Worrisome signs

What should I be looking for?

Skin cancers can all look very different. Common symptoms include a sore or area of skin that doesn’t heal within 4 weeks, looks unusual, is painful, itchy, bleeding or forms a crust. Most moles we have will change over time, however if you have any of the concerning ABCDE features below you should consult your GP.

Note: Skin cancers should be dealt with under the secondary care multidisciplinary team, most will need wide excision and histology although some less aggressive skin cancers can be treated with topical or light based treatments.

Types of Skin Cancer

There are two main types of skin cancer Non-Melanoma cancer, and Melanoma.

Non-Melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma, and some other rare types. These type of skin cancers tend to develop most often on sun exposed sites.

However there is a high cure rate for these cancers and most people are treated with minor surgery, topical or light based therapy.

Basal Cell Carcinoma

(BCC) is the most prevalent form of skin cancer and represents 80% of new skin cancer diagnoses. This tends to develop in sun exposed sites such as the head, ears, face and neck. These cancers tend not to spread to other parts of the body, although can become disfiguring if left untreated. Patients who develop a BCC have a 60% risk of developing another BCC < 5 years. Basal Cell carcinoma can present as a flat scaly red patch, a flesh coloured or red pearly bump, or may appear as an ulcer.

Squamous cell carcinoma

(SCC) is the second most common form of skin cancer. Although not as dangerous as malignant melanoma, it can spread to other parts of the body. SCCs can appear as a new pink spot or thickened scaly spot that is tender and bleeds. Most lesions require surgical excision although sometimes radiotherapy or non-surgical treatments are used.

Malignant Melanoma

Starts in cells called melanocytes. These cells make the pigment melanin that gives colour to our skin and helps protect us from UV radiation. People who originate from hotter climates tend to have darker skin as their melanocytes are more active and make more pigment. In fairer skinned people sun exposure gives a suntan and the melanocytes make more pigment to protect against the sun’s rays. Redheads and blonde individuals have a two to four fold increased risk of developing melanoma, although darker skinned people are still at risk.

Melanoma skin cancer is not as common as Non-Melanoma skin cancer but is more dangerous. However if caught early while still very thin, the cure rate is up to 95%. Melanoma usually presents as a new or changing brown spot or mole. People with congenital moles, or multiple dysplastic (atypical ) moles have a higher risk of developing melanoma. Often these will have irregular colours and borders but occasionally can be pink or skin coloured. These must be detected early as they can spread to the lymph nodes and other parts of the body. In men, melanoma is most likely to affect the back, head and neck area. In women the most common location is the legs. However melanoma can actually occur anywhere melanocytes are found including the nail bed, eyes and mucosal surfaces. These always require surgical excision with wide margins.

Who gets skin cancer

Over 95% of skin cancers are caused by exposure to the sun. However there are several factors that affect your risk from sun exposure:

• Multiple moles or freckles
• Unusual moles (dysplastic naevi)
• Fair skin that burns easily
• Fair hair, light coloured eyes
• Multiple episodes of sunburn, particularly in childhood
• History of severe sunburn, particularly if this caused blistering
• A previous history, or family history of skin cancer
• Use of regular sunbeds

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