Mr Hodges will advise you on the type of skin cancer that you have. Although some rare types can occur, most cases are one of the following.
Basal cell carcinoma (BCC)
The most common type of skin cancer and, in fact, the most common of all cancers that affect human beings. Around 80% of basal cell carcinomas occur on the head and neck as these receive the highest dose of ultraviolet radiation from sunlight.
Tumours often arise on the nose, cheek and ear. Unlike other cancers, they rarely spread around the body so treatment can be very successful if diagnosed early.
If they remain unrecognised, basal cell carcinomas can grow and invade deeply into the skin of the face and even underlying structures such as the cartilage and bone. They can cause significant damage if left for a long time and are commonly called rodent ulcers, as they can gnaw away at tissue.
The treatments available range from:
- Topical medication: Cream or gel that you apply to the skin that contains chemotherapy agents.
- Cutterage and cautery: Superficial surgery to remove small BCCs
- Cryotherapy: Freezing the BCC so that the cells within it die.
- Surgery: Complete removal of the tumour with a margin of healthy tissue.
- Radiotherapy: Recommended if the tumour can’t be removed completely or there is a risk of it coming back.
The treatment you will be offered depends on the subtype of BCC your biopsy shows you have.
- Low risk BCC: The majority of BCCs are low risk and are usually completely cured by surgical removal.
- High risk BCC: These are less common and sometimes require more extensive surgery as they often come back. By more extensive surgery we mean taking the tumour away with a larger margin of healthy tissue around it. Its been shown that removing a 3mm margin around the tumour completely removes the cancerous tissue in 85% of cases but using a larger margin 4mm -5 mm removes all of the cancer in 95% of cases. Radiotherapy may also be used on either low or high risk BCCs if its considered necessary.
Squamous cell carcinoma (SCC)
Squamous cell carcinoma is the second most common type of skin cancer and it also tends to develop on the head or neck. This type of skin cancer develops from the pre-cancerous conditions actinic keratosis and Bowen’s disease.
Squamous cell carcinomas can grow quite rapidly and are capable of spreading around the body if untreated. This process, known as metastasis, occurs late in the disease and is more common with more aggressive forms of squamous cell carcinoma.
Treatment for SCC almost always involves surgery and/or radiotherapy. Surgery involves removing the tumour with a larger margin of healthy tissue than used for basal cell carcinomas. 4mm – 6mm is the norm and the exact margin depends on where the tumour is. SCCs on the scalp, ears and lips are considered high risk and require the increased margin of 6mm.
Once your treatment is complete you will need regular check ups to monitor the skin to make sure any recurrence of the tumour is picked up early. The site, pathological grade and stage of the tumour will be taken into account to determine how frequent your check ups will be and how long you need to be followed up.
This is the third most common type of skin cancer but unfortunately is the most aggressive and has the worst prognosis.
Malignant melanoma often spreads to other parts of the body, setting up secondary tumours in the liver, the bones or the brain.
Melanomas often look like moles and can develop within moles, but not always. The majority of melanomas that do not develop from pre-existing mole arise as a new pigmented lesion on the skin, which is why its always a good idea to see your GP about a new, fresh mole that seems to enlarge rapidly.
A mole that could be a melanoma also tends to have some of the following features:
- It’s asymmetric, so not round but much more irregular.
- It’s not one solid colour but has a range of pigments.
- It’s borders are not very well defined.
- Its itching or it bleeds
- It’s an ‘ugly duckling mole’ – the mole that really stands out from the others you have.
An early diagnosis is even more crucial than for a squamous cell carcinoma and treatment again involves extensive surgery to remove the entire tumour and a healthy margin of tissue, sometimes followed by radiotherapy or chemotherapy. You will also be followed up with regular check ups for at least five years after your treatment has been completed.