There are three common types of skin cancer:
Basal cell carcinoma
Basal cell carcinoma (BCC) is the most common skin cancer in the UK. It is most often seen on areas of skin exposed to the sun, for example your head and neck.
People with fair skin are most at risk. If you sunbathe a lot, use sunbeds or work outdoors, you are at greater risk.
Squamous cell carcinoma
Squamous cell carcinoma (SCC) is the second most common skin cancer in the UK. It is most often seen on exposed body parts such as your head and neck (including lips and ears), forearms and hands.
It is usually caused by too much exposure to ultraviolet (UV) light from the sun or sunbeds.
Although melanoma only accounts for 1 in 10 skin cancers, it is potentially the most serious if not treated early. Melanoma develops when your normal pigment cells grow in an uncontrolled way.
Melanoma can develop in or close to a mole, but can also appear on normal skin. It is often caused by too much exposure to ultraviolet (UV) light in the first 20 years of life.
The first sign of melanoma is often a change in the size, shape or colour of a previous mole. It can also appear as a new darker area of skin.
If you are concerned, visit your GP. They will refer you to a specialist if there is any doubt. If detected early, melanoma can be removed before it has time to spread deeper into the skin or other parts of the body.
If your GP suspects you may have symptoms of skin cancer, you will be referred to the specialist skin cancer team in Belfast Trust for investigation.
You will then be contacted about an appointment.
Investigations and diagnosis
At your first appointment, you will be seen by a member of the specialist skin cancer team.
The specialist will ask you about your symptoms and general health before examining your skin.
They may use a dermatoscope for this examination. A dermatoscope is a hand held microscope used by doctors and nurse specialists to view a mole or suspicious area of skin.
The diagnosis is often clear from the appearance of the skin, but sometimes further investigations are needed to confirm the diagnosis. These include:
Following a diagnosis of skin cancer, most patients will not require further tests.
However, in some cases further tests may be needed to check if cancerous cells have spread beyond the skin to nearby lymph nodes or other organs.
These tests may also help with planning your treatment. Tests may include:
- blood tests
- CT scan
- PET-CT scan
- MRI scan
- biopsy of lymph nodes or other tissue
- genetic tests on melanoma cells
After all tests are complete. your specialist will discuss the results and treatment options with you.
To provide the highest quality of care, skin cancer is treated by a multi-disciplinary team (MDT) of specialists. The team includes:
- consultant dermatologists
- clinical oncologists
- consultant plastic surgeons
- consultant pathologists
- dermatology nurse practitioner
- clinical nurse specialists
- palliative care team
- allied health professionals
- admin staff
The team meets each week to discuss patients with suspected or confirmed skin cancer. They look at all available results for each patient to ensure the best treatment plan has been agreed.
A copy of any discussions will be sent to the patient’s GP.
Treatment for skin cancer depends on your diagnosis and individual circumstances. The doctor will discuss this with you in detail.
Basal cell carcinoma and squamous cell carcinoma
Most non-melanoma skin cancers are treated by surgery. This involves removing (excising) the skin cancer, including a margin of normal skin around it.
This operation is usually done under local anaesthetic. The wound can normally be closed with stitches, but sometimes a graft or skin flap is required.
In some cases, Mohs’ micrographic surgery may be necessary. This is a very specialised type of surgery, also known as margin control excision, performed under local anaesthetic.
It is particularly useful for basal cell cancers that:
- do not have a clear edge
- are at difficult sites on the face
- have happened before and come back again
This technique aims to ensure all the tumour is removed while preserving as much normal skin as is possible.
- Mohs’ micrographic surgery
- Photodynamic therapy
- Topical chemotherapy
- Topical immunotherapy
The main treatment for melanoma is surgery. After a biopsy, when the diagnosis has been confirmed, a second surgery or wide local excision is usually required. This ensures all the melanoma has been removed.
If a large area is removed, a skin graft may be required. If the melanoma has spread to the lymph nodes, surgery to remove the affected lymph glands may be needed.
Sometimes other treatments are used after surgery if there is a high risk the melanoma may come back. These are known as adjuvant treatments and are usually given as part of a clinical trial.
If a melanoma comes back after treatment and spreads to other organs, alternative treatments may be used, either alone or together, to try to shrink the tumour and control symptoms. Macmillan has more information on the treatment of advanced melanoma.
You will be asked to sign a consent form before treatment. No medical treatment can be given without patient consent.
It is important that you read and understand this form before signing it.
After your treatment is complete, you will continue on an outpatient review programme.
These review appointments are important to check if the skin cancer has come back or spread to other areas. They are also an opportunity for you to discuss any concerns you may have.
In general, patients who have already had a skin cancer are at greater risk of developing another skin cancer. They are also at greater risk of developing a recurrence at the site where the previous cancer was.
If you have any problems or notice any new symptoms in between review appointments, contact your GP.
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