Skin Cancers and Melanomas

There are two categories, non-melanoma skin cancer and melanoma.

The term 'non-melanoma' refers to basal cell cancers and squamous cell cancer. In the UK alone there are more than 100,000 new cases of non-melanoma skin cancer diagnosed each year.

Basal Cell Cancer (BCC) – a BCC starts in the basal layer, the lowest layer of the epidermis and is the most common type of skin cancer, accounting for 75% of all cases

• BCC usually appears as a small, pinkish or pearly white lump with tiny surface blood vessels
• It also can appear as a red, dry/scaly patch of skin
• There may be brown or black spots/pigmentation within the patch
• The lump grows slowly, becoming bigger and may begin to crust over and bleed
• It can also develop into a non-healing ulcer

Squamous Cell Cancer (SCC) – SCC starts in the upper layers of the epidermis and is the second most common form, accounting for 25% of all cases

• SCC usually appears as a firm pink lump with a crusted surface
• There may be a spiky horn protruding from the top
• There may be surface scale and rough patches on the lump
• It will be tender to the touch, bleeding easily
• It may develop into an ulcer

Melanoma is the least common form of skin cancer, with less than 15,000 cases diagnosed each year, but it is the deadliest. It can develop anywhere on the body but most commonly on areas of the body that have been overexposed to the sun.

There are several types of melanomas, including:

• Superficial Spreading Melanomas – these account for around 80% of all reported cases of melanoma in the UK. They are moles that spread radially and often have an irregular edge. In the radial growth phase, they usually remain confined to the skin and have not spread, but if they begin to grow deeper they can then metastasise to other parts of the body. If you have a mole with an irregular edge, get it examined by a doctor.
• Lentigo Maligna Melanomas – these account for around 10% of all reported cases of melanoma in the UK. They often begin looking like a freckle on the face of the elderly and enlarge slowly. If they start to grow downwards and become nodular or change shape or pigmentation it is likely that melanoma has developed.
• Acral Lentiginous Melanoma – these are a rare type of melanoma, accounting for only 5% of all reported cases. They occur on the palms of hands, the soles of feet or around a finger/toenail.
• Amelanotic Melanoma – these are another rare type of melanoma, accounting for only 5% of all reported cases in the UK. They may have little or no colour or may be pink or greyish spots on the skin.

Skin cancer is the most common form of cancer in the UK. Roughly 115,000 new cases of skin cancer are diagnosed each year, of which around 15,000 are melanomas.

Incidence rates have increased materially in the past decades, but skin cancer cases have doubled since the 1990s. More than 25% of new cases are in people aged 75 and over.

Some people are at a higher risk of contracting skin cancer, including people with pale skin that burns easily, people with lots of moles or freckles and people with a close family member who has had melanoma. However it is important to know that people of colour can also get skin cancer. Often skin cancer in Black people is not diagnosed until its later stages, meaning it is more difficult to treat.

Skin cancer kills more than 2,500 people each year - that’s seven people every day.

Melanoma is the most dangerous form of skin cancer because of its ability to spread to other organs more rapidly if it is not treated at an early stage.

All skin cancers can be easily treated if caught in the early stages. With early detection, survival rates are high. 9 in 10 people diagnosed with melanoma survive their disease for more than ten years. The earlier the skin cancer is detected, the better the survival rate, so regular mole checks are essential.

Melanoma is caused when skin cells, or melanocytes, begin to grow abnormally. The single most preventable cause is too much exposure to ultraviolet radiation (UVR) from sunlight and there is also evidence that the use of sunbeds can cause skin cancer.

There are certain people who have a predisposition to skin cancer or are more at risk:

+ People who burn easily in the sun
+ People with past episodes of sunburn, often with blister formation and often in childhood
+ People with many moles (more than 50)
+ People who have first-degree family members who have melanomas
+ People with a weakened immune system due to diseases (e.g. HIV), or those on drugs that suppress the immune system (e.g. organ transplant patients)

Melanomas may develop as either a new mole or occur as changes in a pre-existing mole. It is the fifth most common form of skin cancer in the UK, with approximately 13,000 cases being reported each year.

More than a quarter of those cases are in people under 50 years old, which is quite young in comparison to other cancers. More than 2000 people in the UK die every year from melanoma.

There are many ways that you can reduce your risk of skin cancer.

• Limit your exposure to UV radiation
• Use broad-spectrum sunblock when exposed to the sun. Broad spectrum will help protect against both UVA and UVB rays
• Use a minimum of SPF 30 in your sunblock, ensure the UVA protection is adequate as denoted by UVA and apply thickly and frequently
• Avoid the use of sunbeds (Using sunbeds for the first time below the age of 35 increases the risk of developing melanoma by nearly 60%
• Perform a monthly skin self-examination looking for ABCDE of moles

ABCDE Checklist for suspicious features:

• Asymmetry: Moles that are an irregular shape and have two different halves.
• Border: Moles with a ragged border.
• Colours: Moles that have a mix of two or more colours.
• Diameter: Moles that are larger than 6mm (1/4 inch) diameter.
• Evolution: A mole which has changed in size or shape over time.

When performing your monthly skin checks ensure you are doing it after a bath or shower, in a well-lit room, with the aid of a full-length mirror looking for any changes in moles thoroughly.

You can also self-assess yourself for risk of melanoma. The Melanoma Risk Factor Assessment checklist can tell you if you would benefit from a mole check by a dermatologist, or from more regular self-examinations.

The Melanoma Risk Factor Assessment:

• Have you ever been sunburnt badly?
• Does your skin burn first and then tan? Do you tan at all?
• Do you have any outdoor hobbies?
• Have you ever used sunbeds?
• Have you ever lived anywhere abroad that was very hot/sunny?
• Have you ever had a job where you worked outdoors?
• Has anyone in your family ever had melanoma?
• Do you wear sunblock when exposed to the sun?

If you notice any changes to a mole or a patch of skin, it is important to seek the advice of your GP or a dermatologist as soon as possible. If your regular GP has any concerns about the changes in your moles, they will refer you to a consultant dermatologist for further examination.

A dermatologist will perform a full skin examination to check all of your moles. If the dermatologist has any concerns about any unusual moles or patches of skin, they will either go on to remove (excise) the mole or take a sample of a suspicious patch of skin (biopsy) to send in for analysis.

It is important to note that not all changes to moles are the results of skin cancer. It is normal for moles to change in size, number or appearance over time, even some disappearing entirely. Hormonal changes, like those that occur with puberty or pregnancy, can also cause moles to increase in number or to become darker.

Finding skin cancer early saves lives because we are able to stop the metastasis, or spreading, of cancer to other organs or parts of the body. Skin cancer that is detected early is almost always curable.

If caught late, there is a higher chance that it has already spread through the body and affecting other organs. Thin melanomas, less than 1mm, have a 95% 5-year survival rate whereas thick melanomas, more than 4mm, have a 15-20% 5-year survival rate. Recent advances in treatment with immunotherapy have however improved these survival rates.

Performing a self-examination is key to detecting change. You can easily check yourself regularly for new growths or irregular moles - follow the ABCDE mole mapping guide.

If you spot a mole which has changed in size, shape, colour or appearance, you have developed a new mole or lesion or you have found something that just doesn’t look right, you should speak to your GP or dermatologist immediately. You should not wait as certain types of skin cancer can spread rapidly. Early intervention can save lives.

At the Cadogan Clinic, if we discover a cancerous mole, we can remove it straight away at our award-winning Chelsea clinic. Book an appointment with one of our world-class skin cancer specialists today to discuss the options open to you.

The Cadogan Clinic accepts both GP referrals and self-referrals (i.e. enquiries from patients directly).

We offer a variety of techniques to remove skin cancer, ranging from traditional surgical removal to the very latest and advanced 'Mohs' surgery.

In each case, procedures typically take less than half an hour and are quick, pain-free surgical treatments that take place under local anaesthetic.

Mohs surgery is the most advanced technique in removing and treating skin cancer. This surgery is performed by removing thin layers of cancerous skin progressively and examining each layer until only cancer-free skin tissue is left.

We aim to remove as much of the cancer tissues as possible without damaging the remaining healthy tissue. Mohs Surgery allows us to verify that all cancer cells have been removed, increasing the outcome of a cure while reducing the need for another surgery or treatment.

In the past, this type of skin removal surgery was performed by a doctor creating an excision of the cancer tissues, and at the same time removing the surrounding healthy skin. Now with Mohs surgery, there is much less damaging to the surrounding healthy skin, and there are better results.

Mohs surgery is an excellent treatment for skin cancers that have a risk of recurrence, are in more sensitive areas such as the eyes, nose, ears and genitals, or for more aggressive forms of skin cancers, melanomas and carcinomas.

One of the benefits of Mohs surgery is that you most likely won't leave your appointment until all the skin cancer is removed. You will know your results right away, as the doctor will be checking every layer of tissue as they're removed. This is performed as an outpatient procedure, and you will be able to head home the same day knowing that all cancerous cells have been removed.

Mole removal with one our specialist surgical team starts from £599.

There are many ways that you can reduce your risk of skin cancer.

• Limit your exposure to UV radiation
• Use broad-spectrum sunblock when exposed to the sun. Broad spectrum will help protect against both UVA and UVB rays
• Use a minimum of SPF 30 in your sunblock, ensure the UVA protection is adequate as denoted by UVA and apply thickly and frequently
• Avoid the use of sunbeds (Using sunbeds for the first time below the age of 35 increases the risk of developing melanoma by nearly 60%
• Perform a monthly skin self-examination looking for ABCDE of moles

ABCDE Checklist for suspicious features:

• Asymmetry: Moles that are an irregular shape and have two different halves.
• Border: Moles with a ragged border.
• Colours: Moles that have a mix of two or more colours.
• Diameter: Moles that are larger than 6mm (1/4 inch) diameter.
• Evolution: A mole which has changed in size or shape over time.

When performing your monthly skin checks ensure you are doing it after a bath or shower, in a well-lit room, with the aid of a full-length mirror looking for any changes in moles thoroughly.

You can also self-assess yourself for risk of melanoma. The Melanoma Risk Factor Assessment checklist can tell you if you would benefit from a mole check by a dermatologist, or from more regular self-examinations.

The Melanoma Risk Factor Assessment:

• Have you ever been sunburnt badly?
• Does your skin burn first and then tan? Do you tan at all?
• Do you have any outdoor hobbies?
• Have you ever used sunbeds?
• Have you ever lived anywhere abroad that was very hot/sunny?
• Have you ever had a job where you worked outdoors?
• Has anyone in your family ever had melanoma?
• Do you wear sunblock when exposed to the sun?

If you notice any changes to a mole or a patch of skin, it is important to seek the advice of your GP or a dermatologist as soon as possible. If your regular GP has any concerns about the changes in your moles, they will refer you to a consultant dermatologist for further examination.

A dermatologist will perform a full skin examination to check all of your moles. If the dermatologist has any concerns about any unusual moles or patches of skin, they will either go on to remove (excise) the mole or take a sample of a suspicious patch of skin (biopsy) to send in for analysis.

It is important to note that not all changes to moles are the results of skin cancer. It is normal for moles to change in size, number or appearance over time, even some disappearing entirely. Hormonal changes, like those that occur with puberty or pregnancy, can also cause moles to increase in number or to become darker. 

Bleeding or itchy moles can occur when they have been irritated or scratched – moles catching on clothing, being cut by a razor, makeup application, scratching an insect bite and hair removal are all very common triggers. However, these are also sign that the mole is cancerous.

There are definite signs that a mole could be a melanoma and individuals should seek immediate advice from a dermatologist. If you have a new mole or a change in your moles such as bleeding, changes in shape, size or colour, itchy or painful moles- it's imperative that you seek medical advice at the earliest possible stage.

Patients should be vigilant in having moles checked annually or as advised by your dermatologist if you have a history of previously abnormal naevi (moles) or skin cancer. An early diagnosis is crucial in managing this potentially life-threatening disease; skin cancer which is detected and removed early is almost always curable.

The whole process typically takes less than half an hour, although this can be much longer for rarer, more complex cases.

Moles are usually removed under local anaesthetic. After careful examination, the area around the mole will be cleaned and a surgical drape placed around the area to ensure a sterile working area.

Your surgeon will cut all the way around the mole, typically in an oval shape. The mole(s) will be placed in a specimen jar and sent to a lab for analysis. Your surgeon will close the wound with stitches, if required, and cover it with a dressing.

You will be able to go home after your procedure and return to work. It is unusual for such a minor procedure to impact your usual activities.

If you experience any pain following your mole removal, over the counter pain relief such as Paracetamol can be used.
Results of the analysis will be shared with you by our team within 24 hours.

Sometimes your surgeon will ask you to return a few days following your mole removal to inspect the wound and change the dressing. If the wound area becomes red, swollen or bleeds be sure to contact our 24 hour on-call nursing service.

You may also be required to visit our nursing team at a later date to have your stitches removed.

The NHS no longer delivers "non-essential" mole treatments, meaning that the majority of mole removal procedures, or the removal of skin 'lumps and bumps' (e.g. warts, verrucae and skin tags), can no longer be administered for free on the NHS.

A mole that is believed to be life-threatening or cancerous can be removed on the NHS, however.

We recommend that all patients establish the exact length of the expected waiting list with your local NHS Trust. These are unfortunately currently subject to significant delays (e.g. several months or longer), due to the disruption caused by the COVID crisis.