SKIN CANCERS

There are 3 main types of skin cancers. Basal Cell Carcinoma’s (BCC’s) and Squamous Cell Carcinoma’s (SCC’s) are usually pink-red and either scaly, scar-like or pearly nodular. As they develop and enlarge they may ulcerate or bleed. The third type of skin cancer is Melanoma, which is usually multicoloured (black-brown-white) large and irregular.

Anyone in Australia can develop skin cancer but risk is increased for people who:

  • are exposed to ultraviolet radiation (UVR) during childhood and adolescence
  • have repeated exposure to UVR over their lifetime
  • have episodes of severe sunburn
  • have a light complexion (red or fair hair; blue or green eyes; skin that burns easily, freckles and doesn’t tan)
  • are older
  • have had a previous non-melanoma skin cancer (NMSC)
  • have a personal or family history of melanoma
  • have a large number of moles
  • have unusual types of moles (eg dysplastic naevus)
  • are immunosuppressed (including organ transplant recipients)

Most skin cancers are related to both age and sun exposure. Here in Australia we have the highest rate in the world of all types of skin cancer. Most skin cancers do not cause symptoms such as bleeding or itching until they are larger and well developed.

A research study1 published by Ms Terrill showed that over 70% of patients presenting with a skin cancer detected by themselves or their doctor had further skin lesions that required treatment. Therefore a full skin examination will be offered at the initial consultation.


BCC - Basal Cell Carcinoma

  • Are known as a non-melanoma skin cancer (NMSC)
  • They are the most common type of malignant skin cancers, growing slowly and very rarely spreading. If neglected they can grow to a very large size and infiltrate deeply into underling tissues (fat, muscle and bone).
  • They may become ulcerated and bleed as they grow
  • They usually occur on the head, neck and upper trunk areas (areas exposed to uv radiation), but may occur anywhere
There are several types;
  • Nodular - pink, pearly nodule with fine red blood vessels on its surface
  • Superficial - flat, red, scaly
  • Pigmented - pink pearly nodule with black spots within it
  • Nodular Sclerosing - pink scar like
  • BCC’s are extremely common. According to the Australian Institute of Health and Welfare and Australasian Association of Cancer Registries in 2008, 296,000 new cases of BCC were diagnosed in Australia. The majority of these are in people over 40 years of age

 

Nodular Basal Cell Carcinoma Nodular Basal Cell Carcinoma Superficial Basal cell Carcinoma PIGMENTED Basal Cell Carcinoma Ulcerated Nodular Sclerosing
Basal Cell Carcinoma

 

SCC - Squamous Cell Carcinoma

  • Are also a type of non-melanoma skin cancer (NMSC)
  • They are the second most common form of skin cancer
  • They usually appear as red, scaly spots with a thickened base. They may have a thick keratin top on them which can be painful and catch on clothing. They may bleed, crust or ulcerate.
  • They appear on skin most often exposed to ultraviolet radiation (UVR) – the head, neck, forearms and upper body
  • They grow more rapidly than a BCC, growing over weeks to months. If left untreated they may spread to other parts of the body.

 

     
Squamous Cell Carcinoma
with keratin horn
Squamous Cell Carcinoma      

 

Malignant Melanoma

  • is the least common form of skin cancer but is the most deadly
  • They appear as a new spot, or an existing spot, freckle or mole that is changing (colour, size or shape)
  • They are usually irregular in shape and are multicoloured (brown, black, white) and greater than 6mm in size
  • They grows over weeks to months, anywhere on the body (not just in places that get a lot of sun - such as in the eye, on the palms or soles or under finger or toe nails)
  • Risk factors for melanoma are the number of moles and the presence of dysplastic moles. A previous melanoma, previous severe sunburns, a light complexion and a close family member with melanoma also increase an individuals risk of developing melanoma.
  • Excluding non-melanoma skin cancer (NMSC), melanoma is the fourth most common cancer in Australia (after prostate, bowel and breast cancers)
  • If untreated, melanoma cells spread quickly to other parts of the body and form secondary cancers
  • Melanoma has a high relative 5 year survival rate, with over 90% of people alive 5 years after their initial diagnosis
  • The prognosis of a melanoma is however related to the size (depth) of the tumour principally, i.e. the thicker the melanoma the worse the prognosis.

 

   
Malignant Melanoma Malignant Melanoma Malignant Melanoma with multiple secondary nodules of tumour    

Treatment for Skin Cancers

Most skin cancers require surgery. BCC’s and SCC’s require excision with a 3-5mm cuff of normal tissue surrounding the lesion. When small they can be cut out and sewn up directly to provide a straight line scar but if larger usually require reconstruction with specialized techniques such as a skin graft or flap. The cure rate for these type of skin cancers is excellent with surgery (greater than 98%cure rates). Melanoma’s usually require excision with 1-2cm of normal skin around them to prevent the cancer recurring locally.

Superficial BCC’s can be treated with Imiquimod cream when biopsy proven. The success rate is not as good as surgery but the advantage is that no surgery is required and scaring is usually minimal. It can be also used to treat lesions that are large or in difficult areas that would be difficult to treat with surgery. The success rate is 70-80%.

Radiotherapycan be used to treat BCC’s and SCC’s in certain areas of the body. This is useful when surgery would create a significant defect that would be hard to reconstruct or in the frail, medically unwell patient. It may also be used as an adjunct to surgery if the tumour is showing signs of spread in the blood vessels or lymphatic’s.