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Skin cancer

Key points

  • The two main types of skin cancer are non-melanoma and melanoma.
  • There are two forms of non-melanoma cancers: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
  • Symptoms of skin cancer may include any mole, spot or area of your skin changing shape or colour.
  • The treatment options for skin cancer include surgery, radiotherapy or chemotherapy.

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.

How cancer develops

About skin cancer

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.

Illustration showing the types of skin cells that can become cancerous

Skin cancer can occur on any part of your body.

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 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

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

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 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 its 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.

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.


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

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For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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