Skin Cancer

INTRODUCTION

The three main skin cancers are the non-melanocyctic skin cancers (basal cell carcinoma—BCC; squamous cell carcinoma—SCC) and melanoma. The approximate relative incidence is BCCs 80%, SCCs 15–20% and melanomas <5%. About 80% of skin cancer deaths are due to melanoma and the rest mainly due to SCC.

Types

• Basal cell carcinoma (BCC)

• Squamous cell carcinoma (SCC)

• Bowen disease

• Malignant melanoma

• Kaposi sarcoma

• Secondary tumour (lung, bowel, melanoma)

BASAL CELL CARCINOMA

• Mostly on sun-exposed areas: face (mainly), neck, upper trunk, limbs (10%)

• May ulcerate easily = ‘rodent ulcer’

• Slow-growing over years

• Has various forms: nodular, pigmented, ulcerated, etc.

• Can spread deeply if around nose or ear

Management

• Simple elliptical excision (3 mm margin) is best

• If not excision, do biopsy before other treatment

• Radiotherapy, photodynamic therapy and imiquimod are options

SQUAMOUS CELL CARCINOMA

Tends to arise in premalignant conditions, such as solar keratoses, burns, chronic ulcers, leukoplakia and Bowen disease, or it can arise de novo.

SCCs of ear, lip, oral cavity, tongue and genitalia are serious and need special management.

Management

• Early excision of tumours <1 cm with 3–5 mm margin

• Referral for specialised surgery and/or radiotherapy if large, in difficult site or lymphadenopathy

• Surgery is the treatment of choice for most tumours, not cryotherapy, imiquimod or curettage

BOWEN DISEASE (INTRADERMAL CARCINOMA)

This is SCC in situ of the skin.

Management

• Biopsy first for diagnosis

• Wide surgical excision if small

• Skin grafting may be required

Note: Biopsy a single patch of suspected psoriasis or dermatitis not responding to topical steroids.

Malignant melanoma

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