Overview
Skin cancer is the most common cancer in the UK. There are three main types: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. BCC and SCC are collectively called non-melanoma skin cancers and are usually curable. Melanoma arises from melanocytes, grows faster, and is far more likely to spread if not detected early.
How common is it?
Over 150,000 cases of non-melanoma skin cancer and approximately 17,000 cases of melanoma are diagnosed in the UK each year. Melanoma incidence has quadrupled in the UK over the past 30 years.
Causes and risk factors
UV radiation from sunlight and sunbeds damages DNA in skin cells, causing mutations that drive uncontrolled cell growth. Cumulative UV exposure is the most important risk factor for all skin cancer types.
Common risk factors
- UV light exposure (sun and sunbeds)
- Fair skin, light hair, and blue eyes
- Multiple moles or atypical moles (dysplastic naevi)
- Family history of melanoma
- Personal history of skin cancer
- Immunosuppression (organ transplant recipients have 100-fold increased SCC risk)
- Chronic skin conditions and scarring
- Chemical exposure (arsenic)
Symptoms
- BCC: pearly, translucent bump or nodule, often with visible blood vessels, on sun-exposed skin
- SCC: firm red nodule or scaly flat lesion that may crust or bleed, on sun-exposed areas
- Melanoma: follows ABCDE rule: Asymmetry, irregular Border, multiple Colours, Diameter over 6mm, Evolution (change in size, shape, colour, bleeding)
- Any new, changing, or unusual skin lesion should be assessed
When to see a doctor
See a GP urgently (within 2 weeks) for any changing mole, a new pigmented lesion, a non-healing sore, or any skin change that does not resolve in 4 to 6 weeks.
Diagnosis
Clinical assessment using dermoscopy. Excision biopsy of suspicious lesions for histological confirmation. Sentinel lymph node biopsy for melanoma over 1mm thick. CT or PET-CT staging for melanoma. FISH and comparative genomic hybridisation for molecular characterisation.
Treatments
Surgical excision
First-line treatment for most skin cancers. BCC: excision with 4mm margin. SCC: excision with 4 to 6mm margin. Melanoma: wide local excision with margin determined by Breslow depth. Mohs surgery for high-risk BCC and SCC in cosmetically sensitive areas.
Radiotherapy
Alternative to surgery for BCC and SCC in patients unfit for surgery or in certain anatomical locations. Also used adjuvantly for high-risk SCC and for palliation of metastatic melanoma.
Immunotherapy for advanced melanoma
Anti-PD-1 (pembrolizumab, nivolumab) and CTLA-4 (ipilimumab) checkpoint inhibitors have transformed advanced melanoma treatment, producing long-term survival in 30 to 40% of patients with metastatic disease.
BRAF/MEK targeted therapy
Vemurafenib or dabrafenib combined with trametinib (BRAF+MEK inhibition) for BRAF V600-mutated melanoma. Rapid responses but resistance commonly develops within 12 months.
Topical treatment for BCC
Imiquimod cream (immune modifier) or 5-fluorouracil cream for superficial BCCs in selected patients. Also photodynamic therapy for superficial lesions.
Self-care and lifestyle
- Apply SPF 30 or higher broad-spectrum sunscreen every day on exposed skin, reapplying every 2 hours
- Wear protective clothing, wide-brimmed hats, and UV-blocking sunglasses
- Avoid peak sun hours between 11am and 3pm
- Never use sunbeds — they significantly increase melanoma risk
Prevention
Sun protection from early childhood is the most important lifelong prevention. Sunbeds are responsible for a significant proportion of melanomas in young adults. Check your skin regularly and report changes promptly.