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Skin Cancer

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Galsworthy Road Kingston upon Thames Surrey KT2 7QB
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Skin Cancer is the most common type of cancer in the UK.

It is divided into:

• Non- Melanoma Skin Cancer

• Melanoma

Non- Melanoma Skin Cancer (NMSC):

There are two types of NMSC, the most common cancer in the UK is Basal Cell Carcinoma (BCC) also sometimes called a “rodent ulcer”. BCC develops from the basal cells in the lowest layer in the epidermis, it is slow growing and caused by (UV) sun exposure and therefore can be found on areas such as the face , limbs and trunk. Over 100.000 people are diagnosed with BCC every year but it is a treatable cancer with no real risk of spreading.

Most BCC’s are painless. People often first become aware of them as a scab that bleeds occasionally and is non-healing. BCC’s can be  superficial and look like a scaly red flat mark: others have a pearl-like rim surrounding a central crater. If left for years, the latter type can eventually erode the skin causing an ulcer – hence the name “rodent ulcer”.

Other basal cell carcinomas have one or more shiny nodules crossed by small but easily seen blood vessels.

Squamous Cell Carcinoma (SCC)

Squamous Cell Carcinoma is usually faster growing then BCC, it is a non-melanoma skin cancer. SCC that develops from the keratinocytes in the epidermis

The most common cause for  SCC' to develop is due to too much exposure to ultra-violet light from the sun or from sun beds . We see SCC on the face, scalp, neck, and on the back of hands and forearms. SCC can, however, develop in scars, areas of skin that have been burnt in the past, or that have been ulcerated for a long time. People who are immunosuppressed (ie following transplant surgery) are also at risk.

SCC’ don't often spread. If they do, it's most often to the deeper layers of the skin. SCC can spread to nearby lymph nodes and other organs causing secondary cancers, but this is unusual. They may present as a non-healing thickened lesion, they can be crusty, scaly, ulcerated, nodular, plaque like and verrucous ( like a verruca) and can be fast growing.

Further details both of these cancers can be found at:

http://www.bad.org.uk/for-the-public/skin-cancer

http://www.macmillan.org.uk/information-and-support/skin-cancer/understanding-cancer/skin.html

Melanoma

Melanoma is the most serious form of skin cancer, the earlier it is diagnosed the better outcomes can be. Melanoma is a cancer of the melanocytes ( the pigment producing cells) in the skin. It is the 5th most common cancer in the UK with 15,400 cases diagnosed in 2014 and one of the most common cancers in the 15-34 year age group (CRUK), the main risk to developing melanoma is ultraviolet radiation form sun / sunbeds.

People with the following, may have an increased risk of developing melanoma, those who have:

  • lots of moles or freckles
  • pale skin that burns easily
  • red or blond hair
  • a close family member who's had melanoma
  • excessive sun exposure or use of sun beds
  • It is therefore important to check with your GP if any of the following are noted in a existing or new mole:
  • getting bigger
  • changing shape, particularly getting an irregular edge
  • changing colour – getting darker, becoming patchy or multi shaded
  • loss of symmetry – the two halves of your mole do not look the same
  • itching or painful
  • bleeding or becoming crusty
  • looking inflamed                                                  (CRUK 2017)

 

Melanoma always requires surgery but when diagnosed and treated at an early stage it can have very good outcomes. If it is detected at a later stage it has the potential to spread to other parts of the body, may be difficult to treat and may be incurable.

Treatment options for patients with advanced melanoma have improved over the last five years with targeted treatments and immunotherapy as available treatment options. These treatments will generally be available for patients with Stage III / IV (find out more via the Macmillan or Cancer Research UK websites) or through clinical trials, and usually will be offered by in the melanoma oncology service.

Further details can be found at:

http://www.cancerresearchuk.org/about-cancer/melanoma/about

www.nhs.uk/Conditions/Malignant-melanoma

You may be referred by your GP to a skin cancer clinic.

• In this clinic, your appointment will be with a consultant dermatologist or a senior member of their team. You may also have:

• an examination of all your skin as well as the area of concern

• examination with a dermatoscope (a magnifier for examining skin)

• photographs

If any further tests are needed, such as a skin biopsy under local anaesthetic, this will be arranged for you following the appointment, occasionally this can be offered on the same day. You will be informed of the results by letter or appointment within four weeks.

If further skin surgery is needed, this will be facilitated by our plastic surgery team here at Kingston or you may be referred to the Specialist Team at St George’s Hospital.

The Clinical Nurse Specialists are an important part of the skin cancer team, run various clinics and are your point of support and liaison while under the care of the team.

Skin Cancer Multidisciplinary Team (MDT)

All patients with a diagnosis of SCC or melanoma are discussed at our Skin MDT, which meets weekly. Members include plastic surgeons, dermatologists, oncologist, specialist nurses (CNS) histo-pathologist, together they devise a proposed treatment plan for each patient, outlining the options available, which will be discussed with the patient at a clinic appointment.

Treatments for skin cancer

BCC:

  • Topical treatments (creams)
  • Cryotherapy ( freezing)
  • Photodynamic Therapy (PDT)
  • Surgery
  • Radiotherapy

SCC:

  • Surgery
  • Radiotherapy

Melanoma:

Based on the stage of the cancer and other factors, your treatment options might include:

  • Surgery
  • Immunotherapy
  • Targeted therapy
  • Chemotherapy
  • Radiation therapy

Holistic Needs Assesment

People with cancer often require care, support and information in addition to the management of their cancer or condition.

A holistic needs assessment is a discussion with your doctor or nurse to talk about your physical, emotional and social needs. The focus is on you as a whole – not just your illness. Your doctor or nurse will need information from you. However, you decide how much information you would like to share about your current situation. This is an opportunity for you to talk about any worries or concerns you may have. It will help to clarify your needs and ensure that you are referred to the relevant services.

In order to prepare for this discussion, you may be asked to complete a questionnaire to bring to your next consultation.

This is not compulsory and not having this assessment will not affect your care. However, many patients find having an assessment helpful as it can help to identify what help is available.

It may be offered at certain times during your care, including:

  • Around the time of diagnosis or start of your treatment
  • The end of your treatment – when your surgery, chemotherapy or radiotherapy has been completed
  • Any time that you ask for one

It may be carried out over the phone.

With your agreement the doctor or nurse carrying out your assessment may refer you to other services that may be of help to you. Alternatively, if you prefer, you will be given written information about these services.

Skin Cancer Team

Skin Cancer is managed by the Dermatology / Plastics team at Kingston Hospital, patients for radiotherapy are referred to the Royal Marsden Hospital in Sutton.

Dermatology

Dr Natkunarajah

Dr Fletcher

Dr Fogo

Dr Rao

Dr Hogarth

Plastic Surgery

Mr Soldin

Mr Ardehali

Clinical Nurse Specialists (CNS)

Mrs Saskia Reeken – Lead CNS Skin Cancer & Dermatology

Mrs Kate Mayers – Macmillan CNS Skin Cancer

Mr Alberto Barea – Lead CNS Plastics & Dermatology

Further Support

British Association of Dermatologists

www.bad.org.uk

Macmillan Cancer Support

www.macmillan.org.uk

Cancer Research UK

www.cancerresearchuk.org

Skcin

www.skcin.org.uk

NHS Choices

www.nhs.uk/Conditions/Malignant-melanoma

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