This a factsheet is for people who suspect they have or have skin cancer or people who wish to know more about it.

There are two main types of skin cancer, Melanoma and non-melanoma skin cancer (NMSC), Non-melanoma skin cancer is the most common cancer in the UK.

The Skin

The skin is made up of three layers:

• the epidermis
• the dermis
• the supporting subcutaneous layer of loose tissue and fat

Cancer can start from cells in any of these layers.

What is skin cancer?

Skin cancer is created by an abnormal and uncontrolled growth of cells. Skin cancer can grow and spread to other parts of your body (through the bloodstream or the lymph system) where it may grow and form secondary tumours. This is called a metastasis.

There are different types of skin cancer, which are named depending on which cells they form from.

Types of skin cancer

Non-melanoma skin cancer
Each year in the UK over 67,500 people are diagnosed with NMSC.

There are different types of NMSC including those described below.

Basal cell carcinoma
This is the most common form of skin cancer in people with fair skin. It's rare in people with dark skin.

A basal cell carcinoma (BCC) forms from basal cells in the epidermis - usually in areas of skin that are exposed to the sun such as your head and neck. It usually grows slowly and doesn't spread to other tissues.

If left untreated, a BCC will slowly grow and turn into an ulcer. If untreated, this ulcer will grow deeper into your skin and damage nearby structures, for example your nose or an ear. This is rare in the UK because most cases are treated early.

Squamous cell carcinoma
This is the second most common skin cancer.
A squamous cell carcinoma (SCC) forms from squamous cells in the epidermis. It often occurs on areas that are exposed to the sun.

An SCC can spread into the surrounding skin. It can also spread to other parts of the body, but this is rare.
Melanoma skin cancer (malignant melanoma)

Around 7,000 people are diagnosed with melanoma each year in the UK. It affects slightly more women than men. Melanoma is less common in people with dark skin.

Melanoma is an overgrowth of melanocyte cells in the epidermis. These are cells that make a pigment called melanin when your skin is exposed to the sun. Melanoma is the most serious form of skin cancer but it's curable if found early.
Symptoms of skin cancer

Different types of skin cancer can look different
Non-melanomas such as a BCC, for example, can start as a small red, pink or shiny lump. SCCs often appear as small scaly or hard areas of skin with a red or pink base.

Melanoma usually starts as a dark spot or mole on your skin. If a melanoma spreads to other parts of your body, you can develop other symptoms such as swollen lymph nodes (glands throughout your body that are part of your immune system).

Symptoms that may indicate skin cancer include any mole or lesion that:

• gets bigger - especially over 7mm (a quarter of an inch) in diameter
• changes shape - look for an irregular edge
• changes colour - if it darkens, becomes patchy or multishaded
• becomes inflamed
• is itchy or painful
• bleeds or is crusty

These symptoms don't necessarily mean you have skin cancer, but if you have any of them you should visit your GP for advice.

Causes of skin cancer
The cause of skin cancer isn't fully understood at present. But there are certain factors that make skin cancer more likely. The main risk factor for any type of skin cancer is exposure to the intense ultraviolet (UV) light of sunshine.

The factors that may increase your risk of skin cancer include:

• fair skin that burns easily - people with darker complexions have a lower risk of skin cancer
• a family history of skin cancerskin which has a lot of moles (more than 50)
• red or fair hair and blue or green eyes
• freckles•
• bad sunburn at some point in the past
• using a sunbed
• if you work outdoors - you're exposed to more sunlight than if you're office-based
• age - non-melanomas such as SCC and BCC are more common in people over 60 and are rare in children under 14
• smoking
• certain skin conditions - for example scarring from burns or skin ulcers
• exposure to certain chemicals - such as soot, asphalt or arsenic
• a weakened immune system - if you're taking immunosuppressants after an organ transplant for example

Diagnosis of skin cancer
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may refer you to a dermatologist (a doctor specialising in skin conditions) to have further tests including those listed below.

• A biopsy, where a small sample of the skin is removed. The sample is examined in the laboratory to find out what   type of tumour it is and how fast it's growing. This information can help your doctor to determine which treatment
   you should have.
• X-ray, CT, MRI or ultrasound scans will tell your doctor how far the cancer has spread (if at all).
• A sentinel node biopsy, in which your doctor will remove the closest lymph node that a melanoma skin cancer would
  drain into and examine it to see if cancer is present.

Treatment of skin cancer
Your treatment for skin cancer will depend on a number of factors such as your age and whether the cancer has spread and if so, how far. There are a number of treatments which are described below. Your doctor will advise you on which is best for you.
Surgery

Your doctor will remove the cancer and some of the healthy skin surrounding it. The amount of healthy skin will vary depending on the type of cancer and how deep it is in your skin - it can be 2 to 3cm (about an inch) around where the cancer is.

Your doctor will examine your lymph nodes before surgery. If he or she suspects that they may be cancerous you may need more extensive surgery. This will remove the lymph nodes near to the cancer as well as the affected skin.

Skin cancers such as BCC and SCC can also be destroyed by freezing them with liquid nitrogen. SCCs can be treated by other methods including using a prescribed cream called imiquimod (Aldara).

Non-surgical treatments
Radiotherapy may be used following surgery but it's usually used if surgery isn't possible.

Your doctor may recommend immunotherapy if there is a strong chance that your cancer will come back. Immunotherapy medicines, such as interferon alpha-2b (eg IntronA), help your immune system fight the cancer.

A more recent development in immunotherapy is cancer vaccines, however they are only used in research trials at present and aren't widely available.

If the cancer has spread, you may be given chemotherapy.

Prevention of skin cancer
To reduce your risk of skin cancer, you should minimise your exposure to the sun.

• Always use a sunscreen with a protection factor of at least 15.
• Wear protective clothing.
• Stay in the shade as much as possible - especially between 11am and 3pm when the sun is at its strongest.
• Don't use sunbeds.

If you notice any changes in your skin, you should visit your doctor as soon as possible.

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

Further information

Cancer Research UK
0808 800 4040
www.cancerhelp.org.uk

British Association of Dermatologists
020 7383 0266
www.bad.org.uk

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Simon Cawthorn, MS, FRCS, Consultant Surgeon, Spire Hospital, Bristol; National Clinical Lead, The Cancer Services Improvement Programme, England, and by Bupa doctors. It has also been reviewed by Cancer Research UK Information Nurses. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Bupa Fact Sheet Publication date: July 2008

Page created: 13 October 2008