Ask the expert: Skin Cancer Care

Dr Zaki is a Consultant Dermatologist with a specialist interest in the management of skin cancer. He is the Clinical Director at Heart of England Foundation Trust, one of the largest dermatology units in the country. He provides a regional service for frozen section Mohs’ micrographic surgery, a technique used for management of difficult and recurrent skin cancers. He holds memberships of several societies including the American Society for Mohs’ Micrographic Surgery and the British Society for Dermatological Surgery, of which he is also a board member. 

Is skin cancer dangerous?

Although there are many different types of skin cancer, there are three common ones. By far the most common is Basal Cell Carcinoma and in excess of 100,000 people are affected by this in the UK every year. Fortunately, it is also the least dangerous type and very rarely spreads to other organs. 

The second most common is Squamous Cell Carcinoma which affects approximately 25,000 people every year. This can be slightly more dangerous and the majority appear on sun exposed parts of the body such as the face, backs of hands and lower legs.

Malignant melanoma, which is one of the more potentially sinister ones, is much less common and affects less than 10,000 people per year. This can appear anywhere on the body but is most common on the legs in women and the back in men. It is vital that this form of skin cancer is recognised as early as possible as rapid treatment will reduce the risk of this spreading to other organs.

How can I recognise skin cancer?

If you have a mole which has changed in size, shape or colour, always seek advice as early as possible. In the majority of cases, these changes are entirely harmless but if a mole has become cancerous, the earlier the treatment the better. It is also worth remembering that not all melanomas arise from previous moles and if you develop a new skin lesion of any type, do not ignore it.

Some types of skin cancer can be less easy to recognise. Basal Cell Carcinomas often appear as small “pearly” lumps on the skin which gradually get bigger. Growth can be very slow and some lesions may take months or years to develop. If left, these will eventually become ulcers but are better treated before this stage as treatment is often simpler if they are caught early. The same also applies with Squamous Cell Carcinomas which tend to grow faster and some can grow rapidly, sometimes within weeks.

What is the treatment for skin cancer?

This depends on many factors including the type of cancer, which part of the body is affected and so on. In the majority of the cases, surgery is the best option and this can sometimes be undertaken under a local anaesthetic. Radiotherapy is also effective for some types of skin cancers.

There are also several new treatments which provide a higher cure rate than was previously possible.  Mohs’ micrographic surgery is often the best choice for Basal Cell Carcinoma or Squamous Cell Carcinoma at a difficult site, or following reoccurrence after other treatments. Photodynamic therapy is successful at treating pre-cancerous skin lesions or superficial basal cell carcinomas. This requires application of a cream which is absorbed just by damaged skin cells.  These are subsequently destroyed by shining a light to the affected area and this often takes away the need for surgery.

Is skin cancer always dangerous?

The majority of skin cancers can be cured. However, the earlier they are diagnosed, the better the outlook and this applies to all skin cancers – including the majority of melanomas

Should I avoid the sun?

The principle of everything in moderation applies as much to sun exposure as anything else in life.  Whilst a small amount of sun exposure is not likely to be harmful, if you have fair skin or a lot of moles then you need to be particularly careful in the sun. As the general rule, avoid the mid day sun (between the hours of 11.00am and 3.00pm), and use high factor sun blocks and appropriate clothing, such as a hat and long sleeve shirt if you are going to be out in the sun for any length of time. It is worth remembering that a sun tan is a marker of damage to your skin cells. The most important thing is to avoid burning in the sun as this increases the risk of malignant melanoma, the most dangerous form of skin cancer.

I am worried that I have a skin cancer - where can I seek help?

Your own GP is usually the best person to initially assess your concerns. If needed, your GP will refer you to a dermatologist to assess the problem in detail. He or she may also wish to take a biopsy to analyse the skin lesion prior to planning any treatment, if required. It is worth remembering that early diagnosis of skin cancer improves the chances of successful treatment.

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