Skin Cancer - Medical specialists

Skin cancer is typically treated by a multidisciplinary team including, for example, oncologists, radiologists, and pathologists. If you should need some form of reconstructive surgery following your treatment, this will require referral to a plastic surgeon. In addition, your skin cancer specialist will be able to call upon other medical experts to offer support as required.

Overview

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Skin Cancer - Further information

Skin cancer usually occurs where skin has been exposed to sunlight, and presents as an abnormal growth of skin cells. However, skin cancer may also develop on patches of skin not subject to sun exposure.

Skin cancer specialists will typically be asked to treat three main types of skin cancer:

  • basal-cell carcinomas, which occur on the face and other areas of the skin that are exposed to the sun. These skin cancers rarely metastasise (spread elsewhere), are rarely fatal and are usually treated via surgery or radiation.
  • squamous-cell skin cancers are fairly common (less so than basal-cell carcinomas). They can metastasise more frequently, but are still relatively unlikely to do so. Those people with suppressed immune systems are at greater risk, as are those with squamous-cell skin cancers of the lip or ear.
  • melanoma cancers are the least frequently occurring cancers from this group. Melanomas frequently metastasise and could potentially prove fatal if they manage to spread.

There is a further group of less-common skin cancers that a skin cancer specialist may encounter, which include:

  • dermatofibrosarcoma protuberans (a slow-growing cancer of the skin’s middle layer)
  • Merkel cell carcinoma (a rare cancer forming skin-coloured nodules)
  • Kaposi's sarcoma (a cancer that causes skin lesions)
  • keratoacanthoma (a slow-growing skin cancer)
  • spindle cell tumours (a connective tissue cancer)
  • sebaceous carcinomas (an aggressive cancer that typically forms in the eye region)
  • microcystic adnexal carcinoma (a sweat gland tumour)
  • Paget's disease of the breast
  • atypical fibroxanthoma (a skin tumour)
  • leiomyosarcoma (a type of soft-tissue cancer)
  • angiosarcoma (a blood vessel cancer)

What treatment methods are used by skin cancer specialists?

A skin cancer specialist can recommend a broad range of treatments, including the following options and procedures:

  • general surgery, which removes tumours and a small margin of healthy tissue, and may often require no further treatment
  • curettage and electrodessication, which scrapes away skin lesions then treats the area with an electric current to destroy any remaining cancerous cells
  • Mohs surgery, which is a technique that removes tumours piece by piece until a layer of completely clear skin is reached
  • cryotherapy, a procedure that employs liquid nitrogen to freeze and eliminate cancerous cells
  • laser therapy, which uses a high-intensity laser beam to target and destroy skin cancers found in the skin’s surface layers
  • reconstructive (plastic) surgery, which is sometimes required in the aftermath of skin cancer treatment
  • photodynamic therapy procedures, which apply chemical cream to make your skin extremely light sensitive before exposing the area to a strong light source, thus destroying cancerous cells
  • radiation therapy, which uses high-energy rays to eradicate cancerous cells, and most commonly achieves this using an external radiation beam, though brachytherapy (internally targeted radiation) is also used occasionally
  • topical treatments, which are applied as surface creams to treat skin cancer via chemotherapy

Symptoms of skin cancer

Areas exposed to the sun where a skin cancer may appear typically include the face, chest, arms and hands. However, skin cancer can also develop on less-exposed parts of your body, such as the following areas:

  • scalp
  • lips
  • ears
  • neck
  • legs
  • beneath your fingernails
  • the soles of your feet
  • the genital area

People of all skin tones can be affected by skin cancers. Symptoms of basal cell carcinoma are more common on the parts of your body that are exposed to the sun and may present as:

  • a waxy or pearly, raised bump
  • a flat, scar-like lesion that is brown or flesh-coloured

Squamous cell carcinoma symptoms usually appear on sun-exposed areas and may present as:

  • a hard, red, dome-shaped nodule
  • a flat, scaly lesion with a crusty surface

Those with darker skin may find squamous cell carcinoma also appears on less-exposed body parts.
Melanoma symptoms may appear anywhere on the body, including at the site of an existing mole, and may present as:

  • a large, dark-speckled, brownish spot
  • a mole that bleeds or changes in colour and/or size
  • a small red / white / blue / blue-black lesion that has an irregular border
Melanoma
Melanoma on the left cheek of a woman

Causes of skin cancer

The top layer of your skin (the epidermis) is where skin cancers begin. Your cancer is classified (and then treated) according to its precise location within this layer:

  • squamous cells are the inner lining of your skin and can be found just below the outermost surface
  • basal cells lie just below the squamous cells and generate new skin cells
  • melanocytes occupy the deepest level of your epidermis, determine your skin colour, and play a part in shielding your skin from sun damage


Ultraviolet (UV) radiation, which is present in sunlight as well as in the light sources used in tanning studios, is known to damage skin cell DNA. However, the development of skin cancers on less-exposed skin areas suggests that other factors, such as exposure to toxic substances or a weakened immune system, may also play a part.

Diagnosis of skin cancer

To form an initial diagnosis, your doctor is likely to:

  • conduct a physical examination to check for signs of abnormal skin changes
  • conduct a skin biopsy by taking a small sample of skin for further laboratory tests

If cancer is thought to be present, more tests may be needed. Relatively superficial basal cell carcinoma cancers will not usually spread, but other types may need additional diagnostic tests, which may include:

  • using imaging to check nearby lymph nodes for cancer symptoms
  • a sentinel lymph node biopsy procedure to remove and check a nearby lymph node

Skin cancer surgery

Removal via a surgical procedure is the primary treatment for basal cell and squamous cell carcinomas. In most circumstances, this is followed by radiation therapy to ensure all cancerous cells have been killed. The most often recommended types of skin cancer surgery include complete surgical excision, curettage and electro-surgery, Mohs procedure, cryosurgery and laser surgery. These techniques each have their own particular advantages and possible risks, which you can talk through with your doctor.

Skin cancer surgery is often provided by private health clinics, which are in some cases managed by universities, insurers, mutual societies or religious institutions. In addition, there are state-run hospitals (such as the UK’s NHS) that also employ surgeons who specialise in skin cancer surgery.

What does skin cancer surgery help with?

There are a number of clear benefits to the surgical removal of a skin cancer, including:

  • the cancer cells associated with the lesion are completely eradicated, which means the cancer cannot spread to other regions of your body
  • extra tissue is cut away from the margins of the area to ensure no cancer cells are left to regrow and cause the cancer to reappear
  • removal of the lesion also involves an analysis of its composition, which allows pathologists to assess the exact type of cancer cells present, their rate of growth and stage of advancement
  • a surgical wound will usually heal well, leaving little sign of the cancer growth, and if necessary, reconstructive surgery can be employed to restore normal appearance and functioning

When is skin cancer surgery used?

Skin cancer surgery is used to treat both non-melanoma and melanoma types of skin cancer.

The most common types of surgery for non-melanoma skin cancer include:

  • Mohs micrographic surgery, a technique that carefully removes skin layers step by step, and checks each one for the presence of cancerous cells until a clear layer is reached
  • excision, which removes all cancer cells, plus a surrounding margin of healthy tissue
  • curettage and electro-surgery, which first scrapes away the cancerous material and then uses electro-surgery to kill any cancer cells left behind, before sealing the wound

Other surgical procedures that can be used include:

  • cryosurgery, which eradicates skin cancer by freezing the cells
  • laser surgery, which destroys cancerous cells with an intense beam of laser light
  • dermabrasion ,which uses a wire brush to scrape cancer cells from the surface of the skin

Surgical intervention is the most common melanoma treatment and may also involve the removal of lymph nodes to check on the spread of the cancer. Typical surgical procedures include:

  • excision (removal), which aims to take out the entire melanoma, along with some of the surrounding healthy tissue
  • lymphadenectomy (lymph node dissection), which removes cancerous lymph nodes, and perhaps others near the cancer site (to check whether they have been invaded by cancer cells)
  • sentinel lymph node biopsy, which removes the lymph node closest to the tumour – if this is clear, the others are left intact

Following melanoma surgery, there may be a cosmetic or functional need for reconstructive surgery – especially if the treatment procedure involved the removal of a large tumour.

What are the risks of skin cancer surgery?

Skin cancer surgery is a common procedure used to remove skin cancers, and may occasionally present the following risks:

  • the surgical wound might become painful, bleed or become infected
  • there could be scarring after the wound has healed
  • a reconstructive skin graft may prove difficult to heal
  • some cancer cells may still be present around the margins of the surgical incision

The margins (edges) of the surgical wound, which remain after the removal of your skin cancer, will be carefully examined in a laboratory. To ensure all of the cancer has been removed and reduce the risk of any recurrence, a pathologist will check the surrounding area for any signs of cancer cells in the healthy tissue.

Are there alternatives to skin cancer surgery?

Where skin cancer surgery is considered an unsuitable option, there are a number of viable alternatives including:

  • anti-cancer creams may be recommended for specific non-melanoma skin cancers, but only where a tumour is located within the topmost skin layer – the two primary treatment options are chemotherapy creams and immune stimulating creams
  • PDT (photodynamic therapy), which uses a powerful light source shone over a cream applied to make the skin at the site of the cancer extremely light-sensitive – this technique may cause some scarring, but less than a surgical intervention
  • radiotherapy, which eradicates cancer cells using low-dosage radiation
  • electro-chemotherapy, which is a procedure using powerful electric pulses to energise previously administered chemotherapy in order to increase its effectiveness

Chances of recovery from skin cancer

Treated early, almost 95% of basal cell and squamous cell carcinomas can be cured completely, with the remainder eventually reappearing, usually locally. The prospects for melanomas will always depend upon the size of the tumour that has been treated.

Prevention of skin cancer

The risk of developing skin cancer can be reduced by adopting these safeguards:

  • avoiding direct exposure to intense sunlight between 10 a.m. and 2 p.m.
  • applying sunscreen with an SPF (sun protection factor) of 30 or more at hourly intervals during sun exposure
  • using sunscreens that filter UVA and UVB light
  • covering exposed skin if you are prone to sunburn
  • avoiding tanning studios
  • checking your skin every month

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