Skin Cancer


Skin cancers are the most common form of cancer in the West, particularly in people such as farmers who are exposed to lots of sunlight. One form of skin cancer, malignant melanoma, can spread to other organs very rapidly. Successful treatment depends on catching the disease in the early stages.

Cancers An abnormal or uncontrolled growth of the cells that make up the skin can be benign or malignant. If this growth is able to invade neighbouring tissues or spread to distant organs in the body (metastasise), it is known as malignant.

Types of skin cancer

The main types of malignant skin cancer are:

  • malignant melanoma

  • basal cell carcinoma (BCC)

  • squamous cell carcinoma (SCC)

Basal and squamous cell carcinomas are often grouped together and referred to as non-melanoma skin cancer. The main risk factor for any type of skin cancer is exposure to the intense ultraviolet light of sunshine. It is particularly common in places where the sun is strong, such as Australia, and less common in people with dark skin.

Factors that increase the risk tend to have:

  • a family history of skin cancer

  • skin which has a lot of moles

  • fair skin and blue eyes

  • freckles

  • skin that burns easily

  • skin that has been badly sunburned in the last five years

  • skin exposed intermittently to strong sunshine (or sun beds)

The three layers of skin

Normal skin
The skin is made up of three layers: the outer epidermis, the dermis below this and the supporting subcutaneous layer of loose tissue and fat - see diagram. Cells in any of these layers can be the origin of a cancerous growth.

Skin growths
These are not cancers. Benign skin growths include warts, moles, or corns, which are rarely serious problems. There are other, less common benign skin problems that can become malignant. These include: Bowen's disease: A pre-cancerous skin condition which looks like a red scaly area of skin, and is restricted to the epidermis. If left untreated, it can develop into a squamous cell carcinoma. Actinic keratosis: This is a small lump of hard skin, commonly seen in areas exposed to the sun. The condition is usually harmless, but there is a very small risk of them transforming into squamous cell carcinomas.

Malignant skin cancers
Basal cell carcinoma (BCC) Also known as a rodent ulcer, this is the most common form of malignant skin cancer. A BCC arises from cells in the epidermis. Typically it affects only small areas, grows slowly and does not spread to other tissues. Consequently a BCC is not usually life-threatening. However, if left untreated, the cancerous cells can grow deeper into the skin. BCCs are associated with sun-exposure and often affect the face.

Squamous cell carcinoma (SCC) This is the second most common malignant skin cancer, and in rare cases it can be life-threatening. They arise from cells in the epidermis and spread into the surrounding skin, but can also spread to nearby lymph nodes. SCCs appear as thickened skin, nodules or lumps, or can appear as an ulcer. They can be caused by sun exposure and certain viruses that affect the skin, and can occur in old scars. Malignant melanoma This is a particularly dangerous form of skin cancer and often spreads to other tissues or organs. Although it can develop from moles in the skin, most melanomas arise from a pigment-producing cell found in the epidermis. Melanomas resemble moles on the skin, but there are differences. The following list of features can help distinguish a melanoma from a normal mole.

  • asymmetry: A melanoma skin lesion is usually an irregular shape.

  • border: The outline of a melanoma is ragged rather than smoothly defined

  • colour: There is a variation of colour within the lesion.

  • diameter: The lesion is bigger than 6mm across and/or has increased in size recently.

  • elevation: The lesion is raised above the surface of the skin.

Other features which may indicate skin cancer include any spot that changes in size, shape, or colour; itches, bleeds or forms an ulcer. Although these signs do not necessarily indicate skin cancer, you should visit your doctor to have it assessed as soon as possible.

How is skin cancer diagnosed? If skin cancer is suspected, your doctor may recommend a biopsy, which involves removing a sample of the skin from the affected area for examination under a microscope. If necessary, you will be referred to a skin specialist (dermatologist), a cancer specialist (oncologist) or a plastic surgeon. If there is a risk that the cancer may have spread to other organs, other tests such as CT or MRI scans, and X-rays may be needed to check for this.

Prevention Be "sun aware". To reduce the risk of skin cancer, minimise your exposure to the sun. Always use sunscreens, wear protective clothing and remain in the shade as much as possible, and especially between 11a.m. and 3 p.m. when the sun is at its strongest. Don't use sunbeds. Be vigilant: the earlier a skin cancer is identified and treated then the better the outcome. You should show your doctor any skin lesion, which is unusual, new or changing shape as soon as possible.


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