familiar with their skin – this way you are more likely to notice new or changing lesions
• Check all areas of their skin, including skin not normally exposed to the sun
  look for changes in shape, colour or size, or a new spot – if you notice anything unusual such as a bleeding, weeping, growing or a standout spot see your doctor straight away
• Seek assistance from others and use photographs to check difficult to see areas eg back

It is never too late to start protecting your skin from further sun damage. In addition to this, there are many ways to help reverse the damage that has already been done and reduce the number of future skin cancers and pre-cancerous lesions.

Pay attention and follow your instincts. If you have a particular concern about any of your skin lesions you should see a qualified medical practitioner for a full assessment. In some cases, your doctor will feel it’s appropriate to refer on for specialist opinion or management. Although we can have long waiting lists, we allow for urgent review of high-risk skin lesions. 

For an appointment, you will need a referral from your GP. Our team will triage your referral to ensure you are seen in an appropriate timeframe. Please ensure you express your concerns to your GP if you are anxious about any particular skin lesions, if they are also concerned, they should prepare an urgent referral or contact us directly to discuss an appointment.

At your appointment we will assess your skin and identify the suspicious lesion/s. We may take a biopsy of your skin to confirm a diagnosis if required. In many cases a clinical diagnosis can be made and treatment can be planned. Most of the time your skin cancer treatment will need to be rebooked on another day to allow time for the appropriate procedure to be performed. In some cases, a skin cancer can be treated at the time of diagnosis or with a topical treatment at home.