Skin cancers are the most common forms of cancer in the western world. The vast majority are due to sun damage and previous episodes of sun burn. Most are not life threatening. Everyone needs to self monitor their skin and see a Dermatologist if any new skin lesions develop or if existing skin lesions change.
Skin condition: Skin Cancer
Skin cancers are the most common forms of cancer in the western world. People with pale skin are far more affected than those with darker skin. One of the confusing aspects of a skin cancer diagnosis is trying to understand how serious it is. In the vast majority of cases, when detected early and removed, a skin cancer will not be life threatening. Unfortunately, in a small proportion of cases, skin cancers can spread beyond the skin becoming difficult to treat and in a small number of people they can be fatal. It is therefore important to understand which type of skin cancer you have got.
What is this skin condition?
Cancers occur when cells start to divide in an uncontrolled and excessive way. Most cells in the body regenerate to some extent. The growth of all cells in the body is determined by the genetic code contained in all cells and there are specific genes that control cell growth. There is usually very precise control over this growth. Under certain circumstances this control can be damaged, normally when mutations occur in cell growth control genes. Cells start to grow too much and in some cases grow beyond their normal location and spread around the body. Gene mutations occur for a number of reasons
Cancers can occur from any cell type but are more common in cells that a continually growing and regenerating such as the skin. Within the skin there are many different cell types but cancers occur most commonly in 3 cell types
Other rare skin cancers include
There are many other types of cell overgrowth in the skin which will not be discussed in this article.
Why have I got it?
In the case of skin cancer, the most common cause of gene mutations is ultraviolet radiation in sunlight . Every time we get sunburnt our skin is being damaged and gene mutations are occurring. The body has many, clever ways of repairing gene mutations but these are not perfect. One mutation in a single gene is unlikely to directly lead to a cancer. However, with repeated episodes of UV damage, multiple genes become damaged and eventually some are not repaired. This sets the scene for the development of a skin cancer.
Comparing the treatment options
There is no self-treatment option for skin cancer. You need help from a Doctor. You can of course reduce your risk of getting a skin cancer by not getting sun burnt. You can improve your chance of a complete cure by showing new skin lesions to your GP or Dermatologist as soon as possible.
Help from your GP
Skin cancers are usually treated by specialists. However, if your GP is experienced in Dermatology they may be happy to treat milder skin cancers such as non-facial basal cell skin cancer. There are a variety of creams that can work quite well (see below).
Help from a Dermatologist
1. Basal cell skin cancer
The choice of treatment for a basal cell skin cancer will depend on the type of BCC, the size and the location. Different treatments have different success rates with some treatments giving a higher risk of tumour recurrence. Follow this link to the British Association of Dermatologists information sheet.
If your BCC is small or a superficial type and is not on your face you may be offered treatment with either creams, liquid nitrogen or curettage. These treatments do have a slightly higher risk of recurrence than surgery but are quick, usually very effective and often produce less scarring.
There are a variety of creams that are used for superficial basal cell skin cancers. The most commonly used are efudix and imiquimod. Click her to see the British association of Dermatology information sheets; efudix, imiquimod. Both creams trigger quite a lot of inflammation in the skin but once this has settled the cosmetic results are normally very good.
Google images shows a wide selection of images of efudix treatment in progress. As you can see there is sometimes a lot of inflammation although this settles quickly once treatment stops.
Liquid nitrogen is used to destroy the abnormal skin cells. The liquid nitrogen is stored in a canister and an aerosol of liquid nitrogen is sprayed onto the skin. The water in the skin cells freezes and this damages the skin cells leading to cell death. Inflammation usually occurs for up to 5 days following treatment followed by healing.
Curettage and cautery. Curettage involves scrapping away the abnormal skin cells. This produces a graze that normally bleeds slightly. The cautery stops the bleeding. The process is normally repeated 3 times to make sure that all of the abnormal cells have been removed.
For larger BCCs the best option is usually surgery under local anaesthetic
Skin excision. Excision is the word used by Doctors to describe cutting out an abnormal area of tissue such as a skin cancer
MOHS micrographic surgery is a specialised technique used to remove some skin cancers. If the skin cancer is well defined it is not normally needed. However, if the edges of a skin cancer are hard to see or if the cancer is in a cosmetically sensitive site such as the mouth, eyelid or nose then it can be very useful. In MOHS surgery the skin cancer is removed and the edges of the sample are checked, while you wait, to make sure it has all been removed. This allows the MOHS surgeon to remove the minimum skin possible whilst being 100% certain that all of the cancer has been removed.
This sequence of images shows how the treatment of a BCC using MOHs surgery.
2. Squamous cell skin cancer and Malignant melanoma
In the first instance surgery is really the only option for these cancers. In the event of the cancer spreading further there are often many options for treatment including further surgery, chemotherapy and radiotherapy. Discussion of these options is complex and if you need information about these issues please consult your Dermatologist, Plastic Surgeon or Oncologist.
Follow these links to the British Association of Dermatologists information sheets: