Overview
What is skin cancer?
Skin cancer develops when the DNA in skin cells is damaged, causing uncontrolled growth. This may result from UV exposure, tanning beds, inherited genetic factors, or chronic skin irritation. It can appear anywhere on the body but is most common on sun-exposed areas such as the face, neck, hands, and arms.
While many skin cancers grow slowly and are highly treatable, melanoma can spread quickly if left untreated, making early detection and intervention crucial. Understanding the type of skin cancer helps guide the appropriate treatment and improves long-term outcomes.
Who is at risk?
Certain factors can increase a person’s likelihood of developing skin cancer. While anyone can be affected, risk is higher in individuals with particular skin types, genetic predispositions, or lifestyle exposures. Key risk factors include:
- People with fair skin, light hair, and light eyes
- Those with many moles or atypical moles
- Frequent sun exposure or a history of sunburn
- Family history of skin cancer
- Individuals with weakened immune systems
Symptoms and Causes
What are the symptoms of skin cancer?
Skin cancer can present in a variety of ways, depending on the type and location. Early detection is crucial, as changes in the skin are often the first sign. Common symptoms include:
- New growths or lumps on the skin that appear suddenly
- Moles or lesions that change in size, shape, colour, or texture
- Sores that do not heal, crust, or bleed
- Redness, tenderness, or itching in a previously normal area
- Pigmented spots with irregular borders or multiple colours (particularly concerning for melanoma)
Not all lesions are painful, and some may remain unnoticed for months, which is why regular skin checks and self-examinations are important.
Types of Skin Cancer
- Basal Cell Carcinoma (BCC) – BCC is the most common skin cancer in the UK, appearing as a shiny bump, sore, or scaly patch that may crust, bleed, or not heal. It grows slowly and rarely spreads to other organs, but untreated BCC can damage surrounding tissue.
- Squamous Cell Carcinoma (SCC) – SCC usually presents as a firm, red nodule or rough scaly patch, often on sun-exposed areas. It can grow more rapidly than BCC and may occasionally spread to lymph nodes.
- Melanoma – Melanoma is less common but potentially dangerous, presenting as a dark, irregular mole or lesion that may change in colour, shape, or size. Early detection is vital to prevent metastasis to other organs.
Other rarer types:
- Merkel cell carcinoma: aggressive skin cancer often found on sun-exposed areas in older adults
- Kaposi sarcoma: linked to immune suppression, appears as red or purple skin lesions
Warning Signs to Watch
Seek specialist evaluation if you notice:
- A new mole or lesion appearing on the skin
- Changes in size, shape, colour, or texture of existing moles
- A sore that does not heal, crusts, or bleeds
- Pain, tenderness, or itching in a spot that was previously normal
- Rapid growth or multiple new lesions
Diagnosis and Tests
How is skin cancer diagnosed?
Specialists combine visual and clinical assessment with laboratory and imaging tests to confirm the type and extent of skin cancer.
Key diagnostic steps:
- Full skin examination: Inspection of the entire body, including scalp, palms, soles, and between toes, to identify suspicious lesions.
- Dermoscopy: Magnified evaluation of moles or lesions to identify early signs of malignancy.
- Biopsy: A small tissue sample is removed to confirm the type, depth, and severity of the cancer.
- Imaging: Ultrasound, CT, or MRI may be used for deeper lesions or to check lymph nodes in advanced cases.
- Histopathology: Laboratory examination of biopsy samples ensures an accurate diagnosis and informs treatment planning.
Accurate diagnosis is essential for effective treatment, prognosis, and patient confidence.
Management and Treatment
Treatment depends on the type, location, size, and stage of the cancer, as well as the patient’s overall health and preferences.
Treatment options
- Surgery – Surgical removal is the most common treatment, involving excision of the cancer with a margin of healthy tissue under local anaesthetic. Larger or complex lesions may require a skin graft or reconstruction.
- Radiotherapy – High-energy rays target and destroy cancer cells. Radiotherapy is used when surgery is unsuitable, the cancer covers a wide area, or as adjuvant therapy to prevent recurrence.
- Immunotherapy – This stimulates the immune system to attack cancer cells. It includes topical creams like imiquimod for superficial lesions and checkpoint inhibitors for advanced melanoma or SCC.
- Photodynamic Therapy (PDT) – A light-sensitive drug is applied to the lesion and activated with a special light to destroy superficial cancer cells, suitable for early or thin lesions.
- Chemotherapy – Chemotherapy is mostly applied as a topical cream for superficial skin cancers. Rarely, intravenous chemotherapy may be used for aggressive or metastatic disease.
- Multimodal treatment – Advanced cases may require a combination of surgery, radiotherapy, and systemic therapies to achieve the best outcome.
Outlook/Prognosis
The prognosis for skin cancer varies depending on the type and how early it is detected. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are generally highly treatable, and early intervention usually carries minimal risk of complications or spread. Melanoma, while less common, can be more serious; outcomes are excellent when detected early, but delayed treatment increases the risk of metastasis to other organs. Regular follow-up and long-term skin monitoring are essential to ensure early detection of any new or recurring lesions and to maintain overall skin health.
Prevention
While not all skin cancers can be prevented, the following measures reduce risk:
- Use broad-spectrum sunscreen and protective clothing
- Avoid tanning beds and limit sun exposure
- Regular self-examination of the skin for new or changing lesions
- Attend routine dermatology assessments, particularly for high-risk individuals
- Seek prompt evaluation of any suspicious lesions
