Basal cell skin cancer
BCC is the most common type of skin cancer. About 75 out of every 100 cases (75%) of non melanoma skin cancers are BCCs. They develop from basal cells and these are found in the deepest layer of the epidermis and around the hair follicle.
They usually grow relatively slowly and often follow a cycle of crusting, bleeding and nearly healing, but never resolving completely over a period of months or years.
They develop mostly in areas of skin exposed to the sun including parts of the face such as the nose, forehead and cheeks. They may also develop on non-sun exposed sites such as on your back, arms or legs.
BCCs can invade local tissues if neglected, but do not have the potential to spread elsewhere in the body (metastasise) whereas squamous cell carcinoma and malignant melanoma can.
Basal cell carcinoma can usually be completely removed under a local anaesthetic, which will leave a scar and may require a reconstruction (skin graft or skin flap), depending on the size of the lesion that is removed.
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common form of skin cancer. It’s usually found on areas of the body damaged by UV rays from the sun. Sun-exposed skin includes the head, neck, ears, lips, arms, legs, and hands. SCC often grows more rapidly than BCC and may become irritated and bleed.
Squamous cell carcinoma of the skin is usually not life-threatening, though it can be aggressive in some cases. Untreated, squamous cell carcinoma of the skin can grow large or spread to other parts of your body (lymph glands).
Squamous cell carcinoma can usually be completely removed under a local anaesthetic, which will leave a scar and may require a reconstruction (skin graft or skin flap), depending on the size of the lesion that is removed.
Bowen’s disease is a very early form of non melanoma skin cancer. It can appear anywhere on the skin and usually looks like a red patch that might be itchy. If not treated Bowen’s disease may develop into a squamous cell carcinoma.
Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes in the skin. If a melanoma develops, patients usually notice a new brown or black lesion on their skin, or changes occur within an existing mole.
Melanoma is a type of skin cancer that can spread to other organs in the body.
The most common sign of melanoma is the appearance of a new mole or a change in an existing mole. This can occur anywhere on the body, but the most commonly affected areas are the back in men and the legs in women. In most cases, melanomas have an irregular shape and are more than one colour. The mole may also be larger than normal and can sometimes be itchy or bleed. You should have checked any mole that changes progressively in shape, size and/or colour.
About 70% of melanomas start from new, whilst 30% come from an existing mole. Although most are pigmented (brown) some 5% stay pink (called amelanotic melanoma). Melanomas can start anywhere on the skin and rarer sites include the soles of the feet, in between toes or fingers, and under the nails.
Any suspicious mole can be removed under a local anaesthetic with a narrow surrounding margin (2mm) of normal skin. This can then be sent to be checked in the laboratory and this result usually takes several weeks. If a melanoma is diagnosed, a further area of skin around the initial biopsy scar is usually removed under a local anaesthetic. This wider removal may require a reconstruction with a skin flap or skin graft and depending on the thickness of your melanoma a procedure called a sentinel lymph node biopsy may be recommended, at the same time as the wider excision.
Sentinel lymph node biopsy for melanoma
There is a risk of melanoma spreading elsewhere in the body. If melanoma spreads, it will usually begin spreading through channels in the skin (lymphatics) to the nearest group of glands (lymph nodes). Lymph nodes are part of the body’s immune system. They help remove unwanted bacteria from the body and play a role in activating the immune system.
Sentinel lymph node biopsy is a test to determine whether microscopic amounts of melanoma (less than would show up on any X-ray or CT scan) might have spread to the lymph nodes. It’s usually carried out under general anaesthetic at the same time as the wide local excision of the scar at the site of the original biopsy.
Before your operation, a weak radioactive tracer is injected around your scar to provide a picture of which lymph node the melanoma may have spread to. At operation, under general anaesthetic, a blue dye is injected around the scar, just before the wider area of skin is removed. The tracer & blue dye follow the same channels in the skin as any melanoma cells.
The first lymph node the dye and radioactive tracer reaches is known as the “sentinel” lymph node. The surgeon can locate and remove the sentinel node, leaving the others intact. The node is then examined for microscopic deposits of melanoma cells (this analysis can take several weeks).
If the sentinel lymph node is clear of melanoma, this offers reassurance that there is a good chance that the melanoma will not return. If melanoma reaches the lymph nodes, it’s more likely to spread elsewhere.
If the sentinel lymph node contains melanoma, you will be offered regular monitoring in clinic together with CT scans and may be referred to an oncologist for consideration for further treatment.
Rare types of non-melanoma skin cancer
These are less common types of skin cancer and make up only about 1 out of every 100 (1%) skin cancers diagnosed in the UK.
Merkel cell carcinoma, Kaposi’s sarcoma, T cell lymphoma of the skin.
These are all treated differently from basal cell and squamous cell skin cancer.
Merkel cell carcinoma is very rare and can be treated with surgery or radiotherapy, or both. This usually works well, but sometimes the cancer can come back and sometimes it spreads to nearby lymph nodes and require further treatment.
Management of advanced melanoma skin cancer
Melanoma has a risk of spreading elsewhere in the body, usually to the lymph glands that drain the area of skin where the primary tumour was originally removed from.
Mr Durrani will arrange for a CT scan to assess if the lymph glands can be removed and to check for wider tumour spread, together with a biopsy of one of the lymph glands to confirm that the tumour is the cause of the lymph gland enlargement. These lymph glands can be removed in an operation under a general anaesthetic. This may be followed by further treatment, such as chemotherapy or radiotherapy.
If melanoma comes back or spreads to other organs it’s called stage 4 melanoma. In the past, cure from stage 4 skin cancer was very rare but new treatments, such as immunotherapy and targeted treatments, show encouraging results.
Mr Durrani has over 20 years experience of assessing and managing wounds & scars. He will review your scar and recommend an appropriate course of treatment, if available.
Moles that protrude from the skin can be shaved or cut away under local anaesthetic. The method of removal, and whether or not stitches are required, will depend on the size and shape of the mole and will be decided at your consultation. Removal is usually done with a scalpel, and is straightforward and painless. There will be a scar, which is permanent, but this should fade over time. The area removed can be sent for histology for added reassurance.
Skin Tag Removal
There are several techniques used to remove skin tags. Mr Durrani will advise you of the best option for you, which include excision, where the skin tag is carefully cut away using a scalpel, cryotherapy where the skin tag is frozen by applying liquid nitrogen to the area and cautery, where an electrical pulse is passed through the skin tag to damage the cells and cause the skin tag to fall off.
Removal of Lumps & Bumps
Many people develop lumps and bumps in or under the skin. Often these are either simple cysts or a collection of fatty tissue called a lipoma. They can be removed under a local anaesthetic, which does leave a scar, which should fade over time.