Skin Cancer Services
Skin cancer is the most common form of cancer in the UK. Skin cancer consists of two main types- non melanoma skin cancer and melanoma.
In the UK, around 147,000 non melanoma skin cancers are diagnosed every year. Non melanoma skin cancer affects more men than women, and is more common in the elderly.
Skin cancer develops when cells within the skin become abnormal.
Cancer starts in cells in our body. Cells are tiny building blocks that make up the organs and tissues of our bodies. They divide in a controlled way to make new cells and this is how our bodies grow, heal and repair.
Cells receive signals from the body, telling them when to divide and grow, and when to stop growing.
Cancer develops when the normal workings of a cell go wrong and the cell becomes abnormal. The abnormal cell keeps dividing, making more and more abnormal cells. These eventually form a lump (tumour).
This is usually due to damage from ultraviolet radiation (UVR) from the sun or sunbeds.
We are all exposed to some ultraviolet radiation whenever we go outside, and our bodies can usually repair any damage it causes. But, if the exposure is intense or prolonged, or your immune system isn't working normally, it is more difficult to repair and cells can become damaged or abnormal.
When skin cancers develop, the symptoms we see are lumps, spots or changes to our normal skin. The earlier we spot them, the easier they are to remove or treat, which is why it is helpful to check your skin regularly for early signs.
Some types of skin cancer can spread to other areas of the body through the blood or lymphatic system.
However, it takes time for them to grow deep enough in the skin to reach these systems.
Most skin cancers are spotted, treated, and cured before this happens.
Check your skin regularly for early signs of skin cancer and see your doctor straight away if you are concerned.
There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
Basal cell carcinoma, or BCC, is a cancer of the basal cells at the bottom of the epidermis. It is sometimes called a rodent ulcer. It's very common. About 75% of all skin cancers in the UK are BCCs. Most BCCs are very slow-growing and almost never spread to other parts of the body.
When BCCs are treated at an early stage, they are usually completely cured. However, some BCCs are aggressive, and, if left to grow, they may spread into the deeper layers of the skin and sometimes to the bones. This can make treatment difficult.
A small number of BCCs may come back in the same area of skin after treatment. This is known as a local recurrence.
What do Basal cell carcinomas look like?
- Not all Basal cell carcinomas look the same.
- Can appear has small, shiny pink/white lumps on the skin. They may often appear waxy in appearance.
- May also appear has red, scaly patches on the skin.
- Can also appear pigmented.
- Can ooze, itch, crust and bleed.
- Basal cell carcinomas do not usually spread inside the body.
Squamous cell carcinoma, or SCC, is a cancer of the keratinocyte cells in the outer layer of the skin. It's the second most common type of skin cancer in the UK. Most people treated for SCC are completely cured with simple treatment. Usually, squamous cell carcinomas are slow-growing and only spread to other parts of the body if they are left untreated for a long time. Occasionally though, they can behave more aggressively and spread at a relatively early stage.
What do squamous cell carcinomas look like?
- Can look scaly
- May have a crust or scab
- Can look pink or red at the base
- May be raised
- Can be sore or tender
- Can appear has an ulcer.
Most common sites scalp, face, arms, backs of hands and lower legs.
This is a less common type of skin cancer. Melanoma behaves differently to basal cell and squamous cell cancers. It can grow quickly and needs to be treated early.
Malignant melanoma is a type of skin cancer and is the 5th most common cancer in the UK. Melanoma develops from melanocytes which are the pigmented producing cells in our skin. These cells multiple and divide more quickly than usual. Melanin which is the brown/black pigment made my melanocytes then produces a new mole or freckle or a there is a change in an existing mole. This is often one of the first signs of melanoma.
Melanoma is considered the most series skin cancer due to the risk of spread from the skin to other parts of the body. However, if melanomas are caught early and treated, prognosis is good.
Merkel cell carcinoma is a rare, aggressive skin cancer. This type of skin cancer starts in the Merkel cells which are found in the top layer of skin (epidermis). Merkel cells are often found around nerves.
Risk factors for developing Merkel cell carcinoma
- UV exposure
- Weakened immune system
- Aged over 50 years old
Merkel cell carcinomas most often appear has small lumps on areas of the body prone to sun exposure. They may look blue/red in colour and feel firm to touch.
Melanoma in situ is called a stage 0 melanoma. This means that the cancerous cells are confirmed to the top layer of skin (the epidermis). The cancerous cells have not grown into the deeper layers of the skin.
Melanoma in situ is treated by surgical excision, and do not require long term follow up after treatment.
The guide below can be used by patients and families to understand staging and treatment options for melanoma.
The guide relates to cutaneous melanoma (the most common form of melanoma).
Atypical Fibroxanthoma is an uncommon skin cancer that mainly affects older people. This type of skin cancer appears on the neck and head and is most common in men. This skin cancer tends to grow other a few months and often appears has a pink lesion on the skin. The lesions can also weep and bleed.
Sun exposure can change the DNA in the skin which can cause skin cancer. People who work outdoors, enjoy outdoor activities without use of sun protection, are at an increased risk of developing skin cancer.
Sunbed and sunlamp use. The artificial UV light can damage the DNA in the skin. The likelihood of developing skin cancer is further increased the earlier someone started to use sunbeds and the more frequently they were used.
Severe sunburn as a child increases the risk of a future skin cancer. Damage from UV light may not show until later in life.
Skin type. People with a fair complexion that burns more easily in the sun, have an increased risk of developing skin cancer. There is also an increased risk for people with red or blonde hair, blue or green eyes and people with freckles.
People who are immunosuppressed due to medication or a pre-existing medical condition are also at an increased risk of developing skin cancer.
Radiotherapy. A previous site of radiotherapy may have an increased risk of a skin cancer at the site especially BCCs.
A previous skin cancer diagnosis can also increase the risk of developing another skin malignancy.
A clinical nurse specialist in skin cancer is a trained registered nurse who has undertaken extra specialist education in the care of skin cancer patients. The skin cancer nurse may also be known as your Key Worker.
A Key Worker is someone who is the link between you and all the other people involved in your care and is the main hospital contact person for you during specific parts of your treatment. The person who is your key worker may change depending on your treatment and where you are receiving your care at a particular time.
This is a nurse who can provide information and support for you and your family throughout your care. The nurse will be experienced in helping patients that have skin cancer and will work with the team to co-ordinate your care. For some people with skin cancer the treatment is simple and getting back to normal afterwards is relatively straightforward. However, we aim to offer every patient an assessment with us (or the Leeds team if you have been referred there) so that we can find out as much as possible about your individual concerns. This is called a Holistic needs assessment. If you feel that you would benefit from a Holistic needs assessment or if you would simply like to discuss any issues that may be of concern to you, then please do not hesitate to contact your Key worker. People who are involved in your care
Every specialty needs a team of experts to offer the best treatment available. This is called a Multidisciplinary Team. (MDT) The team is made up of people who are experts in cancer in different ways. There are people who can understand what cancer cells look like and how they behave and other experts who specialise in surgery to get the best outcomes for you.
Your MDT meets every two weeks. Your case will be discussed by the team when you are diagnosed so that we can plan your treatment. In addition, we will discuss your case again when your surgery is complete to ensure that the skin cancer has been adequately treated and to plan your follow up. If you develop any evidence of recurrence or further new lesions throughout your follow up these will also be bought to the meeting by one of the professionals in your team in order to discuss and make a further plan of action.
This is a senior doctor who specialises in treating patient with different types of skin problems including skin cancer.
Surgeons are hospital doctors who are experts in surgery to correct damage to the skin and removal of skin lesions including skin cancer. The surgeon you see will be an expert in treating skin cancer in a particular area of the body. Your surgeon may be a Plastic surgeon, a Maxillo-Facial surgeon or Ophthalmologist if your skin cancer is near your eye for example re are many people in the team looking after you as an individual.
Histopathologists are responsible for making tissue diagnoses and helping clinicians manage understand the treatments required for a patients cancer care.
The main treatment of skin cancer is surgical excision. This will involve removing the cancerous lesion plus a margin of good tissue around the lesion to help prevent recurrence.
Other treatments such as radiotherapy or immunotherapy are sometimes needed.
For further information, support or advice please contact the specialist nursing team on 01484 343375.
The team is available Monday to Friday 8am to 4pm excluding bank holidays.