Skin cancer

The single biggest risk factor for skin cancer is exposure to ultraviolet (UV) light. This can come from sunlight, or from indoor tanning devices such as sunbeds.

Macmillan Cancer Support also has more information on the causes and risk factors of skin cancer.

Staying safe in the sun matters for everyone. It matters even more if you have already had skin cancer, or if you have had treatment for another type of cancer.

Macmillan Cancer Support has more information about sun safety and cancer treatment.

If you have symptoms, contact your GP. They will examine you and may take photos of the skin change.

Sometimes, a specially trained GP may be able to remove the affected area.

If they think your symptoms could be a skin cancer, your GP can refer you to a specialist at a hospital. This is usually a doctor who specialises in treating skin diseases. They are called a dermatologist.

Your GP follows national guidelines to decide how quickly you need to see the specialist.

If they think you might have a melanoma or a squamous cell carcinoma (SCC), they will make an urgent referral for a dermatologist appointment. This means your GP is asking for a dermatologist appointment for you within 2 weeks, or as soon as the clinic can arrange it.

If your GP thinks that you have a basal cell carcinoma (BCC), they will make a routine referral. This means they are asking for a less urgent appointment for you, usually within 18 weeks. This is because nearly all BCCs grow slowly and are unlikely to change much during this time.

At the hospital

At the hospital, a dermatologist will examine the affected area of skin. They will also ask you questions about how long you have had symptoms, and any changes you may have noticed. They can learn a lot from a simple examination.

They may use an instrument called a dermatoscope to look more closely and examine the skin. It looks like a magnifying glass with a light.

It is not always possible to tell whether skin changes are cancer just by looking at the skin. Your doctor may talk to you about having a biopsy. This is when a sample of tissue is taken and then tested to find out more.

A biopsy can usually be done in an outpatient clinic. The doctor will numb the area with a local anaesthetic. They will remove all or part of the affected skin and send this to the laboratory for tests.

Different types of biopsies are used to diagnose skin cancer.

An incision biopsy is when a doctor removes a small piece of the abnormal area, using a surgical knife. They will then use stitches to close the small wound.

An excision biopsy is like an incision biopsy, but the whole abnormal area is removed. The doctor will also remove a small amount of healthy tissue around the abnormal area. This is called the margin.

If you have an abnormal mole that may be melanoma, you may have the whole mole removed with an excision biopsy.

A punch biopsy is when a doctor uses a small, round cutting instrument to remove a sample of skin. You might need stitches to close the area.

A shave biopsy is when a doctor uses an instrument to shave off the top layer of the affected area of skin. The wound forms a scab and heals without the need for stitches.

Waiting for test results can be a difficult time. Macmillan Cancer Support have more information that can help.

Further tests

If the biopsy shows you have a skin cancer, your doctor will usually check other areas of your skin. This is to find out if there are other possible areas of skin cancer.

Basal cell carcinoma (BCC)

If you have a basal cell carcinoma (BCC), you probably will not need any further tests, as long as the cancer has been completely removed. This is because BCCs almost never spread.

Melanoma

If you have a melanoma, you may have tests to check the lymph nodes nearby.

Squamous cell carcinoma (SCC)

If you have a squamous cell carcinoma (SCC), your doctor may feel the lymph nodes close to the cancer to check whether any are enlarged. This is because SCCs can occasionally spread.

Your doctor may recommend that you have an operation to take samples of the nearby lymph nodes. They will only do this if they think the cancer may have spread there, which is rare.

Scans

You may have some scans if your doctor thinks that the cancer has started to spread. These scans are not usually needed when you are first diagnosed.

Your doctor will explain more about these tests to you.

An ultrasound scan uses soundwaves to build up a picture of an area of the body. The person doing the scan will use some gel and a small device called an ultrasound probe on your skin.

A CT scan uses x-rays to build up a detailed picture. A CT scanner looks like a large, thick ring. You will lie still on a narrow bed that moves slowly backwards and forwards through the ring.

An MRI scan uses magnetism to build up a detailed picture. During the scan, you will need to lie still on a bed inside a long cylinder (tube).

A PET scan uses a low dose of radiation to check the activity of cells in different parts of the body. You will have an injection about 1 hour before the scan.

The scanner looks like a large, thick ring. You will lie still on a narrow bed which moves slowly backwards and forwards through the ring.

Treatment for skin cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

The treatment you will be offered will depend on the type of skin cancer.

Macmillan Cancer Support have more advice on cancer treatment options.

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) treatment

Surgery is often used to treat BCC or SCC. It’s usually the first and only treatment needed.

Other skin cancer treatments are sometimes used instead of surgery.

Melanoma treatment

Surgery is the main treatment for melanoma. Some people may need further surgery or other melanoma treatments depending on the stage of the melanoma.

You may have some treatments as part of a clinical trial.

After skin cancer treatment

Many people who have surgery for BCCs and SCCs don’t need long-term follow-up hospital appointments. But your doctor may want you to have regular check-ups for a time. This is to make sure that treatment has been successful and the cancer hasn’t come back.

You can also talk to your doctor or specialist nurse about any problems or worries you may have.

Follow-up after treatment for melanoma depends on the stage of the melanoma.

Skin checks

Once you’ve had a skin cancer, you have a higher risk of developing it again in the same area. This is called a recurrence. You’re also more at risk of developing another one somewhere else on your skin.

Your specialist team may advise you to have regular skin checks with your GP. It’s important to regularly check your skin for any new symptoms or changes that could be cancer.

Using a mirror can help if there are areas you can’t see easily, like your back. Or you can ask a family member or friend, if you feel comfortable doing so.

If you have any problems, or notice any new symptoms in between check-ups, tell your doctor as soon as possible.

Macmillan Cancer Support have more information about follow-up care after cancer treatment.

Body image after skin cancer treatment

Doctors will try to minimise the effects of skin cancer treatments on your appearance. Many people have only minor scarring after treatment. But for some, it may be more obvious.

If treatment has changed the way you look, you may feel differently about yourself and your body image. Body image is the picture in your mind of how your body looks and works. The effects will often improve with time, but you may feel more self-conscious about how you look.

Everyone’s reactions are different. You may feel more self-conscious about your body but find it manageable. Or you may find your concerns are on your mind a lot of the time, which may affect how you cope.

Talking with people you trust can help. This could be your family, friends, cancer doctor or nurse. Talking to another person who has been through something similar can also help.

There are practical things that can help you to:

• feel better about your appearance
• manage changes to your body
• improve your confidence

You may want to consider using camouflage make-up to cover a scar. Talk to your doctor or specialist nurse about camouflage make-up or about any concerns you have. Changing Faces has more information about skin camouflage.

Macmillan Cancer Support have more information about body image and cancer treatment.

Support after skin cancer

It’s important to remember there’s no right or wrong way to feel about a skin cancer diagnosis. Everyone’s reactions are different, and you might have a mixture of emotions.

Talking to others

Even if you were diagnosed with a skin cancer that’s likely to be cured, you may feel anxious or upset for a while. Talking about your feelings can be helpful.

You may find it helpful to talk with your family, friends, doctor or nurse. Sometimes it’s easier to talk to someone who is not directly involved in your situation.

If you’re finding it difficult to cope, your cancer doctor, specialist nurse or GP may be able to refer you to a counsellor who can help.

Macmillan Cancer Support

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan skin cancer forum – you can talk to others affected by skin cancer, ask questions and share your experience

Support from other organisations

Other organisations who offer information and support include:

• Changing Faces – offers a range of advice and information services about visual differences to the face or body
• Know your skin – supports people with skin conditions and provides information about different skin conditions
• Skcin – focuses on the prevention of skin cancer through education, promoting sun safety and early detection

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How to prevent further skin cancers

After you’ve had treatment for skin cancer, it’s even more important to protect yourself from the sun.

Macmillan Cancer Support have information on sun safety and cancer treatment.

It’s important to never use an indoor tanning device, like a sunbed or sunlamp. If you want to look tanned, use fake tan. It’s also important to check your skin regularly for any changes

If you’re not often outdoors or in the sun, ask your specialist doctor or GP to check your vitamin D levels.

Vitamin D is important for general health and can become low in people who avoid the sun or are indoors most of the time. You may need to take vitamin D supplements if your levels are low.