How to spot skin cancer and how to treat it

Skin cancer is a scary prospect. The same sun that provides the warmth, light and energy needed for life can damage our skin cells, turning them against us in a potentially lethal way. However, if it is spotted early, skin cancer can be relatively easy to treat, and even for more advanced skin cancers, there is hope. We talked to expert dermatologist Dr Saqib Bashir, who explained what skin cancer looks like and how it can be treated.

What does skin cancer look like?

Skin cancer can have a variety of different appearances. This is because there are different types of skin cancer and many parts of the skin can be affected by the sun’s rays. Depending on the patient, skin cancer might present with:

• A mole or a freckle that is changing in size, shape or color over a period of weeks or months.
• A flesh-coloured lump that is growing rapidly over a period of weeks. Sometimes, these may bleed or crust,
• An area of skin that seems to scab up and heal again and this may repeat over and over.

Those are the three main appearances of skin cancer.

Different types of skin cancer

• Basal cell carcinoma – the most common type of skin cancer we see and the most common cancer of all. This is often seen as a shiny, pearly growth, which may bleed or crust, often on sun-exposed areas of the skin like the face, upper body and scalp.
• Squamous cell carcinoma is a little more aggressive than basal cell carcinoma and can appear as a fast-growing lump, which may have some dead, dry skin on the top.
• Malignant melanoma - less common, but well-known because it has a potential to spread. It may arise appearing like a freckle or mole that is changed and gone dark or red or has started to bleed or crust.

How does skin cancer affect the body?

The different types of skin cancer can affect the body in different ways.

The most common type – basal cell carcinoma – does not really affect the body other than the skin and structures that it is lying on. For example, if the basal cell carcinoma is on your abdomen, only the skin of the abdomen in that particular area will be affected. In other areas which are more cosmetically important, such as the eyelids, the ears, the nose, or the lips, the basal cell carcinoma can burrow in a bit deeper into the structures underneath. However, it’s very unusual – in fact, very rare – for a basal cell carcinoma to spread in the body or to affect the body in other ways.

In contrast to this, the other two common types of skin cancer—squamous cell carcinoma and malignant melanoma—do have the ability to affect other parts of the body and spread remotely. Therefore, there’s more urgency in their treatment and they’re taken a bit more seriously for that reason.

What options are there for skin cancer treatment?

There are a variety of options for skin cancer treatment, depending on exactly which skin cancer we’re dealing with and at what stage it’s diagnosed.

The earliest stages of skin cancer are relatively easy to treat; sometimes with cream, sometimes simply scraping off the area and cauterizing it. When the cancer is more advanced than this, we can do local surgery under local anaesthetic, perhaps with some stitches to the skin in the area affected.

Should things become more advanced than that, there are still other options, for example, radiotherapy or options such as chemotherapy or immunotherapy, in which the treatment is administered to the whole body.

What is Mohs surgery?

Mohs surgery is a specialised form of skin cancer surgery performed by a dermatologist specially trained in the technique. The skin cancer is cut out under local anaesthetic with the patient still awake, but the idea is to keep a very small hole. The skin cancer can be analysed almost immediately after it’s been removed, and, should there be any left behind, a small area can be cut again just to make sure it’s all gone. The idea is that we keep testing and cutting until the entire skin cancer is removed.

The advantage is we can keep the surgical hole no bigger than it needs to be, hopefully just matching the size of the growth itself. The other great advantage of this technique is we have a high degree of assurance that skin cancer has been completely removed. This clearance can reach as high as 99% and therefore, Mohs surgery remains the best technique for removing many types of skin cancer.