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Skin cancer

Skin cancer occurs when cells in your skin grow uncontrollably and abnormally. These cells multiply and form cancerous areas or lumps. You can get skin cancer anywhere on your body.

Your skin is made up of two layers, the epidermis and dermis. These are supported by a deeper layer of tissue called ‘subcutaneous tissue’. The epidermis is the top layer of your skin and has three types of cell (squamous cells, basal cells and melanocytes). This topic covers the different types of skin cancer that may start in any of these cells: these are melanoma and non-melanoma skin cancers.

An image showing the types of skin cells that can become cancerous

Details

  • Types Types of skin cancer

    Non-melanoma skin cancer: basal cell carcinoma

    There are two types of skin cancer that are known as non-melanoma skin cancers. These are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

    BCC is a type of cancer that starts in the basal cells lining the bottom layer of your epidermis. Around 75,000 BCCs are diagnosed in the UK each year.

    BCC grows slowly and doesn’t usually spread to other parts of the body, though it can grow into the healthy tissues surrounding the site of the cancer. BCC most often occurs on places where your skin has been exposed to the Sun, for example, your face, head, neck and hands.

    Non-melanoma skin cancer: squamous cell carcinoma

    SCC is a type of cancer that starts in the squamous cells lining the top layer of your epidermis. About 25,000 SCCs are diagnosed every year.

    SCC usually grows more quickly than BCC and may spread into other parts of your body. Like BCC, SCC usually occurs on places where your skin has been exposed to the Sun. In people with dark skin it’s different; SCC may develop in areas that aren’t usually exposed to sunlight.

    Melanoma

    Melanoma or a cancerous mole 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 to some extent protects your skin from the harmful effects of the Sun. Melanoma may develop in a normal mole or in normal skin. Melanoma can spread to other parts of your body.

    Over 13,000 melanomas are diagnosed each year in the UK. Melanoma can occur anywhere on the body – not just areas that are often exposed to the Sun. In men, melanoma is most common on the back; in women, on the legs.

  • Symptoms Symptoms of skin cancer

    Non-melanoma

    Basal cell carcinoma (BCC) can appear and present itself in different ways. It might have any of the following features.

    • A lump that has lots of blood vessels around it.
    • Plaques (red, scaly bumpy patches of skin) and lumps that have a raised rolled border (edge) around them.
    • Scabs or wounds that won’t heal, which may crust. 
    • Lumps and plaques that have a pearly or waxy appearance. 
    • Lumps and plaques which bleed easily.

    Squamous cell carcinoma (SCC) might look like:

    • a lump that grows over time 
    • red lumps, plaques or sores that bleed and crust  
    • ulcers (sores) on previously scarred or damaged skin, these may or may not feel tender and/or itchy 
    • a thin red or flesh-coloured plaque 
    • a dome-shaped lump with a crater or hard skin in the middle of it

    Melanoma

    Some of the first signs of melanoma are often the appearance of a new mole or a change in how one of your existing moles looks. The ABCDE checklist (below) notes a few changes that might indicate a melanoma. Melanoma may have any of these features.

    • Asymmetry. One half is different from the other. 
    • Border. The edges are uneven and jagged. 
    • Colours. A mixture of different colours may be present (e.g. black, brown and pink). 
    • Diameter. The mole is usually bigger than 6mm in diameter. 
    • Evolution. A mole that changes either over time or suddenly.

    It’s also important to get checked out if your mole oozes, bleeds, crusts or itches.

    It’s important to remember that not all melanomas have these features and that 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 may be the one described above, or a different tool.

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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.

    Guidance from the National Institute for Health and Care Excellence (NICE) was recently updated to help GPs know when to refer you for tests faster (two weeks). This is usually if they think you may have squamous cell carcinoma or melanoma. Basal cell carcinoma doesn’t usually need a fast referral because it doesn’t usually spread to other parts of your body. Your GP will make a decision based on your symptoms and history and will explain what will happen.

    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 involves removing a sample of your skin, usually under local anaesthesia. Your sample will be sent to a laboratory to find out the type of cell involved and whether the cells are benign (non-cancerous) or malignant (cancerous). Find out more about how a skin biopsy is carried out in our FAQs.

    After your condition is diagnosed, depending on your type of skin cancer and its stage, you may have further tests including the following.

    • Scans. These may include X-rays, ultrasound, CT or MRI scans. They are done to check if the cancer has spread to other parts of your body (metastases). 
    • 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 has spread to your lymphatic system.

    There’s no national screening programme for skin cancer in the UK. This is partly because skin cancers like melanoma aren't very common. Make sure you keep an eye on your skin every month so that you spot any changes. One way to do this is to take photos every month and use a ruler to compare the images for any changes. If you have any questions or concerns about a change in your skin, contact your GP for advice.

  • Treatment of non-melanoma skin cancer Treatment of non-melanoma 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, and how deeply it has grown into your skin and surrounding tissues
    • if the cancer has spread to other parts of your body

    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. Most small cancers can be removed under local anaesthesia, but larger cancers and those where the skin is tighter and difficult to remove may need to be done under general anaesthesia. Your doctor will explain your options.

    Surgery 

    Excision

    You may have a procedure called an excision to remove basal skin carcinoma (BCC) or squamous cell carcinoma (SCC). Excision is when the 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. A small wound can be closed with stitches, but if you have a large area of skin removed, you may need a skin graft.

    See our FAQs for more information about skin grafts and skin flaps.

    Mohs surgery

    In this procedure, your surgeon will remove layers of the affected skin in stages. They will look at the removed layer under a microscope straightaway to check if all the cancer has been removed. This is repeated until all the cancer has been removed. This is a type of surgery that you may have if a BCC or SCC is in an area that’s difficult to reach such as your head or neck, or you might have it if the cancer has come back (recurrent).

    Curettage and electrodessication

    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 technique is usually repeated three times during one appointment. It might be used if you have BCC or SCC that’s on the surface of your skin.

    It’s important to remember that, if you have BCC or SCC and it's caught early, you may not need any further treatment once the cancer has been removed.

    Non-surgical treatments 

    Cryotherapy

    Cryotherapy is when liquid nitrogen is used to freeze the affected area of your skin to destroy the cancerous or abnormal cells. It's sometimes used to treat a BCC or SCC that’s on the surface of your skin.

    Radiotherapy

    Radiotherapy involves using radiation to destroy your cancer cells. For BCC, It’s only used in specific circumstances where the cancer is in a complicated place or has come back. For example, it may be used if you’re an older person (over 50) and the BCC is in a difficult place like an eyelid.

    Radiotherapy may be considered for SCC that’s on the surface of your skin (if surgery isn’t a suitable option for you). Or it may be used alongside surgery for SCC that has spread.

    Immunotherapy

    Immunotherapy is treatment with medicines that aim to stimulate your immune system to fight against cancer.

    Imiquimod is a cream that may be given if you have a BCC or SCC that’s on the surface of your skin. It activates your immune system and helps it to clear abnormal or cancerous cells.

    Chemotherapy

    Fluorouracil is a chemotherapy cream that may be used if you have a BCC or a SCC that’s on your skin’s surface.

    Vismodegib is a form of oral chemotherapy that has recently become available for treating BCC in certain circumstances. It may be used if a BCC is advanced or in the very rare instance that BCC has spread to other parts of your body.

    It’s possible that you might have radiotherapy and/or chemotherapy alongside other treatments to help relieve some of your symptoms. This may be if the cancer is advanced and has spread to other parts of your body.

    Photodynamic therapy

    Photodynamic therapy is a treatment which involves you taking medicines to make your skin sensitive to light. A special light is then passed over the affected area of your skin, which aims to kill the cancer cells. Photodynamic therapy can be used on a BCC or SCC that’s on the skin’s surface. It’s only available in some dermatology clinics.

  • Treatment of melanoma skin cancer Treatment of melanoma 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, and how deeply it has grown into your skin and surrounding tissues
    • if the cancer has spread to other parts of your body

    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. Most small cancers can be removed under local anaesthesia, but larger cancers and those where the skin is tighter and difficult to remove may need to be done under general anaesthesia. Your doctor will explain your options.

    Surgery

    The main form of treatment for melanoma is to remove it through surgery. 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.

    You may have a sentinel lymph node biopsy at the same time you have the cancer removed. This is to check if cancer cells have spread to your lymph nodes.

    If cancer has spread to your lymph nodes, you may need to have what’s called a lymphadenectomy, a procedure to remove all of your lymph nodes in the affected area, even healthy ones. This is to remove them before the cancer can spread or come back.

    Non-surgical treatments 

    Immunotherapy

    Immunotherapy is treatment with medicines that aim to stimulate your immune system to fight against melanoma.

    Imiquimod is a cream that may be offered if you have early stage melanoma and you’re unable to have surgery for any reason. For example, it the cancer is in a place that would cause a lot of disfigurement.

    Ipilimumab is a medicine that may be offered if melanoma is at an advanced stage and has spread.

    Targeted treatments

    Targeted treatments are medicines that block the growth and spread of cancer.

    These medicines may be suitable if you have advanced stage melanoma (it has spread and can’t be operated on) and a mutation in a gene called BRAF V600. You may be offered dabrafenib and vemurafenib.

    Chemotherapy

    If melanoma is at a more advanced stage and has spread to other parts of your body, you may be offered chemotherapy, and in particular a medicine called dacarbazine. This may be offered after trying other therapies such as targeted treatments or immunotherapy.

  • 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

    Over-exposure to ultraviolet (UV) radiation from the Sun or sunbeds is a key risk factor for skin cancer.

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

    • fair skin •
    • many freckles 
    • red or blond hair 
    • blue eyes 
    • a large number of moles or large unusually shaped moles  
    • skin that burns easily • been very sunburned in the past 
    • close relatives who have had skin cancer 
    • a weakened immune system – for example, if you are taking medicines that suppress your immune system 
    • been exposed to certain substances, such as arsenic
  • Prevention Prevention of skin cancer

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

    • Protect your skin from 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 sunlight 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, preferably on a monthly basis. If you see any changes in your skin, it’s important that you see your GP. 
    • Cutting down your exposure to the Sun will reduce your risk of developing skin cancer, and will also reduce sun-related damage to your skin. This may reduce sun-related ageing effects, such as wrinkles.
    An image showing some top sun safety tips

    Image source: The British Skin Foundation

  • Help and support Help and support

    Being diagnosed with cancer can be a very difficult and distressing time for you and your family. An important part of cancer treatment is having the right 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 – see the links in our ‘Other helpful websites’ section.

  • FAQ: Having a skin biopsy How is a skin biopsy carried out?

    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 these techniques.

    • 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 (cancerous).  
    • 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 a punch, 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 three weeks. If non-dissolvable stitches are used, they will be removed by your doctor at a follow-up appointment.

  • FAQ: Having a skin graft How is skin replaced after the cancer has been removed?

    When you have skin cancer surgically removed, some of your healthy skin may have to be removed too. If this is a large area and can’t heal on its own or with stitches, you will have the skin replaced with a skin graft or skin flap.

    Skin graft

    A thin sheet of skin is taken from another area of your body and placed over the area where the cancer was removed. The area your skin is taken from for the graft depends on factors such as the colour and texture of your skin and the skin thickness that’s needed. A graft is usually held in place with sutures (surgical clips) and a dressing will be placed over it.

    The area that the healthy skin was taken from will either be closed with stitches or left to heal by itself under a special dressing. The area where your skin is replaced will be delicate as it heals, so you will need to take special care of it. You can take paracetamol if you need pain relief. After it’s healed, the skin may look different from your surrounding skin and may be a slightly different colour.

    Skin flap

    A skin flap is a 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 left intact – this will help it to heal. The flap is held in place with stitches and a dressing will be placed over it. Skin flaps may give a better cosmetic result because they use skin that is similar to the colour, type and thickness of the skin that has been removed.

    Your surgeon will discuss which option is best for you.

  • FAQ: Sunburn and skin cancer If I get sunburned, will I get skin cancer?

    Getting sunburned doesn’t mean you will definitely get skin cancer. However, getting burned does increase the risk of skin cancer later on. This is because even once your skin has healed, the DNA in your skin’s cells has been damaged.

    The more times you get sunburned and the more severe it is, the higher your risk of melanoma. Furthermore, research shows that melanoma is more common in people who expose their skin to the Sun intermittently. For example, they go out in the Sun at weekends or when they are on holiday, rather than spend regular time in the Sun every day. Melanoma is more likely to develop on areas of your body that are exposed to the Sun intermittently – such as your back or legs. This is different to BCC and SCC – non-melanoma skin cancer is more likely to occur on parts of your body that get a lot of exposure to the Sun.

    Because the effects of the Sun can be so damaging, it’s really important that you take steps in the future not to let your skin redden and get burned by the Sun.

    An image showing some top sun safety tips

    Image source: The British Skin Foundation

    If you get sunburned it, your skin will be red and tender, it may sting and feel tight and hot. Here’s how to treat it.

    • Move out of the sunlight and stay inside where it’s cool. 
    • Drink plenty of water. 
    • Have a cool/tepid shower. 
    • Apply a moisturiser. 
    • Use hydrocortisone ointment or cream on any very red or painful areas and take a pain killer. 
    • See a doctor if your skin blisters badly.
  • Other helpful websites Other helpful websites

    Further information

    British Skin Foundation 

    British Skin Foundation logoThe British Skin Foundation is the only UK charity dedicated to raising funds for skin disease and skin cancer research. Their website contains handy ‘Skinformation’ pages for the public. Plus you can join their online community and ask questions, swap skin tips and share your experiences with others. 




    British Association of Dermatologists (Skin Support) 

    An image showing the Skin Support logoSkin Support was launched by the British Association of Dermatologists as a Department of Health funded website providing psychological support for people with all types of skin conditions. The website brings together patient information leaflets, support groups, self-help materials and help-lines.



    Cancer Research UK

    You can phone or email Cancer Research UK's nurses about any questions you have, either for yourself or a loved one.



    Sources

    • Melanoma and other skin cancers. National Cancer Institute. www.cancer.gov, published 11 January 2011 
    • Skin cancer. Oxford handbook of oncology. Oxford Medicine Online. www.oxfordmedicine.com, published September 2015 
    • Basal cell carcinoma. Medscape. emedicine.medscape.com, updated 15 September 2015 
    • Skin cancers – recognition and referral. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2015 
    • Basal cell carcinoma. The MSD Manuals. www.msdmanuals.com/, last full review/revision date July 2015 
    • Melanoma. BMJ Best Practice. bestpractice.bmj.com, last updated 18 January 2016 
    • The skin and melanoma. Cancer Research UK. www.cancerresearchuk.org, updated 14 October 2015 
    • Melanoma symptoms. Cancer Research UK. www.cancerresearchuk.org, updated 21 October 2015 
    • Squamous cell carcinoma. The MSD Manuals. www.msdmanuals.com, last full review/revision date July 2015 
    • Squamous cell carcinoma of the skin. BMJ Best Practice. bestpractice.bmj.com, last updated 29 January 2016 
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), June 2015. www.nice.org.uk 
    • Skin biopsy techniques in general practice. PatientPlus. patient.info/patientplus, last checked 15 July 2014 
    • Melanoma screening. Cancer Research UK. www.cancerresearchuk.org, updated 14 October 2015 
    • Guidelines for the management of basal cell carcinoma. British Association of Dermatologists. www.bad.org.uk, published 2008 
    • What is cancer immunotherapy? American Cancer Society. www.cancer.org, last revised 23 July 2015 
    • Vismodegib. Medicines Complete. www.medicinescomplete.com, accessed 12/04/2016 
    • Melanoma assessment and management. National Institute for Health and Care Excellence (NICE), July 2015. www.nice.org.uk 
    • Ipilimumab for previously untreated advanced (unresectable or metastatic) melanoma. National Institute for Health and Care Excellence (NICE ), July 2014. www.nice.org.uk 
    • Targeted cancer therapies. National Cancer Institute. www.cancer.gov, accessed 12 April 2016 
    • Dabrafenib for treating unresectable or metastatic BRAF V600 mutation‑positive melanoma. National Institute for Health and Care Excellence (NICE), October 2014. www.nice.org.uk 
    • Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation positive malignant melanoma. National Institute for Health and Care Excellence (NICE), December 2012. www.nice.org.uk 
    • Sunscreen fact sheet. British Association for Dermatologists. www.bad.org.uk, published 2013 
    • Skin biopsy technique. Medscape. emedicine.medscape.com, updated 23 May 2016 
    • Tests for skin cancer. Cancer Research UK. www.cancerresearchuk.org, updated 9 September 2014 
    • Skin grafting. DermNet NZ. www.dermnetnz.org, last modified date is 25 April 2016 
    • Flaps. DermNet NZ. www.dermnetnz.org, last modified 29 December 2013 
    • Sun and UV facts and evidence. Cancer Research UK. www.cancerresearchuk.org, last reviewed 24 March 2015 
    • How the sun and UV cause cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 24 March 2015
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  • Author information Author information

    Reviewed by Natalie Heaton, Specialist Editor, Bupa Health Content Team, July 2016.
    Peer reviewed by Dr Anton Alexandroff, Consultant Dermatologist.
    Next review due July 2019.

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