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Skin cancer

Cancer is an abnormal and uncontrolled growth of cells, which multiply to form a tumour. Tumours can be benign or malignant. Benign tumours aren’t cancerous, whereas malignant tumours are.

Skin cancer is caused by the uncontrolled growth of cells in your skin.

Your skin is made up of two layers, the epidermis and dermis. These are supported by a layer of tissue. The epidermis is the top layer and has three types of cells (squamous cells, basal cells and melanocytes). This factsheet will cover the different types of skin cancer that may start in any of these cells.

Skin cancer can occur on any part of your body.

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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the types of skin cells that can become cancerous

Details

  • Types Types of skin cancer

    Non-melanoma

    Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are known as non-melanoma skin cancers. Around 100,000 people in the UK are diagnosed with non-melanoma skin cancers each year.

    BCC is a type of cancer that starts in the basal cells lining the bottom layer of your epidermis. It grows slowly but, if left untreated, it can grow deeper into your skin and sometimes into your surrounding tissues. BCC usually occurs on places where your skin has been exposed to the sun, for example your face, head, neck and hands.

    SCC is a type of cancer that starts in the squamous cells lining the top layer of your epidermis. It’s the second most common type of skin cancer in the UK. SCC usually grows more quickly than BCC and may spread into your surrounding skin or other parts of your body. Like BCC, SCC usually occurs on places where your skin has been exposed to the sun.

    Melanoma

    Melanoma is a type of cancer that starts in the melanocytes in your skin. Melanocytes are cells that make a pigment called melanin when your skin is exposed to the sun. Melanin gives your skin its colour and protects your skin from the harmful effects of the sun. Melanoma can often spread to other parts of your body.

    About 13,000 people are diagnosed with melanoma each year in the UK. Melanoma is often found on the neck, shoulders and hips in men, and on the legs, hips and shoulders in women. It might also occur on areas of your skin that have not been exposed to sunlight, for example the soles of your feet.

  • Symptoms Symptoms of skin cancer

    Non-melanoma

    BCC and SCC are usually small pink or red lumps and might have a hard or scaly surface. If left untreated, they can become crusty, start to bleed or turn into ulcers.

    Melanoma

    The first sign of melanoma is often the appearance of a new mole or a change in how one of your existing moles looks. The ABCDE check list can be a good way to tell the difference between a normal mole and a melanoma.

    • Asymmetry. One half of a melanoma is usually different to the other.
    • Border. The edges of melanomas are uneven and jagged.
    • Colours. Melanomas are a mixture of two or more colours, usually black, brown and tan.
    • Diameter. Melanomas are bigger than 6mm in diameter.
    • Evolution. A mole that changes over time is more likely to be a melanoma.

    It’s important to remember, these symptoms aren't always caused by skin cancer, but if you have them, see your GP.

    If you see your GP about a mole on your skin, he or she will use a checklist to examine it. This will either be the one described above, or a tool known as the 7-point checklist. This involves monitoring your mole over eight weeks and rating its features. These are:

    • a change in size
    • an irregular colour
    • an irregular shape
    • inflammation
    • oozing
    • a change in the way your mole feels
    • a diameter larger than 7mm

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  • Diagnosis Diagnosis of skin cancer

    Your GP will ask you about your symptoms and examine you. He or she may also ask about your medical history. Your GP may refer you to a dermatologist (a doctor who specialises in skin conditions) for further tests.

    If you’re referred to a dermatologist, he or she may first examine your skin with a special microscope (dermatoscope) to see if you need a biopsy. A biopsy is a test that will help to diagnose your condition. It involves removing a sample of your skin, usually under local anaesthetic. Your sample will then be sent to a laboratory for testing to determine the type of cells and if they are benign or malignant.

    After your condition is diagnosed, depending on your type of skin cancer and its stage, you may have further tests. These are described below.

    • Scans. These may include X-rays, ultrasound, CT or MRI scans. They are done to check whether the cancer has spread to other parts of your body.
    • A sentinel lymph node biopsy. Lymph nodes (or glands) are part of your body's immune system, called the lymphatic system. The sentinel lymph node is the first lymph node that cancer cells are most likely to spread to. A sentinel lymph node biopsy may help to identify if melanoma is in your lymphatic system. The first lymph node that your cells drain into is identified, removed and tested to determine if the cancer has spread.
  • Treatment Treatment of skin cancer

    The treatment you have will depend on:

    • the type of skin cancer you have
    • your general health
    • the position and size of your cancer
    • how far your cancer has spread

    Removing your affected skin and tissue is usually the first treatment option for all types of skin cancer. But, your doctor will discuss your treatment options with you.

    Non-melanoma

    Surgery

    If you have BCC or SCC, you may need to have a procedure called an excision. This is when your cancer and some of your healthy skin surrounding it is removed. The amount of healthy skin that is removed will vary depending on how deep the cancer is in your skin. If you have a large area of skin removed, you may need a skin graft to repair it.

    See our FAQ for more information about how your skin may be replaced after the cancer has been removed.

    Curettage and electrodessication is when the affected part of your skin is cut away. An electric needle is then used to destroy any cancer cells that are left behind. This treatment might be used if your BCC is on the surface of your skin or if your SCC is at a very early stage.

    Curettage and electrodessication can be effective, but will usually need to be repeated two or three times.

    Cryotherapy is when liquid nitrogen is used to freeze the affected area of your skin and is then cut away. It's often used to treat a BCC that is on the surface of your skin or if your SCC is at a very early stage.

    Non-surgical treatments

    It’s important to remember if you have BCC or SCC and it's caught early, you may not need any further treatment.

    Radiotherapy is a treatment that involves using radiation to destroy your cancer cells. You may be offered radiotherapy on its own or with surgery if you have a large SCC. If your SCC has spread to other parts of your body, radiotherapy might also be used to help relieve some of your symptoms. It’s important to remember that radiotherapy can cause some side-effects including hair loss and radiation burns.

    Chemotherapy involves using medicines to help destroy cancer cells. If you have BCC, you may be given chemotherapy in the form of a cream called 5 fluorouracil to rub on the affected area.

    If you have SCC and it has spread to other parts of your body, you may be given chemotherapy tablets.

    Immunotherapy involves using a cream called imiquimod to stimulate your immune system to fight your cancer. Imiquimod is most effective in treating small BCCs.

    Photodynamic therapy is a treatment which involves you taking medicines to make your skin sensitive to light. A laser is then passed over the affected area of your skin, which aims to kill the cancer cells. Photodynamic therapy can be used for both BCC and SCC. You may need to have it more than once to try to prevent the cancer from coming back or spreading.

    Melanoma

    Surgery

    The main form of treatment for melanoma is to remove it through surgery in the same way as for non-melanoma. You may be advised to have a second operation to remove more skin from around the area – this is called a wide local excision. It’s done to try to ensure that all the cancer cells are removed.

    Non-surgical treatments

    If your melanoma is at a more advanced stage, you may be offered additional treatments, such as chemotherapy. These may help to shrink your melanoma and relieve your symptoms, but won’t cure it.

    Dacarbazine is a chemotherapy medicine that’s most commonly used to treat melanoma that has spread to other parts of your body. But some research suggests that it isn’t very effective for many people, and so you may not always be offered this type of chemotherapy.

    You may be offered other treatments such as immunotherapy medicines or targeted therapies. Immunotherapy medicines aim to stimulate your immune system to fight against melanoma. An example of an immunotherapy medicine is ipilimumab. This medicine tries to help the cells in your immune system to work more effectively. Targeted therapies are medicines that block the growth and spread of cancer. Vemurafenib is a type of targeted therapy. In 2012, the National Institute for Health and Care Excellence (NICE) approved these medicines as possible treatment options for advanced melanoma when surgery isn’t possible.

  • Skin cancer checks

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including skin cancer checks.

  • Causes Causes of skin cancer

    The main risk factor for both types of skin cancer is over-exposure to ultraviolet (UV) radiation from the sun or sunbeds.

    Your chance of getting skin cancer may also increase if you have:

    • fair skin
    • many freckles
    • unusually shaped or very large moles
    • skin that burns easily
    • close relatives who have had skin cancer
    • a weakened immune system – for example, if you have HIV/AIDS, or are taking medicines that suppress your immune system
    • certain skin conditions, such as eczema
    • been exposed to certain chemicals, such as soot
  • Prevention Prevention of skin cancer

    The following steps may help to reduce your risk of skin cancer.

    • Protect your skin in the sun. If you're outdoors, use a sunscreen with a sun protection factor (SPF) of at least 30 and cover up with suitable clothing and a wide-brimmed hat. When the sun is most intense, which is between 11am and 3pm, try to stay in the shade.
    • Don’t use sunbeds. The intensity of the UV rays in sunbeds is stronger than the UV rays of the sun at midday.
    • Check your skin and any moles regularly. If you see any changes in your skin, it’s important that you see your GP.

    Cutting down your sun exposure will not only reduce your risk of developing skin cancer, but will also reduce sun damage to your skin. This can lead to ageing effects, such as wrinkles.

    Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors (oncologists) and nurses are experts in providing the support you need. You may also find it helpful to join a support group.

  • FAQs FAQs

    How is a skin biopsy carried out?

    Answer

    A skin biopsy is when a small sample of your skin is removed. It’s then tested to determine the type of cells and if they are malignant (cancerous). A skin biopsy can be done in several different ways.

    Explanation

    A skin biopsy can help to confirm if you have skin cancer. It involves a small sample of your skin being removed. Your sample will then be sent to a laboratory to be examined under a microscope to check if the cells are malignant.

    Your skin biopsy will usually be done in hospital by a dermatologist (a doctor who specialises in identifying and treating skin conditions). You will be given an injection of local anaesthetic before your biopsy. This completely blocks pain around the area where your skin will be removed and you will stay awake during the procedure. Your doctor will take a small sample of your skin, using any one of the techniques described below.

    • Shave biopsy. This is when the top layer of your skin is removed.
    • Punch biopsy. This is when a deeper, circular sample of your skin is removed.
    • Incisional biopsy. This is when a scalpel is used to remove a small area of your skin that may be malignant.
    • Excisional biopsy. This is when a scalpel is used to remove the whole area of your skin that your doctor thinks may be cancerous. Some of your surrounding healthy skin may also be removed.

    Stitches are used to close your wound if you have an incisional or excisional biopsy. These may be dissolvable stitches. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about a week. If non-dissolvable stitches are used, they will be removed by your doctor at a follow-up appointment.

    How will my skin be replaced after the skin cancer has been removed?

    Answer

    You may need to have a skin graft or skin flap if you’ve had a large area of skin removed.

    Explanation

    Some of your healthy skin may have to be removed if the area of skin cancer is large. There are two ways in which this can be done.

    Skin graft

    A thin sheet of skin is taken from another area of your body and placed over the area the cancer was removed from. The skin is usually taken from a place that isn't too visible, for example from your thigh. It's usually held in place with sutures (surgical clips).

    The area that the skin was taken from will look like a large graze until it has healed (this may take around two to four weeks). The area where your skin is replaced will be delicate as it heals, so you will need to take special care of it. After it’s healed, the skin may look different to your surrounding skin and may be a slightly different colour.

    Skin flap

    A skin flap is a thick layer of skin that is taken from the area close to where your cancer has been removed. The blood supply to the skin flap is still left intact which will help it to heal. It’s held in place with stitches. A skin graft is simpler to do than a skin flap. However, your doctor may suggest a skin flap if the appearance of your skin is important, for example, if the cancer is on your face.

    What are the chances of skin cancer coming back after I've had it once?

    Answer

    If you’ve had skin cancer once, it may increase your risk of getting it again.

    Explanation

    How likely you are to get skin cancer again will depend on the:

    • type of skin cancer you have
    • size of your tumour
    • location of your tumour
    • type of treatment you’ve had

    Talk to your doctor about how likely it is that your skin cancer could come back or spread elsewhere in your body.

    After having treatment for skin cancer, you will need to have regular check-ups with your doctor. The number of follow-up appointments you have with your doctor will depend on the type of skin cancer you had and the stage it was at. Your doctor will also show you how to examine your skin and explain what to look out for.

    You will need to be extra careful in the sun. Below are some things you can do to reduce your risk of skin cancer coming back.

    • Don’t go out in the sun when it's at its strongest (between 11am and 3pm).
    • Always wear a high-factor sun cream – at least sun protection factor (SPF) 30.
    • Don’t use a sunbed, tanning booths or tanning lamps.
    • Check your skin regularly and if you notice anything unusual or spot any moles changing shape or colour, contact your GP.

    What type of sunscreen should I use to protect my skin in the sun?

    Answer

    You should use a sunscreen that protects you from both UVA and UVB types of ultraviolet radiation.

    Explanation

    Ultraviolet radiation is given out by the sun. There are two types of ultraviolet radiation – UVA and UVB. A small amount of exposure to UVA and UVB radiation is good for you because it helps your body to produce vitamin D. However, too much can damage your skin and may increase your risk of getting skin cancer. For this reason, use a sunscreen that protects you against both UVA and UVB radiation, known as a 'broad spectrum' sunscreen.

    The sun protection factor (SPF) of a sunscreen indicates how much protection it provides against UVB radiation. UVA protection is sometimes shown with a star rating between zero and five, with five stars being the highest level of protection. However, this is only a guide and the level of UVA protection is affected by the SPF of the sunscreen.

    The British Association of Dermatologists advises using a sunscreen of at least SPF 30 with a UVA protection of four stars or more.

    Below are some things to remember when wearing sunscreen and when you’re out in the sun.

    • Reapply your sunscreen every two hours or more, especially if you’re sweating a lot or swimming.
    • Don't stay in the sun for too long – sunscreen won’t protect you from sunburn.
    • Check your sunscreen isn't out of date – they usually last 12 to 18 months after being opened.
    • Apply sunscreen generously.
    • If you want to put moisturiser or insect repellent on, put it on after applying your sunscreen.
    • Cover up with clothing such as a long sleeved t-shirt, and wear a hat and sunglasses.
    • Try and stay in the shade when the sun is most intense, which is between 11am and 3pm in the UK.
    • Take particular care with babies and young children.

    For more information about protecting your skin from the harmful effects of the sun, see our factsheet on Sun care.

  • Resources Resources

    Further information

    Sources

    • General information about melanoma. National Cancer Institute. www.cancer.gov, published 7 February 2014
    • What is cancer? National Cancer Institute. www.cancer.gov, published 8 February 2013
    • Sentinel lymph node biopsy. National Cancer Institute. www.cancer.gov, published 11 August 2011
    • The skin, Types of skin cancer, Symptoms of melanoma, Symptoms of basal cell and squamous cell skin cancers, Risk factors, Treatment, Diagnosis, Follow-up care. National Cancer Institute. www.cancer.gov, published 11 January 2011
    • Skin cancers. Oxford handbook of oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, 2010 (online version)
    • Concise colour medical dictionary. 3rd ed. Oxford: Oxford University Press, 2002:233, 420, 634, 651, 585 (printed version)
    • Melanoma risks and causes. Cancer Research UK. www.cancerresearchuk.org, published 14 January 2014
    • Skin cancer risks and causes. Cancer research UK. www.cancerresearchuk.org, published 8 October 2013
    • Skin cancer symptoms. Cancer Research UK. www.cancerresearchuk.org, published 8 May 2013
    • Skin cancer prevention. Cancer Research UK. www.cancerresearchuk.org, published 4 March 2013
    • Types of skin cancer. Cancer Research UK. www.cancerresearchuk.org, published 28 February 2013
    • Imiquimod cream for skin cancer. Cancer Research UK. www.cancerresearchuk.org, published 23 February 2013
    • Surgery for skin cancer, Tests for skin cancer. Cancer Research UK. www.cancerresearchuk.org, published 14 February 2013
    • Types of skin cancer, Risk factors and causes of skin cancer, Topical immunotherapy for skin cancer, Surgery for skin cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 September 2011
    • Squamous cell carcinoma of the skin. BMJ Best Practice. bestpractice.bmj.com, published 25 November 2013
    • Basal cell carcinoma. BMJ Best Practice. bestpractice.bmj.com, published 15 April 2013
    • Melanoma. BMJ Best Practice. bestpractice.bmj.com, published 20 February 2012
    • Cutaneous squamous cell carcinoma Medscape. www.emedicine.medscape.com, published 3 February 2014
    • Basal cell carcinoma Medscape. www.emedicine.medscape.com, published 16 December 2013
    • Skin grafts. Medscape. www.emedicine.medscape.com, published 3 May 2013
    • Curettage and electrodessication Medscape. www.emedicine.medscape.com, published 23 April 2013
    • Skin biopsy. Medscape. www.emedicine.medscape.com, published 1 June 2012
    • Basal cell carcinoma. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Black and brown skin lesions. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 January 2012
    • Basal cell carcinoma. PatientPlus. www.patient.co.uk/patientplus.asp, published 26 June 2011
    • Squamous cell carcinoma of skin, Malignant melanoma of skin. PatientPlus. www.patient.co.uk/ patientplus.asp, published 22 June 2011
    • Stage 1 melanoma, Stage 2 melanoma, Stage 4 melanoma, Sunscreen factsheet. British Association of Dermatologists. www.bad.org.uk, published 2013
    • Squamous cell carcinoma, Basal cell carcinoma. British Association of Dermatologists. www.bad.org.uk, published 2012
    • Revised UK guidelines for the management of cutaneous melanoma. British Association of Dermatologists. www.bad.org.uk, published 2010
    • Multi-professional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. British Association of Dermatologists. www.bad.org.uk, published 2009
    • Guidelines for the management of basal cell carcinoma. British Association of Dermatologists. www.bad.org.uk, published 2008
    • Bath-Hextall F, Perkins W, Bong J, et al. Interventions for basal cell carcinoma of the skin. Cochrane Database of Systematic Reviews 2007, Issue 1. doi:10.1002/14651858.CD003412.pub
    • Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma, Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation-positive malignant melanoma. National Institute for Health and Care Excellence (NICE), published December 2012. www.nice.org.uk
    • Skin cancer prevention: information, resources and environmental changes. National Institute for Health and Care Excellence (NICE), 2011. www.nice.org.uk
    • Photodynamic therapy for non-melanoma skin tumours (including premalignant and primary non-metastatic skin lesions). National Institute for Health and Care Excellence (NICE), 2006. www.nice.org.uk
    • Skin cancer - suspected. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2005
    • Cutaneous melanoma. Scottish Intercollegiate Guidelines Network (SIGN), published July 2003. www.sign.ac.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 7 March 2014 (online version)  
  • Related information Related information

  • Author information Author information

    Reviewed by Kuljeet Battoo, Bupa Health Information Team, June 2014.

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