Your skin is made up of two layers, the epidermis and dermis, and these are supported by a layer of tissue. The epidermis is the top layer and has three types of cells (squamous cells, basal cells and melanocytes). This factsheet will focus on skin cancer that starts in any of these cells.
Types of skin cancer
There are three main types of skin cancer. These are named after the type of cell the cancer first occurs in.
- Basal cell carcinoma is where cancer starts in the basal cells lining the bottom layer of your epidermis. It’s the most common type of skin cancer in the UK. Three in four people diagnosed with skin cancer have this type. It’s slow growing but, if left untreated, can grow deeper into your skin and sometimes into surrounding tissues. Basal cell carcinoma is often found on your face, scalp, ears, hands, lower legs and back.
- Squamous cell carcinoma is where cancer starts in the squamous cells lining the top layer of your epidermis. It’s the second most common type of skin cancer in the UK. One in five people diagnosed with skin cancer have this type. Squamous cell carcinoma usually grows slowly but can spread into your surrounding skin or other parts of your body. Squamous cell carcinoma is often found on your face, neck, lips, ears, hands, shoulders, arms and legs.
- Melanoma is where cancer starts in the melanocytes. These are cells that make a pigment called melanin when your skin is exposed to the sun. Melanin gives your skin its colour and protects your skin from the harmful effects of the sun. Melanoma can grow quickly and spread to other parts of your body. It can become life-threatening, but can be successfully treated, if found early. About 11,800 people are diagnosed with melanoma each year in the UK. Melanomas are often found on the back in men, and on the legs in women.
Basal and squamous cell carcinomas may also be known as non-melanoma skin cancers.
Symptoms of skin cancer
Symptoms that may indicate skin cancer include any mole, spot, lump or area of skin that:
- doesn't heal within four weeks
- is itchy, painful, scaly, bright pink or bleeds for longer than four weeks
- changes in size – gets bigger
- changes shape – look for an irregular edge
- changes colour – darkens, becomes patchy or multi-shaded
- becomes an ulcer
These symptoms aren't always caused by skin cancer but if you have them, see your GP.
Causes of skin cancer
The exact reasons why you may develop skin cancer aren't fully understood at present. But there are certain factors that make skin cancer more likely. The main risk factor for skin cancer is over-exposure to ultraviolet light from the sun or sunbeds. Age is another risk factor, however, one in three people diagnosed with melanoma are under 55.
You may also be more likely to get skin cancer if you have:
You may also be more likely to get skin cancer if you have:
- fair skin, especially with red or fair hair
- many freckles
- unusually shaped, or very large, moles
- skin that burns easily
- close relatives who have had skin cancer
- a weakened immune system – for example, if you have HIV/AIDS, or are taking medicines that suppress your immune system
- certain skin conditions, such as eczema
- been exposed to certain chemicals, such as an insecticide called carbaryl
Diagnosis of skin cancer
Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history. Your GP may refer you to a dermatologist (a doctor who specialises in skin conditions) for further tests. You may have the following tests to diagnose your condition.
- A skin biopsy. A sample of your skin is removed usually under local anaesthetic.
- A fine needle aspiration. A sample of cells from the lump and/or nearby lymph nodes is removed.
The samples will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.
After your condition is diagnosed, you may have further tests.
After your condition is diagnosed, you may have further tests.
- Scans – these may include X-rays, ultrasound, CT scans or MRI scans. These are done to check whether the cancer has spread to other parts of your body.
- A sentinel lymph node biopsy. The first lymph node that cells drain into is identified, removed and tested to determine if the cancer has spread.
Treatment of skin cancer
The type of treatment you have depends on the type of skin cancer you have, your general health, your age, the position and size of the cancer and how far it has spread. Your surgeon or oncologist will discuss your treatment options with you.
Surgery
Removing the affected skin and tissue is usually the first treatment option. There are different methods of surgically removing skin cancer depending on the type you have.
- Excision. Your surgeon will remove the cancer and some of your healthy skin surrounding it. The amount of healthy skin that is removed will vary depending on the type of cancer and how deep it is in your skin. If you have a large area of skin removed, you may need a skin graft to repair it.
- Curettage and electrocautery. The affected area is cut away and sealed using heat.
- Cryotherapy. Liquid nitrogen is used to freeze the affected area and then it’s cut away.
Surgery is sometimes followed by chemotherapy or radiotherapy to make sure all the cancer cells are destroyed.
Non-surgical treatments
Non-surgical treatments may be used before surgery to help shrink the cancer or after surgery to reduce the chance of the cancer coming back or spreading. They can also be used to treat cancer that has spread or come back. The most commonly used non-surgical treatments for skin cancer are listed below.
- Radiotherapy – a beam of radiation is targeted into the affected area. The aim of the treatment is to destroy cancer cells with minimal damage to the surrounding healthy tissue. You may have radiotherapy if the cancer covers a wide area or after surgery to stop the cancer coming back.
- Chemotherapy – an anti-cancer medicine called 5-fluorouracil is used to destroy the cancer cells. This may be given as a cream to be applied directly to the affected area, as tablets or injections.
- Immunotherapy – manufactured substances such as imiquimod cream or interferon are used to stimulate your immune system to fight the cancer.
- Photodynamic therapy – you can take medicines to make your skin sensitive to light, and then a laser is passed over the affected area, which kills the cancer cells.
Prevention of skin cancer
The following steps may help to reduce your risk of skin cancer.
- Protect yourself in the sun and don't let your skin burn. If you're outdoors between 11am and 3pm use a sunscreen with an SPF (sun protection factor) of at least 15 and cover up with suitable clothing and a wide-brimmed hat.
- Don’t use sunbeds.
- Check your skin and any moles regularly. If you see any changes and they don’t improve within four to six weeks, see your doctor.
- Live a healthy lifestyle. Eating a healthy, balanced diet, maintaining a healthy weight, drinking sensibly and not smoking may help to protect against skin cancer.