Skin Cancer

Skin cancer types and what to look for

Actinic keratoses
These are one of the earliest stages in the development of skin cancers. They are small, scaly areas caused by sun damage: the face, ears, neck, forearms, scalp and back of hands. They occur particularly in fair skinned people who have had high sun exposure.

This condition can be treated with cryosurgery (freezing using liquid nitrogen), photodynamic therapy (by use of a special cream in conjunction with a special lamp) or topical chemotherapy (by applying cream). Other treatments are laser, minor surgical excision or scraping away.

Basal Cell Carcinoma (BCC)
This is the most common form of skin cancer, accounting for 80% of all cases of skin cancers. BCCs commonly appear as non-healing fleshy bumps (like a small pearl), nodules or red patches. Mostly they are found on the head, neck and areas exposed to sunlight. BCCs do not usually spread, but need to be treated adequately to prevent them coming back. With proper treatment there is a high cure rate, although they can return.

Treatment is usually relatively straightforward with simple surgical excision using a local anaesthetic often the only requirement. Alternative treatments include topical therapeutic agents (anti-cancer creams), photodynamic therapy (light therapy), excision and Mohs micrographic surgery (specialised surgery for invasive skin cancer, which has the highest cure rate, is effective for high risk BCCs).

Bowen’s disease
Bowen’s disease, or intraepidermal squamous cell carcinoma, is a growth of cancerous cells confined to the outer layer of the skin. It usually appears as a red patch of skin, a non-healing ulcer or a red scaly patch. It is commonly found in fair skinned people at sites of high sun exposure.

The cause, as ever with skin cancer, is long term exposure to the sun. It is not a serious condition, but if not treated properly, SCCs can be very damaging to the body. So we prefer to treat, or at least monitor, Bowen's disease. A patch of Bowen’s disease may appear similar to other skin conditions, such as psoriasis. So we may recommend a biopsy to make the diagnosis.
Squamous Cell Carcinoma (SCC).

Treatment is usually relatively straightforward. Simple wide surgical excision using a local anaesthetic is often all that is required. Alternative treatments include Mohs micrographic surgery (specialised surgery for invasive skin cancer, which has the highest cure rate) and radiotherapy. Topical treatments and PDT are not usually used in this form of cancer because of its more aggressive nature.

Treatments

We offer two forms of treatment: Mohs Micrographic Surgery and Photodynamic Therapy (PDT).

Mohs Micrographic Surgery
Mohs Micrographic Surgery is a highly specialized technique used for the complete removal of skin cancer including basal cell carcinomas and squamous cell carcinomas. It is the gold standard for treating these cancers in high-risk areas of the skin. The Mohs surgeon follows the extensions of the tumour until all the cancerous tissue is completely removed.  This technique has the highest cure rate of any treatment for such skin cancers and it also leaves the smallest of wounds while completely removing the tumour. This offers you a good long-term cosmetic outcome from your treatment.

At Skin Care Network we have invested in the highly specialised surgical and laboratory facilities required for Mohs surgery. In addition we are supported by well-trained Mohs nursing and histopathology technicians.

Many skin cancers are deceptively large, being much more extensive under the skin than they appear to be from the surface. The advantages of Mohs surgery is that your Mohs surgeon at Skin Care Network will track these tumours along blood vessels, nerves or cartilage and remove all these cancerous ‘roots’.

Before the Mohs surgery starts it is not possible to predict precisely how much skin will have to be removed. The final area might be only slightly larger than the initial skin cancer, but occasionally the removal of the deep ‘roots’ of a skin cancer results in a sizeable defect.

The benefit of Mohs surgery is that it removes only the cancerous tissue, while normal skin is spared. So Mohs surgery is particularly useful for cancers located in areas such as the nose, ears, eyelids, lips, hairline, hands, feet and genitals, where conservation of healthy tissue is important for cosmetic or functional purposes.

Most Mohs cases will be completed in three or fewer stages, requiring less than four hours. After the skin cancer has been removed, there are a number of alternatives for closing the defect. One of these is to allow the wound to heal naturally, without the necessity of additional surgery. If required, your Dermatologist can perform simple or complex wound repair. However some wounds, difficult or especially large wounds, require the specialist reconstructive skills of a plastic surgeon, which can be carried out at Skin Care Network or in a hospital.

At Skin Care Network, Mohs surgery is usually performed as a day case (usually in half a day) or as an outpatient procedure in the clinic. You may experience some swelling and bruising. Patients come back to the clinic after seven days for the removal of stitches.

Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical area.

Photodynamic Therapy
Photodynamic Therapy (PDT) is a novel treatment for superficial (surface) skin cancers. It gives an excellent cosmetic result and is totally non-invasive. PDT works by the application of a drug to the skin which is specifically taken up by the cancer cells but not the normal skin cells. Then a bright light is used to activate the drug, leading to specific destruction of the skin cancer with minimal scarring.

PDT therapy, or the ‘red light that cures cancer’, is available at Skin Care Network for the treatment of basal cell carcinomas, actinic keratoses and Bowen’s disease. Hospital trials have shown that this treatment destroys more than 90 per cent of these common skin cancers.

A cream is applied to the affected area and left for about three hours to allow a drug called Metvix to penetrate the cancerous tissue. The affected area is then exposed to red light for ten minutes, triggering a chemical reaction like a depth charge which destroys the cancer cells but leaves normal tissue undamaged.  Treatment requires two sessions lasting 10 – 15 minutes each, three hours apart. This needs to be repeated a week later for BCCs and Bowens disease.

Although most patients feel itching or tingling sensations, the process is largely pain free. Recovery is within two to three weeks.  Healthy skin cells are not affected because they have not absorbed large amounts of the drug. As it dies, the cancerous lesion forms a crust, which falls off five to ten days later. It has the great advantage that it leaves little scarring, making it an attractive alternative to surgery, particularly for those with lesions on the face.

A recent trial of over 100 patients with the most common form of cancer suggested the treatment was just as effective as surgery.

Useful websites

http://www.nhs.uk/conditions/cancer-of-the-skin/pages/introduction.aspx
http://www.nhs.uk/conditions/malignant-melanoma/pages/introduction.aspx
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Melanoma/Melanoma.aspx
http://cancerhelp.cancerresearchuk.org/type/melanoma/
http://mohssurgery.i4adev.com/files/public/patient_information_brochure.pdf
http://www.skincancer.org/Basal-Cell-Carcinoma/
http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/what-is-bowens-disease