Skin cancer is the second most common cancer in the UK with over 40,500 new cases every year. There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM). Due to certain similarities basal cell and squamous cell carcinoma are often grouped together and referred to as non-melanoma skin cancer. The prevalence of BCC in the population is 2.1%. BCC is twice as common as SCC. MMs account for 1-in-10 skin cancers

Types and Causes

Basal cell carcinoma arises from the cells in the base of the skin and is the most common skin tumour in the UK. It is usually seen in caucasians, particularly those with fair complexion, fair hair and blue eyes. The type of skin affected is almost always hair bearing skin, though occasionally basal cell carcinoma is found on the soles of the feet. Most basal cell carcinomas are slow growing and do not spread. However, if left, they can erode the skin and cause an ulcer, known as a rodent ulcer.

Squamous cell carcinoma starts in the surface cells of the skin and is the second most common type of skin cancer in the UK. This is a slow growing cancer but may spread to other parts of the body if left untreated. Like basal cell carcinoma, squamous cell carcinoma tends to occur in caucasians or white skinned people, with more males than females being affected.

Malignant melanoma although not the most common form of skin cancer, does cause the greatest concern as it is curable if found early, but can be very difficult to cure if it has spread into the deeper layers of the skin. MM develops in cells known as melanocytes, which are responsible for the colour of our skin. This type of cancer usually starts in the skin. Rarely it can arise in other parts of the body, such as the eye, the mouth, or in the internal organs.

There is strong evidence that ultraviolet (UV) rays from the sun or sun beds can damage the skin and cause cancer. The likelihood of developing a skin cancer increases with age and non-melanoma skin cancer is more common in those over 40 years old.

Certain risk factors have been identified. These include people who are fair skinned, burn easily in the sun, are red-haired with freckles, have sunspots (solar keratoses), have had previous skin cancer and those who work or spend long periods outdoors. The risk of developing skin cancer can be reduced by cutting down on exposure to ultraviolet light and increasing protection measures. These include wearing protective clothing, wide brimmed hats and using a strong sun block (minimum SPF 15). Children and young adults who are over-exposed to the sun and suffer blistering or burning are at increased risk of developing a MM in later life. Very rarely, malignant melanoma may be due to a genetic or familial tendency to the disease.

Symptoms Both basal and squamous cell skin cancers can appear anywhere on the body but are more likely to appear on exposed skin, especially the face, neck, arms, hands and lower legs. They can appear in a variety of forms: a small lump on the skin (which is smooth and pearly or waxy in appearance, or which bleeds, crusts and does not heal, or is wart-like in appearance); a flat red spot or a firm red lump.

Most MMs start in normal skin. Others may develop in existing moles. If it does develop from a mole, changes include: a change in size; altered shape; change in colour; itching, crusting or bleeding. People should be encouraged to report any unusual marks on the skin which last more than a few weeks or an existing mole which shows any of the above signs.

Many people feel overwhelmed when told they have a diagnosis of skin cancer. The impact can be particularly devastating if the cancer is on a prominent part of the body, such as the face, neck or arms/hands. The prospect of potentially disfiguring treatment can be hard to cope with. People in this situation need accurate information and sensitive support to help them understand what is happening.

Treatments Treatment options include: surgery; electrocautery; cryosurgery; lymph gland removal; radiotherapy; chemotherapy and, immunotherapy (for MM). These treatments may be used alone or in combination. Most people with non-melanoma skin cancer are cured, whilst the prognosis for MM depends on the depth of the cancer in the skin. It is important to report a MM early.