Skin Cancer

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There are 3 common skin cancers


1    Basal Cell Carcinoma (BCC/Rodent ulcer)

2    Squamous Cell Carcinoma

3    Melanoma


BCC

BCC on shoulder


BCC adjacent to left eye.


macroscopic image of BCC on nose


dermatoscopic image of same BCC


The BCC is the commonest skin tumour occurring in man.  It develops on sun-exposed areas of the body eg face, chest, shoulders, upper back and the arms.  It is seen exclusively in light skinned individuals and is almost never diagnosed in people with pigmented skin.  BCCs are usually not dangerous as they do not commonly spread to distant parts of the body.


How is a BCC diagnosed?


  1. 1. Clinically - ie by its visual appearance.  BCCs are translucent in appearance and pearly in nature.  Several types may be seen.


Five types can be recognised:

Nodulo-ulcerative:  this type has the appearance of a nodule on the skin.  Often the centre breaks down to form and ulcer.

Pigmented:  Flecks of dark pigment appear within this type of BCC.  It may be confused for a melanoma

Morphoeic:  Scar like in appearance.

Superficial:  Occurs on the surface of the skin, without invading into the deeper layers of the skin.  The edge is very slightly elevated.

Fibroepithelioma


2.    Biopsy

A minute piece of skin is removed under local anaesthetic and sent to the laboratory for analysis.


How is BCC treated?


  1. •Surgical excision - the BCC is cut out and the skin stitched together.


  1. •Moh's surgery - a specialised type of surgical treatment where only minimal tissue is excised


  1. •Cryosurgery - treatment with liquid nitrogen


  3. •Radiotherapy - using X Rays


  1. •Interferon - injected into the BCC three times a week for 3 weeks (9 injections in total)


  1. •Imiquimod - applied on a BCC on three days a week for six weeks.  Used only for Superficial BCC.


  1. •PDT - Photodynamic therapy is a latest innovation in the treatment of BCCs - particularly superficial BCCs.


  1. •Small BCCs may also be treated with electrocautery


BCC treated with electrocautery.  No recurrence in 4 years.



SCC






SCC on lower lip


SCC on right ear


Squamous Cell Carcinoma - also associated with sun exposure and more common on light skin than in pigmented individuals, this tumour may be seen in any colour of individual.  It may be associated with other factors as well (apart from sunlight) eg burns and skin TB.  It is possible for SCCs to arise from Solar keratoses (scaly areas of sun damage on the skin - especially common on the arms, scalp, face, chest and back).  For this reason solar keratoses are treated with liquid nitrogen when they are noticed.


Squamous cell carcinomas can be prevented by the regular treatment of SOLAR KERATOSES with liquid nitrogen. 


A solar keratosis is a pre-cancerous tumour which could change into a squamous cell carcinoma within a few years.    Solar keratoses are flat and scaly and occur on sun-exposed areas viz. the backs of the hands, the forearms, scalp, face and "V" of the neck and chest.  The upper back may also be involved.


solar keratoses on the back of the hand

(singular = solar keratosis
    plural = solar keratoses, pronounced kera-toe-seez)


Melanoma


This is the most dangerous of all skin cancers as it may spread to other parts of the body eg liver, spleen, lymph nodes.  Melanomas may develop from existing moles.  To learn what type of changes to look for in an existing mole, click here.  If a melanoma is detected early and removed, there is an excellent chance of survival.