Skin cancer There are various forms of skin cancer. Working on the South Coast as a dermatologist I encounter a lot of skin cancer and I have a wide experience in both diagnosis and treatment. I have a special interest in the diagnosis and treatment of facial skin cancers having trained in skin surgery at St Johns’ Institute of Dermatology, I continued to train in facial surgery within the Maxillofacial Department at Western Sussex Hospitals Trust. I now train Specialist Registars in facial skin cancer surgery, I have been the skin cancer lead for Western Sussex Hospitals Trust for 5 years and was the skin cancer chair for the Sussex NSSG and the educational lead for 3 years. I have a particular interest in the use of dermoscopy in diagnosis of skin cancer, particularly melanoma, I lecture in this subject. Treatment for pre-cancerous and established skin cancer varies and it is important that your dermatologist chooses the most effective treatment, that will treat the skin cancer but also cause minimal skin damage and subsequent scarring.

Sun damage and pre-cancerous conditions

Patients who have had a lot of sun exposure, for example from outdoor sports such as sailing and ski-ing may have sun damage to their skin. This may manifest with premature lines, freckling and changes in pigmentation of the skin. Pigmentary changes may be seen as areas of darker skin e.g. sun spots/liver spots on areas of lighter skin. Some times the skin develops warty/rough areas. These may be actinic keratoses. If left, a small percentage of these lesions may become cancerous, thus we recommend their treatment. A more established change in the skin,where one can develop scaling pink or pigmented plaques, is called Bowens disease. This is precancerous and needs treatment. Often this can be treated with freezing (cryotherapy) a cream for example Efudix or light treatment (photodynamic therapy).

Assessing the importance and relevance of these different types of conditions is difficult, and should be undertaken by a trained specialist.

Basal cell carcinoma

This is the most common type of skin cancer. It almost never spreads beyond the skin and is considered low risk. There are various forms of a basal cell carcinoma. It is important to recognise the type of basal cell carcinoma, as this will influence our treatment. Surgical removal is usually the treatment of choice for this type of skin cancer. In some cases cryotherapy, a topical cream or photodynamic therapy may be appropriate. Although this cancer is usually a local problem, if left it can invade adjacent areas, and it is important to recognise and treat early.

Squamous cell carcinoma

This is often seen in sites that have had alot of sun exposure. It usually appears on the scalp, hands, sometimes ears and lips. A nodule, often with a warty centre, appears and can grow very rapidly. It is important to recognise this cancer as there is a small but significant risk of spread beyond the skin to other organs.

Malignant melanoma

This is the most serious skin cancer. There are over 10 000 new cases a year in the UK. The incidence rates of melanoma have more that quadrupled in the last 30 years.It is important to pick this skin cancer up early, as if removed in the early stages the risk of recurrence is very low. A melanoma can arise de-novo or as change with a pre- existing mole. Important features to look for are increase in size and particularly change in shape. Change in colour is also important – is the mole darker, developing different colours within it, or is it red and inflamed? Is it symptomatic, itching or bleeding? Does it simply stand out, looking different to your other moles?

If you are at all concerned it is very important to seek an opinion quickly. A dermatologist will examine the mole in question and usually give you a full skin check. It may be necessary to remove the mole if there is any clinical uncertainty. This can be done easily under a local anaesthetic.