Skin Cancer

There are several different types of skin cancer. The most commonly occurring are:

1. Basal cell carcinoma

This is the most common form of skin cancer. Basal cell carcinomas are uncontrolled growths or lesions that occur in the skin’s basal cells (the deepest layer of the epidermis).

They:

  • appear as open sores, shiny bumps or scars, red or pink patches.
  • are caused by cumulative intense exposure to the sun.
  • are easy to treat in the early stages however they will require more extensive treatment if they are left to grow.
  • rarely spread beyond the original tumour site but some rare, aggressive forms can be fatal if not treated promptly.

2. Squamous cell carcinoma

This is the second most common form of skin cancer. Squamous cell carcinoma is a tumour caused by the uncontrolled growth of abnormal cells in the skin’s squamous cells (the upper layer of the epidermis).

They:

  • look like open sores that may crust or bleed, or scaly red patches, or growths with a depression in the centre.
  • are caused by exposure to the sun’s UV rays and are most common in areas that are frequently exposed to the sun, such as the lower lip, the rim of the ear, a balding scalp, face, hands, arms, legs and neck.
  • can also occur in the lining of the mouth or nose (mucous membrane). If left untreated they can become disfiguring and even fatal.

The larger an SCC becomes the greater the possibility of metastasis (spreading to other parts of the body). Incidence of SCCs has risen sharply in recent years.

3. Malignant melanoma

This is the most dangerous form of skin cancer. A malignant melanoma is a cancerous growth that develops when unrepaired DNA damage to skin cells triggers mutations. These mutations cause the skin cells to multiply rapidly, causing malignant tumours in the melanocytes, which are the pigment-producing cells in the basal layer of the epidermis.

Melanomas often resemble moles and sometimes they develop from moles. They are most commonly black or brown but they can be red, purple, bluish, white or flesh-coloured. If recognised and treated early, melanomas are nearly always curable. However, if left untreated the cancer can spread to other parts of the body and can be fatal.

Warning signs for melanomas are moles that appear asymmetrical with uneven edges. They may have a variety of colours, or several shades of the same colour rather than being a single, uniform colour. They may grow in size and become larger than a benign mole. If you notice any change in a mole – size, shape, itching, bleeding or crusting – always see a doctor

Most skin cancers are caused by exposure to the sun. Skin cancer is on the increase across the world.

We are part of the skin cancer team at several major hospitals including Hillingdon, Heatherwood and Wexham Park. We work alongside the oncologists to treat patients with skin cancer.

What to expect

If your GP suspects you may have skin cancer, you will be referred to see a specialist. Normally appointments come through quickly – usually around two week.

We hold a parallel skin cancer clinic every two weeks to review skin cancer patients.

Most skin cancers are treated by surgical excision (cutting out the affected area) under local anaesthetic. Recent advances mean that far less tissue is removed now than was previously the case, resulting in quicker recovery and a smaller scar. Most skin cancers can be removed under local anaesthetic as a day case procedure (i.e. without an overnight hospital stay).

Normally the procedure takes no more than 30 minutes, with tissue samples being sent to the lab for analysis. After the procedure, you will be monitored to ensure you have recovered well before being sent home with detailed information about how to care for the wound and when to come back to the clinic for assessment.

Mohs surgery

Some types of Basal cell carcinomas and Squamous cell carcinomas are now treated using Mohs surgery. This is carried out in stages, all in one visit while you wait for results from the laboratory. It is a highly effective form of skin cancer surgery.

After removing the tumour it is examined under a microscope. If any cancer cells remain, the surgeon knows their precise location and can perform a further procedure, there and then, to remove them. This ensures that the procedure is meticulous at removing cancer cells, while retaining as much healthy tissue as possible.

What results can be achieved?

The results depend on many different factors, including the type of tumour, how soon it was diagnosed and treated, and the patient’s overall health and wellbeing at the time of surgery.

Mohs surgery has a very high success rate – according to the International Skin Cancer Foundation, up to 99% for a skin cancer that hasn’t been treated before and up to 94% for a skin cancer that has recurred after previous treatment.

Possible Risks

Like all types of surgery, treatment for skin cancer is not without risks, however leaving the cancer untreated has far more serious implications. Among the possible risks of surgery are:

  • Infection – this can normally be treated with antibiotics.
  • Lymphedema – if your lymph nodes are removed as a result of the cancer, lymphatic fluid can collect in surrounding tissues causing discomfort and pain.
  • Swelling and bruising
  • Numbness
  • Bleeding
  • Pain – this can be managed with painkillers.

After surgery

You will be sent home with instructions about how to care for the wound and what to do or not do to improve your chances of making a full recovery.

If tissue samples were sent away to the lab for analysis, you will be recalled to the clinic to discuss your results once we have them back. If you have stitches you should avoid over-exerting yourself for a few weeks.

They will normally be removed after around seven days.

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