Skin Cancer

Skin cancer is the commonest diagnosed malignancy in Ireland each year; thankfully, most are localised problems which can be treated and cured by simple removal. Most will never spread beyond the original site but in some higher risk examples they can have that potential. Like most medical problems the earlier they are diagnosed and treated the better; for many skin cancers surgery is curative and surgically fixed and for some types early removal will reduce the risk of spread and give a better chance of a good outcome.

Skin cancers can occur all over the body, but the highest risk sites are in the more sun exposed areas such as the face, head, neck upper chest and limbs. International guidelines recommend that certain types be removed with a margin of normal skin to reduce the chance of leaving some cells behind and for it to come back later. The face, in particular, has several areas where the complete removal of a skin cancer is required such that the skin is replaced (reconstructed) by moving around adjacent skin (flap) or importing new skin from a little further away (skin graft). A decision is made between the surgeon and the patient about the type of anaesthetic that is most appropriate given the procedure and the patient’s medical status.

A full skin examination is an integral part of every consultation as frequently patients may be unaware of other issues than those they present with.

Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma (BCC) is the commonest form seen in Ireland. In its very earliest stage it may be appropriate to use a medicated cream; however, in most cases it is optimally managed with a simple surgical procedure to completely remove the lesion (all specimens are sent to the laboratory for analysis). Initially it can grow very slowly and will often be present for many months before a patient is seen by their doctor. Oftentimes it may be diagnosed by chance when being seen for another condition and sometimes patients will present with several at the same time. It is extremely rare that these cancers will ever spread.

Squamous Cell Carcinoma (SCC)

Squamous Cell Carcinoma (SCC) is the second commonest skin cancer encountered in Ireland. It is often more complicated as it can range from very mild forms when simple surgery is sufficient to more serious lesions that can be aggressive and have the potential to spread away from the original site. Laboratory results guide the surgical plan and any additional treatment that may be needed afterwards. SCC has a precancerous phase called “in-situ” or Bowen’s disease and a trial of non-surgical treatment may be appropriate.

Melanoma

Melanoma is a less common form of skin cancer than BCC and SCC but is frequently more serious. It is a cancer of the pigment forming cells of the skin and while it can occur in darker skinned individuals it is far more common in those with fair skin, blue eyes etc. It occurs more commonly in those with higher ultraviolet (UV) exposure from the sun or sunbeds. More so than the other skin cancers it can affect younger patients but the risk does increase with age.  

Early diagnosis and treatment is extremely important to remove the lesion completely and decide if other tests and treatment are needed based on those results. All melanomas are treated as part of a skin Multi-Disciplinary Team (MDT) that work together to ensure that patient care meets the highest standards and complies with agreed international guidelines. Even after the initial treatment has finished patients are kept under close follow-up for several years.

If you have any concern about a pigmented lesion / mole which is changing it is advisable to seek medical advice without delay.

Rare Malignancies

Rare malignancies include soft tissue sarcoma and adnexal tumours are treated with a multidisciplinary team approach