Ultraviolet light from the sun is the main cause of skin cancer. Skin cancer is becoming more common and there are several possible reasons for this. People are living longer and so their lifetime sun exposure is greater. They often have more time and money for outdoor recreation and holidays in sunny climates and many people still consider suntans to be healthy and attractive. It is likely that most skin damage from ultraviolet radiation occurs before the age of 20. It is thought that a build-up of overexposure to the sun over a period of several years can lead to the development of basal cell and squamous cell skin cancers.
Black- or brown-skinned people have a very low risk of developing skin cancer because the melanin pigment in their skin gives them protection. A fair-skinned person who tends to go red or freckle in the sun will be most at risk. Children and young adults who have been overexposed to the sun have an increased risk of developing some form of skin cancer. This will not show up until later on in life - usually after about age 40, and often not until the 60s or 70s.
Areas of skin that have been badly burned, or have long-term inflammation have an increased risk of squamous cell carcinoma.
Radiotherapy given to treat other conditions can sometimes cause skin cancers in the treatment area later in life.
People who have to take drugs which lower their immunity (immunosupressants) - for example, after a kidney transplant - are also at increased risk of getting skin cancer.
Other rare possible causes are overexposure to certain chemicals at work, including coal tar, soot, pitch, asphalt, creosotes, paraffin waxes, petroleum derivatives, hair dyes, cutting oils and arsenic. You should wear protective clothing if you are handling these substances frequently.
Some people with rare hereditary conditions have a higher risk of developing skin cancer. However, non-melanoma skin cancers are not caused by inherited faulty genes that can be passed on to other family members and so other members of your family are not at a higher risk of developing skin cancer.
What are the symptoms?
Both basal cell and squamous cell carcinomas can appear in a variety of forms.
Basal cell cancers can develop as a small lump on your skin which is smooth and pearly or waxy in appearance. It may bleed sometimes or develop a crust. It may begin to show signs of healing and yet never quite does. Instead, you may see a flat, red spot, which is scaly and crusty. Sometimes there is just a firm, red lump. Skin cancers are usually painless and grow slowly. They can appear anywhere on your body but are most likely to occur on exposed skin, especially your face.
Squamous cell carcinomas often have a scaly appearance. Sometimes they have a hard, horny cap and can feel tender to touch. They are also found on the face, bald scalps, arms, backs of hands and lower legs.
If you notice anything unusual on your skin which does not go away within a month, you should show it to your doctor. There are, however, many other conditions that may appear in the skin which are not cancer, particularly among older people. You may still wish to have these treated for cosmetic reasons.
Signs and symptoms of non-melanoma skin cancer:
Most likely to appear on face, neck or other exposed skin.
Small lump - smooth or waxy - may bleed - may develop a crust - may be itchy flat, red spot - scaly and crusty firm, red lump - painless, growing slowly lump with scaly or horny top.
How it is diagnosed?
Usually you begin by seeing your GP (family doctor), who will examine you and decide whether to refer you to a specialist for further tests and treatment. A specialist in skin diseases is called a dermatologist. Your treatment may be carried out by the dermatologist. Depending on the area of the body affected by the cancer and the type of treatment that is necessary you may be referred to a general surgeon, a plastic surgeon or a clinical oncologist (radiotherapy and chemotherapy specialist).
The specialist will be able to tell a great deal from a simple examination of the affected area of skin. However, it is not always possible to distinguish between skin cancers and benign conditions by examination alone. You may be advised to have a biopsy. This is a quick and simple procedure which can usually be done in the outpatient department using a local anesthetic. The doctor will remove all or part of the lump and send it to the laboratory for analysis under a microscope by a pathologist.
As basal cell carcinomas almost never spread, there will probably be no need for further tests as long as the cancer has been completely removed.
As squamous cell carcinomas may occasionally spread, your doctor may want to do one or two other tests as well as the physical examination and biopsy. This is to make sure that there is no need for further treatment. The tests are particularly important if you have had treatment for skin cancer before and it has come back (recurred). During the physical examination, the doctor will probably feel the lymph glands close to the cancer to see if any of them are enlarged. You will probably be asked to have a chest x-ray and possibly blood tests to assess your general health. If any other tests are necessary your doctor will discuss these with you.
Staging of skin cancers
Most people with basal cell cancers do not need to have tests to find the stage of the cancer, as it is very rare for them to spread beyond the initial area of skin. Tests will only be done if the cancer is very large.
Although it is rare for squamous cell cancers to spread, tests to find the stage are more likely to be done for these because in some people they may spread.
A commonly used staging system is outlined below:
Stage 0 is also called carcinoma in situ.
Carcinoma in situ means that cancer cells are present, but they are all contained in a small area in the top layer of skin (the epidermis) and have not started to spread or grow into deeper layers of skin. Squamous cell stage 0 is also called Bowen's disease. If it is not treated, it can develop into a squamous cell skin cancer. Cancer BACUP can send you information about Bowen's disease.
The cancer is less than 2cm across and has not spread.
The cancer is more than 2cm across and has not spread.
The cancer has spread into the tissues under the skin and possibly to nearby lymph nodes.
The cancer has spread to another part of the body. This very rarely occurs with squamous or basal cell cancers of the skin.