Skin Cancer

What is a skin cancer?

Skin cancer is one of the most common cancers in the United Kingdom, and there are several factors that can contribute to the development of this disease.

Skin cancer is an uncontrolled growth of mutated skin cells and occurs when skin cells become mutated by UV radiation or other factors. Genetics also play a part in skin cancer development.

When the mutated skin cancer cells grow, they form a cluster, otherwise known as a tumour. Even at this point, most types of skin cancer can be successfully treated.

Some types of skin cancer have the ability to spread and may eventually reach the lymph nodes, and then pass further afield. It is this route by which skin cancer can spread to other organs.

At Kinvara Private Hospital, our Dermatologists and Plastic Surgeons have the expertise to treat the different types of skin cancer. Dermatologists often perform the initial evaluation, whereas the Plastic Surgeon is responsible for removal of the skin cancer and reconstruction of the resulting defect if required.

Our Plastic Surgeons have the expertise regarding all types of reconstruction following skin cancer removal, including skin grafts and skin flaps.

What are the different types of skin cancer?

Basal Cell Carcinoma (BCC)

This is the most common cancer in the UK and least dangerous. It grows very slowly and it is extremely rare for it to spread to beyond its original site. If left untreated, it slowly grows outwards and downwards and can penetrate underlying tissue and bone, causing serious destruction.

Basal cell carcinomas often appear around the eye and if left untreated can cause damage to the delicate tissue around the eye or the eye itself.

Basal cell carcinoma may appear in many forms, often beginning as a small, pearly nodule.

The two most important factors in developing BCC is having light-coloured skin and sun exposure. The face is the most common location for BCC development, but approximately 20% occur in areas that are not sun exposed, such as chest, back, arms, legs, and scalp.

Weakening of the immune system, whether by disease or medication, can also promote the risk of developing BCC.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is the second most common type of skin cancer and frequently appears on the lips, face or ears. Together with basal cell carcinomas, they are referred to as non-melanoma skin cancers. They typically appear as a red, scaly patch, a group of crusted nodules, or an ulcer that doesn’t heal.

Squamous cell carcinomas have the ability to spread to distant sites, including lymph nodes and internal organs

A pre-cursor to SCC is solar or actinic keratosis. These are rough, red or brown, and scaly patches on the skin and are usually found on areas exposed to the sun. They can sometimes develop into squamous cell cancer.

Malignant Melanoma

Melanoma is the most serious form of skin cancer and can spread throughout the body.

Melanoma are malignant tumours of melanocytes, cells in the skin that produce a dark pigment called melanin. The function of this pigment is to protect the deeper layers of the skin from the sun’s harmful ultraviolet (UV) rays.

The majority of melanomas are black or brown. However, some melanomas are skin-coloured, pink, red, purple, blue or white.

Malignant melanoma is usually signalled by a change in the size, shape or colour of an existing mole, or as a new growth on normal skin. If you notice a change in any of your moles, you need to see your GP or Dermatologist.

What are the treatments for skin cancer?

There are a variety of treatments for BCC and SCC, and the one you are offered depends on

the size of the skin cancer, where it is on your body, the biopsy result, whether you have had the skin cancer before, your general health and any preferences you may have.

Cryotherapy – liquid nitrogen is used to freeze and destroy the skin cancer cells. It is a quick and low-risk way of treating small, superficial BCCs.

Curettage – the skin cancer is scrapped away using a curette (a spoon-shaped instrument).

Excision biopsy – this surgical technique is the preferred method for removing lesions suspected to be melanoma. The entire tumour along with a margin of tissue that is not a visible part of the tumour is removed. In the majority of cases the wound is closed directly but in some instances a skin graft or skin flap may be needed to close the wound.

Radiotherapy –  can be a very effective treatment for BCCs and SCCs and may be used instead of surgery. Radiotherapy may also be used after excisional surgery if there is a risk that some cancer cells are still present.

Photodynamic therapy (PDT) –the patient is given a light-sensitive drug (also called a photosensitising agent) which is taken up the cancer cells. The patient is then exposed to a special light, which activates the light-sensitive drug to destroy the cancer cells.

Topical chemotherapy – a cream is applied to the skin cancer and contains a drug called 5-Fluorouracil, or 5FU (Efudix®). It can be used to treat some early superficial BCCs.

Immunotherapy – a cream called imiquimod (Aldara®) is applied to the skin cancer and stimulates the body’s natural defence to kill the skin cancer cells. Imiquimod is ideally suited to treat early superficial BCCs.

Mohs surgery – a type of surgery in which the skin cancer is shaved off one layer at a time. The excised layer is examined under a microscope and the process is repeated until the excised layer of skin is free of cancer cells. Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate.

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