“Skin cancer has several distinct forms and I have the expertise to treat all of them. I first examine your skin carefully and take a full medical history. You will then need further tests, including a biopsy in which a small sample of skin is removed. Once we have identified the type of cancer you have, your treatment can start straight away.“

Mr Hodges will advise you on the type of skin cancer that you have. Although some rare types can occur, most cases are one of the following.

Basal cell carcinoma (BCC)

The most common type of skin cancer and, in fact, the most common of all cancers that affect human beings. Around 80% of basal cell carcinomas occur on the head and neck as these receive the highest dose of ultraviolet radiation from sunlight.

Tumours often arise on the nose, cheek and ear. Unlike other cancers, they rarely spread around the body so treatment can be very successful if diagnosed early.

If they remain unrecognised, basal cell carcinomas can grow and invade deeply into the skin of the face and even underlying structures such as the cartilage and bone.  They can cause significant damage if left for a long time and are commonly called rodent ulcers, as they can gnaw away at tissue.

The treatments available range from:

• Topical medication: Cream or gel that you apply to the skin that contains chemotherapy agents.
• Cutterage and cautery: Superficial surgery to remove small BCCs
• Cryotherapy: Freezing the BCC so that the cells within it die.
• Surgery: Complete removal of the tumour with a margin of healthy tissue.
• Radiotherapy: Recommended if the tumour can’t be removed completely or there is a risk of it coming back.

 The treatment you will be offered depends on the subtype of BCC your biopsy shows you have. 

• Low risk BCC: The majority of BCCs are low risk and are usually completely cured by surgical removal.
• High risk BCC: These are less common and sometimes require more extensive surgery as they often come back. By more extensive surgery we mean taking the tumour away with a larger margin of healthy tissue around it. Its been shown that removing a 3mm margin around the tumour completely removes the cancerous tissue in 85% of cases but using a larger margin 4mm -5 mm removes all of the cancer in 95% of cases. Radiotherapy may also be used on either low or high risk BCCs if its considered necessary.

Squamous cell carcinoma (SCC)

Squamous cell carcinoma is the second most common type of skin cancer and it also tends to develop on the head or neck. This type of skin cancer develops from the pre-cancerous conditions actinic keratosis and Bowen’s disease.

Squamous cell carcinomas can grow quite rapidly and are capable of spreading around the body if untreated. This process, known as metastasis, occurs late in the disease and is more common with more aggressive forms of squamous cell carcinoma.

Treatment for SCC almost always involves surgery and/or radiotherapy. Surgery involves removing the tumour with a larger margin of healthy tissue than used for basal cell carcinomas. 4mm – 6mm is the norm and the exact margin depends on where the tumour is. SCCs on the scalp, ears and lips are considered high risk and require the increased margin of 6mm.

Once your treatment is complete you will need regular check ups to monitor the skin to make sure any recurrence of the tumour is picked up early.  The site, pathological grade and stage of the tumour will be taken into account to determine how frequent your check ups will be and how long you need to be followed up.

Malignant melanoma

This is the third most common type of skin cancer but unfortunately is the most aggressive and has the worst prognosis.

Malignant melanoma often spreads to other parts of the body, setting up secondary tumours in the liver, the bones or the brain.

Melanomas often look like moles and can develop within moles, but not always.  The majority of melanomas that do not develop from pre-existing mole arise as a new pigmented lesion on the skin, which is why its always a good idea to see your GP about a new, fresh mole that seems to enlarge rapidly.

A mole that could be a melanoma also tends to have some of the following features:

• It’s asymmetric, so not round but much more irregular.
• It’s not one solid colour but has a range of pigments.
• It’s borders are not very well defined.
• Its itching or it bleeds
• It’s an ‘ugly duckling mole’ – the mole that really stands out from the others you have.

An early diagnosis is even more crucial than for a squamous cell carcinoma and treatment again involves extensive surgery to remove the entire tumour and a healthy margin of tissue, sometimes followed by radiotherapy or chemotherapy. You will also be followed up with regular check ups for at least five years after your treatment has been completed.

Your body is protected by its largest organ, your skin. When its healthy and working well, we take it completely for granted but if things go wrong skin can become painful, red, itchy and truly embarrassing. This is definitely the case when lumps and bumps develop on the skin of the face because this is the part of you that everyone looks at when they interact with you.

Benign skin lumps are not cancerous and are not likely to turn into cancer. Medically, they often don’t need to be treated as they do you no physical harm. They can, however, cause embarrassment and low self esteem, particularly if they are obvious and on your face.

Diagnosing them is straightforward and removal can then be performed with excellent results.

Non-cancerous skin conditions

Skin lumps that are not cancerous and that never become cancerous are common and affect many people at some time in their life.

Skin tags

These are usually small lumps that hang from the skin. They commonly occur on the face around the eyelids but they can also arise on the neck line and under the arms.

Although they are usually completely innocent they can still be annoying. Those under the arms and on the neck can get sore if your clothes rub against them and the ones on the face just look unsightly.

Once diagnosed, skin tags can be removed very simply, leaving a tiny scar, if that, in most cases.

Skin cysts

The most common type of skin cyst is the sebaceous cyst also known as an epidermoid cyst or a wen.

You will probably first notice a small lump within the skin that might develop a hole, known medically as a punctum. The cyst can produce white foul smelling material, which isn’t pleasant.

As a cyst enlarges it can become very obvious and if it gets infected, the area around it can be very red and painful. Proper drainage of the infection and antibiotics are then required.

Cysts are best removed and only a small incision is used. There will be a small scar but this will be far less noticeable than the original cyst.

Moles

Moles can be pigmented (dark brown) or non-pigmented (skin coloured). Virtually everyone has at least one and many people have multiple moles. It is a good idea to keep an eye on moles and see your doctor if changes occur. Suspicious moles should always be checked as they can be cancerous.

Non-cancerous moles are simply fleshy lumps that grow slowly over many years. Usually moles on the face are removed for cosmetic reasons. Those on other parts of the body may need to go because they are rubbed by clothing.

All moles are checked to make sure they are not cancerous and, if removal is required, two main techniques are used:

• The mole is excised (cut out) creating a little scar.
• The mole is shaved repeatedly leaving a small graze-like wound that heals with very good cosmetic results.

These skin problems are not cancer, but they do have a strong tendency to become cancerous if they are ignored and not diagnosed or treated. Although relatively common in the UK, few people are really aware of them.

Actinic keratosis

Not many people have heard of a condition called actinic keratosis, but it affects about one in five fair skinned people over 60. It develops due to exposure to UV light and causes thickened patches of skin, which can turn cancerous over time.

It is important to get an accurate diagnosis and your GP will refer you to a specialist who can examine your skin and differentiate actinic keratosis from other skin conditions.

A range of treatments is available to prevent the skin becoming cancerous in the future. Mr Hodges can advise what is best in your case but therapy can involve creams and gels that you apply yourself, through photodynamic therapy, laser treatments and chemical peels, to surgery.

Bowen’s disease

This is another pre-cancerous skin condition that tends to affect older people but that is rarely talked about. It iss most common in women over 70 and it causes red, sometimes itchy patches, often on the legs, arms, abdomen or back. Left untreated it can develop into a form of skin cancer known as squamous cell carcinoma.

Getting an accurate diagnosis is important, as the symptoms of Bowen’s disease are very similar to other common skin conditions such as eczema or psoriasis.

Once a diagnosis has been made treatment involves a range of possible therapies to prevent the transition into cancer.