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Skin cancers

detailed skin body diagram

Skin cancers can occur on any part of the skin and can be divided into 3 main types which can be classified as 2 separate groups. Firstly, non-malignant melanoma skin cancer and secondly malignant melanoma skin cancer.

Non-malignant melanoma skin cancer

Facts and figures

Non malignant melanoma skin cancers arise in the upper layers of the skin and are extremely common, 74% of these are basal cell carcinomas (sometimes referred to as rodent ulcers), 23% are squamous cell carcinomas and the other 3% are a mixed group of rare skin cancers.

They are more than 102,000 new cases registered each year in the UK, but exact numbers are difficult to assess as it is estimated that approximately 30-50% of basal cell carcinomas (BCC) and 30% of squamous cell carcinomas (SCC) are not entered onto the cancer register.

Higher incidence in men, male to female ratio is 13:10. Age related, incidence rises from 40 years of age and peaks in the 70+ age group.

They commonly appear on areas exposed to the sun, mainly on the face, neck, bald scalp, arms, back of hands and lower legs. Risk of spread from these tumours is only 0.5% for BCC and 2-5% for SCC. Approximately 90% are successfully cured.

Risk factors are sun exposure and sunbeds (ultra violet radiation) particularly in Caucasians, estimated that 50-90% of basal cell carcinomas and 50-70% of squamous cell carcinomas are linked to UV radiation, outdoor workers have a 43% increased risk of developing a basal cell carcinoma and 77% increased risk of developing a squamous cell carcinoma.

Risk factors also include previous skin cancer, psoriasis and Bowen’s disease (pre-cursor to squamous cell carcinoma) as well as some occupational exposure to coal tar pitch, soot, mineral oils, arsenic and possibly creosotes and petroleum refining.

Symptoms may include:

  • BCC.
  • Non-healing scaly area of skin.
  • Non-healing small red or pink lump.
  • Smooth lump with a ‘pearly’ appearance.
  • Non-healing lump or sore that crusts over/bleeds/itches or sometimes breaks down and develops into an ulcer.
  • SCC.
  • Non-healing scaly area of skin or pink lumps.
  • Non-healing area of skin that may have a hard, crusty surface that is sometimes tender and may bleed.


Investigations will include:

  • Skin biopsy and possibly dermatoscopy.


Depends on several factors:

  • The type of skin cancer.
  • The size and position of the tumour.
  • The stage of the cancer.


Surgery will depend on the size and position of the skin tumour. Initially it will be an excision biopsy removing the lesion and a surrounding area of healthy tissue, which may be adequate for small tumours.

If the excision biopsy indicates that a tumour may not have been completely removed, further surgery (wide local excision) may be performed to remove more tissue to reduce the risk of recurrence.

In a few cases of squamous cell carcinoma, which are more aggressive than basal cell carcinomas, malignant cells may be found in the local lymph nodes and removal of these nodes may be advised.

Curettage and electrocautery can be used for superficial small basal cell carcinomas but its use is on the decline. It involves ‘scrapping away’ the skin tumour and then using an electric needle to destroy any remaining malignant cells.

Photodynamic therapy

This is using light sources in combination with light sensitising drugs to destroy the cancer cells. It is most useful for some large superficial tumours.


Radiotherapy is frequently used to treat these skin cancers and is very effective. Often they occur on areas of the body such as the face and neck where surgery may be quite disfiguring.

It is very useful for small and large tumours, for those that have spread into the deeper layers of the skin and those where surgery will have a poor cosmetic result. Also, may be the treatment of choice if surgery is declined or the patient is not fit for surgery.

Radiotherapy is sometimes prescribed post-surgery (adjuvant) to reduce the risk of recurrence and sometimes used to treat involved lymph nodes.


Topical chemotherapy is sometimes used for early basal cell carcinomas and squamous cell carcinomas. This will involve applying a cream containing the chemotherapy drug fluorouracil (5FU) to the area.


Immunotherapy is sometimes used for superficial early stage basal cell carcinomas and Bowen’s disease and involves applying imiquimod cream to the affected area.

Malignant melanoma skin cancer

Facts and figures

Melanoma is the 5th most common cancer in the UK. Overall slightly higher incidence in females, male to female ratio approximately 10:11. In the 20-24 year age group the male to female ratio is 4:10 but from 60 years of age it is higher in men i.e. 11:10 in the 60-64years age group and 17:10 in those aged 85+ years.

Incidence rises steadily from the age of 20 years and the number of cases diagnosed each year is increasing.

Risk factors are sun exposure and sunbeds (ultra violet radiation) particularly in Caucasians, 86% of cases are linked to UVR exposure. Also, a family history of malignant melanoma, particularly if one or more relatives were diagnosed at under 30 years of age, large number of moles (100+), previous malignant melanoma, Crohn’s disease and ulcerative colitis, HIV and AIDS infection. Also, some occupational exposure to coal tar pitch, soot, mineral oils, arsenic and possibly creosotes and petroleum refining.

Aggressive tumours that will spread quickly to other parts of the body if not treated early, not always detected early as may resemble normal mole for some time.

Symptoms may include:

  • Mole getting bigger.
  • Change in shape of a mole, particularly if developing an irregular edge.
  • Change in the colour of a mole.
  • Loss of symmetry- 2 halves of the mole looked noticeably different.
  • Mole becoming, itchy, painful or inflamed.
  • Mole bleeding or crusting over.


Investigations will include:

  • Possibly dermatoscopy.
  • Skin biopsy – mole removed with surrounding tissue and sent for analysis.
  • Ultrasound scan – if malignant melanoma greater than 1mm deep or lymph nodes in the area are swollen.
  • Sentinel node biopsy- if positive will probably remove other lymph nodes in the area (lymphadenectomy).
  • CT scan – if malignant melanoma cells are found in the lymph nodes or the melanoma is more than 4mm deep.


Depends on several factors:

  • The depth of melanoma.
  • The spread of disease.


Surgery is the main treatment for malignant melanoma; the extent of the surgery will depend on any residual mole in the surrounding skin of the biopsy site, depth of the melanoma growth beneath the skin, the position of the melanoma on the body and the potential impact of surgery.

In early stage and where there are no lymph nodes involved, surgery to remove the melanoma may be adequate. In medium stage, where the melanoma is 2mm or thicker or thicker than 1mm and ulcerated or the disease has spread into the skin and lymph nodes, surgery to remove the melanoma will need to be followed by surgery to remove more tissue, may be a wide local excision (WLE) usually down to the level of the muscle to reduce the risk of recurrence.

There is a substantial risk of recurrence or spread to other parts of the body in stage 2 and above.


Radiotherapy may be used in advanced malignant melanoma cases where the disease has spread to shrink the tumour and control symptoms. These tumours tend to spread to the liver, brain, bone and lung.


Chemotherapy is being used in some clinical trials for advanced malignant melanoma equating the use of post-operative (adjuvant) chemotherapy. Drugs most commonly used are decarbazine DTIC, carmustine (BCNU), vinblastine or cisplatin.

Biological therapy

Biological therapies are being used in advanced cases of malignant melanoma to try and control the disease. The drugs tend to work by stopping the melanoma cells producing BRAF protein which would encourage cell growth.

Two such drugs are vemurafenib and dabrafenib.

Cancer vaccines are being researched which may stimulate the immune system to fight the malignant melanoma in advanced cases or those at high risk of recurrence.

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