Skin cancer

There are 2 groups of skin cancer:

• Non-melanoma, which are more common and less likely to spread
• Melanoma, which depending on its stage can need more invasive treatment and potentially spread to other sites

What to expect from your appointments with us

You may have an initial appointment with medical photography, your photograph will then be sent to a dermatologist to review.

You may have an initial face to face appointment with a specialist nurse or Doctor, they will take details from you regarding your presenting problem and clinically assess it.

You may be asked to undress as the clinician will need to review your skin, a chaperone can be requested and gowns are available.

What to expect from your diagnostic tests and investigations

Skin cancer is diagnosed following various tests. Your medical team may request some of the following tests and investigations:

• Physical examination – A skin specialist may be able to confirm the diagnosis by doing a physical examination. They will also ask you questions about how long you have had the affected area of skin, any changes you may have noticed and your history of sun exposure .
• Dermoscopy – Gives a magnified view of skin lesions and can help the team determine between a benign lesion and one that requires further investigation. It looks a bit like a magnifying glass with a light.
• Biopsy - A biopsy is a minor surgical procedure where either part of, or all of the tumour is removed so it can be examined under a microscope. A biopsy is normally done in a dermatology outpatient clinic, with local anaesthetic given to numb the area. A pathologist (a doctor who specialises in analysing cells) will then look at it under a microscope in a laboratory. This will allow the team to determine the type of cancer you have and if it is likely to spread.
• Lymph node examination – If there are concerns that your cancer could have spread, you may have a physical examination of your lymph nodes. If the cancer has spread, it may cause these glands to swell. Although glands can also become enlarged for other reasons such as infection.
• CT – CT scans take pictures of your body to find out where the cancer is and whether it has spread to other parts of the body.
• MRI – MRI uses strong magnetic fields and radio waves to create a cross sectional picture of the body. You will have an MRI scan to see if your cancer has spread.
• Ultrasound – Uses high frequency sound waves to create an image of part of the inside of the body.

Treatment options and what to expect

Non- melanoma:

Your specialist team will advise which, if any, of the below are suitable for you

Surgery - This will involve cutting out the cancer along with any surrounding healthy tissue to ensure the cancer is completely removed. In the majority of cases, this is enough to cure non-melanoma skin cancer. Sometimes if the surgery is more complicated to complete you may be referred to another team of surgeons.

There are other non-surgical treatments, which are as follows:

Cryotherapy - This uses a cold treatment to destroy the cancer. It will see liquid nitrogen used to freeze the cancer, which will cause the area to scab over. The scab containing the cancer will then fall off your skin. This process takes about one month. This can only be used on very early stage non melanoma lesions

Anti-cancer cancer creams - These are only used when the cancer is contained within the top layer of the skin. The cream is applied to the affected area for several weeks.

Radiotherapy - This involves using a low dose of radiation to destroy the cancer.

Immunotherapy - Immunotherapy works by helping the immune system recognise and destroy cancer cells.

Melanoma

The treatment you have will depend on where the cancer is, if it has spread and your general health.

Surgery - This is the main treatment for Melanoma. There are a number of different surgical procedures that can be carried out. The team may decide they only need to remove the melanoma and the healthy skin around it. You may also be offered a sentinel lymph node biopsy dependant on the stage of melanoma. This can help determine if the cancer has spread to the local lymph nodes. If this is the case, you may be able to have additional preventative treatment to help reduce the risk of the cancer coming back. If the cancer has spread you may require further surgery.

If the melanoma is on an area of your body that doesn’t have much loose skin such as your scalp, you may need a skin graft. This involves taking healthy skin from another part of your body, that is not usually visible, and attaching (grafting) it to the affected area.

Radiotherapy - This involves using a low dose of radiation and it is sometimes used to reduce the size of large melanomas and help control the symptoms. Our Radiotherapy pages have more detailed information.

SACT treatments

You may hear the following treatment being described as SACT, which means systemic anti-cancer therapies. These include chemotherapy and immunotherapy and are treatments that work throughout the entire body.

Immunotherapy - Immunotherapy works by helping the immune system recognise and destroy cancer cells. It is sometimes used to treat melanomas that cannot be treated by surgery, have spread to lymph glands or other areas of the body.

Targeted Therapy - There are different types of targeted therapy. Each type targets specific genes in the cancer cell that is helping it grow.