Q. What types of skin cancer are there?

A. There are three main types of skin cancer: basal cell carcinomas, squamous cell carcinomas and malignant melanoma. The first two are slow-growing and easy to treat, but malignant melanoma is a dangerous, fast-growing cancer that spreads very quickly.

 

Q. How common is skin cancer?

A. The official UK figures are 6,000 cases of melanoma a year and 62,000 cases of other skin cancers. The incidence of melanoma is increasing, probably because of increased exposure to sunlight but also due to better diagnosis. The figure of 62,000 other skin cancers is an underestimate because these cancers are slow-growing and often remain undiagnosed in elderly people. Roughly three out of every four non-melanoma skin cancers are basal cell carcinomas and the other quarter are squamous cell carcinomas.

 

Q. What are the risk factors for skin cancer?

A. For all types of skin cancer, over-exposure to ultraviolet light, from sunlight or sunbeds, is the main risk. Research into malignant melanoma suggests that over-exposure in childhood puts people at risk of getting melanomas later in life. There are several other things that increase the risk of skin cancer: having very fair skin that burns easily, having lots of moles (over 50) on your body, having had skin cancer before, your close relatives having skin cancer and being treated with anti-rejection drugs (ie after an organ transplant). Exposure to radiation or long-term exposure to chemicals such as coal tar, soot, pitch, asphalt, creosote, paraffin wax or arsenic, can increase your risk of non-melanoma skin cancer.

 

Q. What are the symptoms of melanomas - what do they look like?

A. The majority of melanomas occur on the head, neck, arms and back - i.e. the skin exposed most to sunlight. Most of them are very dark or black, but they can sometimes be lighter brown or even speckled. The surface is usually raised and sometimes rough. They are not normally circular in shape, but some can be quite close to a circle. In their early stages, they often look like a mole, but with a ragged outline or different shades of color in it. Sometimes, they appear to be a mole that is bleeding, oozing or crusty. However, the most important thing is that melanomas usually change shape or color as they grow. Any spot that changes color or shape should be reported to your doctor.

 

Q. What do basal cell carcinomas look like?

A. The vast majority of basal cell carcinomas occur on the face. They start as a small, pink, pearly or waxy spot, often circular or oval in shape. As they grow, they become a raised, flat spot with a 'rolled' edge and they may develop a crust. Next, they begin to bleed from the centre and an ulcer develops This is called a rodent ulcer and, if left long enough, it can become quite large and eat away the skin and tissue below.

 

Q. What do squamous cell carcinomas look like?

A. Squamous cell carcinomas are most common on the limbs, head and neck. They are pink and irregular in shape, usually with a hard, scaly or horny surface, although they can sometimes become an ulcer. The edges are sometimes raised. They can be tender to the touch.

 

Q. How dangerous are skin cancers?

A. Malignant melanoma can be one of the most dangerous types of cancer. They all spread into nearby tissues, but some grow faster and spread further than others. If diagnosed late, treatment is not usually able to cure the cancer.

Squamous cell carcinomas also spread, but most of them spread so slowly that they are not very dangerous. Even the ones that spread more rapidly can be effectively treated as long as they are diagnosed reasonably early.

Basal cell carcinomas almost never spread, apart from the slow growth of the rodent ulcer itself. Even in advanced cases, treatment is almost always successful.

 

Q. Does skin cancer run in families?

A. There are some rare, inherited skin diseases that make people highly sensitive to sunlight and much more likely to get any type of skin cancer. People inherit their normal skin type and skin cancer is more common in paler, freckly skin. In addition, there is good evidence that, if you have a close relative (brother, sister parent or child) with skin cancer, you have about twice the normal risk of getting that type of skin cancer.

 

Q. What causes skin cancer?

A. Ultraviolet light - from sunlight or sunbeds - is the main cause of skin cancer. It can damage the DNA that makes up the genes in skin cells. The wrong type of damage to the wrong genes will make a cell become cancerous. There are three types of UV light, called A, B and C. UVC is filtered out by the atmosphere and does not get to our skin. UVB was originally found to cause sunburn and skin cancer, but more recently, it has been discovered that UVA can also cause skin cancer.

 

Q. Can sun beds cause skin cancer?

A. UVB is known to cause sunburn and skin cancer, so most sunbeds were originally designed to produce UVA only. However, more recent research has found that UVA can also cause skin cancers. As a result, many modern sunbeds produce far less UVA, although others still produce very high levels.

 

Q. Does sun cream protect against skin cancer?

A. UVB is known to cause sunburn and skin cancer, so sun creams were originally designed to block out only the UVB. We now know that UVA can also cause skin cancer and, these days, some sun creams block out a lot of UVA as well as UVB. However, the main concern is that, because sun creams prevent burning, they make people think they can spend much longer in the sun, which will definitely increase their risk of getting skin cancer.

 

Q. How is skin cancer treated?

A. For almost all non-melanoma skin cancers and for early melanomas, surgery to remove the cancer and a small amount of surrounding tissue is all that is necessary. If a melanoma has spread, chemotherapy can be used, but it is not usually effective. After a melanoma has spread, surgery and radiotherapy can be used on the secondary tumours. This will prolong life but it is not a cure.

 

Q. How effective are skin cancer treatments?

A. Surgical treatment of non-melanoma skin cancer is usually completely effective. For melanomas, if the tumour can be removed surgically before it has spread, the treatment is usually very effective. By removing more tissue around the tumour (the margin), the surgeon is more likely to remove the beginning of any spread and increase the chance of a cure. Once a melanoma has spread around the body, treatment is usually aimed at prolonging life as the chance of a cure is very small.

 

Q. Is early diagnosis important?

A. Early diagnosis is absolutely crucial for malignant melanoma (see above) as treatments for advanced melanoma are rarely effective. However, for other types of skin cancer, early diagnosis is sensible, but not a matter of life or death.