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How to manage non-melanoma skin cancer and pre-cancerous skin changes
Chronic sun damage over many years and localised sun damaged skin (actinic keratoses) are forms of skin damage that dermatologists at Clinica London are highly skilled in treating. This is particularly the case as there is a risk of progression within these areas of sun damage to other deeper forms known as non-melanoma skin cancers (NMSC).
Types of skin Cancer
Firstly, there are two main categories of skin cancer: melanoma and non-melanoma. Non melanoma cancers (NMSC) comprise mainly of basal cell carcinomas (BCC) and squamous cell carcinoma (SCC) and are far less dangerous than melanoma skin cancer, known as malignant melanoma.
Basal cell carcinomas make up 80% of all skin cancers in the UK. They are sometimes referred to as rodent ulcers as they are very much locally growing and do not spread anywhere else.
Causes of Basal Cell Carcinomas and Squamous Cell Carcinoma
The most common cause of BCC and SCC are exposure to ultraviolet radiation (UVR) and these lesions are commonly seen on areas that are exposed to the sun such as your face, head, neck and ears. They can also arise on the eyelids, especially at the corner towards the side of the nose. BCC are not infectious.
What do Basal Cell Carcinomas look like?
BCCs can vary greatly in appearance but dermatologists often first become aware of them as a scab that bleeds and does not heal completely or a new lump on the skin. Others form a lump and have a pearl like rim surrounding a central crater and there may be small red blood vessels across the surface. If left untreated, BCCs can eventually cause an ulcer, hence the name rodent ulcer. Most BCCs are painless although sometimes they can be itchy or bleed if they get caught.
What do Squamous Cell Carcinoma look like?
SCCs can vary in their appearance, but most usually appear as a scaly or crusty raised area of skin with a red, inflamed base. SCCs can be sore or tender and they can bleed but this is not always the case. Ultraviolet light damage can cause SCC directly, or sometimes it can induce a scaly area called actinic keratosis or Bowen’s disease. These can change into SCC if left untreated.
Who is at risk of Basal Cell Carcinomas and Squamous Cell Carcinoma ?
- Generally,in fair skinned adults, those who burn easily and rarely tan (generally light coloured or red hair although some may have dark hair but still have fair skin)
- Those who have had a lotof exposure to the sun such as people with outdoor hobbies or outdoor workers and people who have lived in sunny climates
- People who have used sunbeds or have regularly sunbathed
How will my Basal Cell Carcinomas/ Squamous Cell Carcinoma be diagnosed?
Not all scaly, rough areas are worrisome. Dermatologists at Clinica have been trained extensively to understand the skin and can review all your skin concerns and expertly access its health.
How will Basal Cell Carcinomas/ Squamous Cell Carcinoma be treated?
There are several successful treatments. At Clinica, our dermatologists normally treat BCC depending on the subtype, either with strong creams (5-Flurouracil, Imiquimod), liquid nitrogen (at -70C) or surgery to remove the top layers of the affected skin under local anaesthetic and stitching the normal skin back together. Sometimes we scrape the BCC away and seal the skin by heat, again under local anaesthetic.
Other services include Mohs’ micrographic surgery and radiotherapy. If the BCC is on the eyelids or close to them, oculoplastics at Clinica (Ms Jane Olver and Ms Tessa Fayers) are actively involved in removing the tumour and the eyelid reconstruction.
For SCC, surgery is recommended, which can be performed in-house and which may need further treatments on discussion.
Skin Self-care Tips
Here are some important sun safety tips:
- Examining your skin on an intermittent basis.
- Protect your skin with clothingand do not forget to wear a hat that protects your face, neck and ears, and a pair of UV protective sunglasses.
- Spend time in the shadewhen it’s sunny, between 11am and 3pm.
- When choosinga sunscreen, look for a high SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA. Apply plenty of sunscreen 15-30 minutes before going out in the sun and reapply every 2 hours, as well as straight after swimming and towel-drying. Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.
We recommend visiting Clinica London when there is any growing, tender, firm, skin-coloured nodule, sometimes with adherent surface scale, crust, or central ulceration (see pictures below).
See our prices for consultations.
Basal cell carcinoma
Actinic damage /early superficial BCC
KERATOACANTHOMA *may form Squamous cell carcinoma (SCC)