SKIN CANCER

( By JASCAP )

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Symptoms & diagnosis

Symptoms of skin cancer

Both basal cell and squamous cell cancers can appear in a variety of forms. They are usually painless and grow slowly. They can appear anywhere on your body but are most likely to occur on exposed skin, especially your face.

Basal cell cancers may:

  • be smooth and pearly
  • look waxy
  • appear as a firm, red lump
  • bleed sometimes
  • develop a crust or scab
  • begin to show signs of healing and yet never quite heal
  • be itchy
  • look like a flat, red spot which is scaly and crusty
  • develop into a painless ulcer.

Squamous cell cancers most often develop in areas that have been damaged by exposure to the sun. They are mainly found on the face, bald scalps, arms, backs of hands and lower legs.

Squamous cell cancers have a scaly appearance and sometimes have a hard, horny cap. They can feel tender to touch.

Changes in your skin

If you notice anything unusual on your skin which does not go away within a month, you should show it to your doctor. However, there are many other conditions that may appear in the skin which are not cancer, especially in older people. You may want to have these treated for cosmetic reasons.

How skin cancers are diagnosed

Usually you begin by seeing your GP, who will examine you and decide whether to refer you to a hospital specialist for further tests and treatment. Some GPs can do minor operations. They may be able to take a sample of the skin (biopsy). This will be sent to the laboratory to be examined under a microscope.

However, many doctors would prefer to get a skin specialist to remove any suspected skin cancer.

At the hospital

Most people with suspected skin cancer are referred to a specialist at their local hospital for advice and treatment. A specialist in treating skin diseases is called a dermatologist . However, depending on the area of the body affected by the cancer and the type of treatment needed you may also be referred to:

  • a general surgeon
  • a plastic surgeon.

Often these doctors work together and are known as a multidisciplinary team, or MDT. Other staff will be available to help if necessary, such as:

  • specialist nurses who give information and support
  • pathologists who advise on the type and extent of the skin cancer by examining tissue under the microscope
  • oncologists (cancer specialists)
  • counsellors and psychologists.

Biopsy

The specialist will be able to tell a great deal from a simple examination of the affected area of skin. However, it's not always possible to tell the difference between skin cancers and benign (non-cancerous) conditions by examination alone, so you may be advised to have a biopsy.

This is a quick and simple procedure which can usually be done in the outpatients department using a local anaesthetic. The doctor will remove all or part of the affected area and send it to the laboratory. In the laboratory it will be examined under a microscope by a pathologist.

Further tests

If you have a basal cell cancer, you probably won't need any further tests as long as the cancer has been completely removed. This is because basal cell cancers almost never spread.

If you have a squamous cell cancer, your doctor may want to examine you all over as well as taking a biopsy. This is to make sure that you don't need any further treatment as squamous cell cancers can occasionally spread.

The tests are particularly important if you've had treatment for skin cancer before and it has come back (recurred). During the physical examination, your doctor will probably feel the lymph glands close to the cancer to see if any of them are enlarged.

They may recommend that you have an operation to sample some of the nearby nodes if they think there's a risk that the cancer has spread to them. This is rare and will not be needed if you have a basal cell carcinoma (BCC).

Very occasionally, ultrasound, CT or MRI scans are done if your doctor thinks there's a possibility that the cancer has begun to spread. These scans are not usually needed when you are first diagnosed.

It may take 2-4 weeks for the results of the biopsy to be ready. A follow-up appointment to give you the results may be arranged before you go home.

This waiting period will be an anxious time for you. It may help to talk things over with a close friend or relative, or a support organisation .

Staging of skin cancers

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the extent of the cancer helps the doctors to decide on the most appropriate treatment. Most people with basal cell cancers do not need to have tests to find the stage of the cancer, as it is very rare for them to spread beyond the initial area of skin. Tests will only be done if the cancer is very large.

Although it is rare for squamous cell cancers to spread, tests to find the stage may be done because in some people they may spread.

A commonly used staging system is outlined below:

Stage 0 is also called carcinoma in situ. Carcinoma in situ means that cancer cells are present, but they are all contained in a small area in the top layer of skin (the epidermis). They have not started to spread or grow into deeper layers of skin. Squamous cell stage 0 is also called Bowen's disease. If it is not treated, it can develop into a squamous cell skin cancer.

Stage 1 The cancer is less than 2cm across and has not spread

Stage 2 The cancer is more than 2cm across and has not spread

Stage 3 The cancer has spread into the tissues under the skin and possibly to nearby lymph nodes

Stage 4 The cancer has spread to another part of the body. This very rarely occurs with either squamous or basal cell cancers of the skin.

TNM staging system

Another staging system known as the TNM system is commonly used. This can give more precise information about the extent of the cancer.

  • T describes the size of the tumour.
  • N describes whether the cancer has spread to the lymph nodes.
  • M describes whether the cancer has spread to another part of the body (secondary or metastatic cancer).
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