Skin Cancer Awareness Month

May is skin cancer awareness month. As a dermatology nurse, and former skin cancer specialist nurse, I have seen first hand the damaging effects of prolonged and unprotected UV exposure on the skin.

If you are reading this blog then you are likely interested in aesthetic treatments to slow down the ageing process, well guess what? UV radiation is the leading cause of premature skin ageing, causing pigmentation and depleting collagen and elastin stores leading to sagging, laxity and wrinkles. The process of getting a tan is the skin cells trying to protect themselves from this harmful radiation, therefore there really is no such thing as a safe tan, even if you are not burning.

More importantly, UV radiation causes cellular damage which can also lead to cancerous changes. In this blog I will discuss the most common types of skin cancer, how to spot them and what to do if you are concerned about a skin lesion.

Skin cancers are usually categorised into melanoma and non-melanoma groups. Non-melanoma skin cancers tend to be less worrying than their more aggressive counterpart, but can still be problematic if left untreated.

Basal Cell Carcinoma (BCC)

BCC’s are the most common type of skin cancer. They are slow growing and do not spread to other parts of the body, although they can be cosmetically a nuisance if they appear on the face, nose, ears or scalp. Many people who have a BCC report that it has been there for several months or even years, without them realising it was a skin cancer. This is because they can look like a spot, a scar or something inflammatory. They may also come and go, or flare up intermittently. BCC’s are found on sun exposed areas of the skin and the treatment to remove them is skin surgery. If they appear on cosmetically challenging areas, such as the face, then specialist surgery called Mohs surgery would be advised.

Some features of a BCC are: shiny/ pearlescent bumps, brown/black or blueish with a translucent edge, rolled edges with a central ulceration, dry/ rough flat red patches, small red broken blood vessels on the surface (telangiectasia), crusting and bleeding, appearing to have healed and then returning.

BCC with pearly rolled edges and central ulceration.

Cutaneous Squamous Cell Carcinoma (SCC)

cSCC’s are the second most common type of skin cancer, and are more harmful than a BCC. SCC’s can spread to other parts of the body if left untreated, usually to the lymph nodes in the first instance. SCC’s arise on the background of sun damaged skin, known as Actinic Keratosis (AK) or due to the Human Papillomavirus (HPV), with the latter being more prevalent in patients who have a weakened immune system.

SCC’s are more commonly found on sun exposed areas and present as: pink/red lumps with a central depression, rough or scaly red patches with irregular borders, open sores or thickened wart like skin. They may also crust over and bleed and rapidly increase in size.

SCC treatment will involve surgery to remove the growth (Mohs surgery if this is on the face, scalp or ears). Any suspected skin cancer is sent for analysis and a grading score given to help classify the aggressiveness. This helps clinicians to make decisions around treatment planning. Gradings are usually numbered between 1-4, with the higher grades indicating more abnormal looking cells. If you have a higher grade SCC then further investigations such as CT scans and lymph node biopsies are likely to be required to rule out further spread.

SCC with overlying scale and central depression. Irregular borders and thickened wart like skin.

Melanoma

Melanoma, also called Malignant Melanoma, are one of the most serious and worrying types of skin cancer. They can be aggressive and spread to other parts of the body if left untreated.

This type of skin cancer starts in the melanocyte skin cells. Melanocytes are responsible for making the pigment that gives skin its colour, the pigment is called melanin. This is why melanoma are often brown and associated with changing moles or the development of a new pigmented (brown), unusual looking lesion on the skin. They can develop anywhere on the body but are most commonly found on areas of the skin that are exposed to the sun, but they can also appear on the soles on the feet, palms of the hands and within the nail bed.

The treatment for melanoma is usually surgery and then further monitoring over a period of time. However, depending on the severity grading further investigations and combinations of treatment, including immunotherapy, radiotherapy and chemotherapy, may be required.

When assessing moles/ lesions for melanoma we are looking at the following features:

Asymmetry- normal moles tend to be quite symmetrical, usually oval or round in shape. Whereas melanoma, as shown below, are more likely to be asymmetrical.

Borders-normal moles or other pigmented lesions, such as sun spots, tend to have well defined borders that clearly separate the mole from the surrounding skin. As you can see from the image below, melanoma borders are more ragged and less well defined.

Colour- normal moles are generally uniform in colour, they may be pink, tan, brown or black. Melanoma however, may have several different shades of brown or even grey and blue within their pigment.

Diameter- normal moles are usually smaller than 1/4 inch (about 6-8mm in diameter). I have seen totally harmless larger moles, so this is not always a clear indicator in isolation, but if there are other symptoms and your mole is growing/ larger than 8mm then this could be indication of cancerous change.

Evolution- this refers to what is going on with the mole. If it is changing in size, shape, colour or it is bleeding and scabbing then get it checked out.

If you are concerned about a suspicious skin lesion, then your first point of call is your GP. If they are concerned they will refer you to a dermatologist, who will look at the lesion under a dermatoscope. This is essentially a magnifying glass that allows the doctor to look at the clinical features of the mole and determine if a biopsy is required.

The best way to reduce your skin cancer risk is to avoid excess UV exposure. NEVER use sun beds or tanning lamps and ALWAYS protect your skin with SPF when out in the sun. Ideally you would protect your skin all year round, but it is especially important in the spring/ summer months when there is more UVB radiation.

Melanoma with irregular borders, different colours, asymmetry and large diameter.