Diagnosis and treatment planning

What are the different types of skin cancer?

There are many different types of skin cancer, but the main ones are:

• Basal cell carcinomas (BCCs): also called rodent ulcers, these are slow-growing and typically invade locally rather than spreading around the body (metastases).
• Squamous cell carcinoma (SCC): these can spread to the lymph nodes and/or distant sites around the body and are typically faster growing and more aggressive, requiring urgent treatment.
• Melanoma: a malignant tumour of melanocytes, the cells responsible for pigmentation, these are typically pigmented and can be aggressive with early spread. They may require adjunctive measures such as sentinel lymph node biopsy (SLNB) in which a biopsy of key lymph nodes is taken from nearby under guidance to assess for the possibility of early metastases.

Rarer tumour types include Merkel cell carcinoma (MCC), atypical fibroxanthomas (AFX), dermatofibrosarcoma protuberans (DFSP) among others.

How is my skin cancer diagnosed?

As a Fellowship-trained skin cancer surgeon, I have seen and treated thousands of skin cancers and spent time with leading dermatologists, perfecting my diagnostic skills. In the first instance, I will examine your lesion and look for characteristic features in the appearance and behaviour to help me to reach a diagnosis. This is usually supplemented with dermoscopy, examining the lesion with a particular type of magnification to further improve the diagnostic accuracy.

If there is uncertainty regarding the diagnosis, or we are considering alternative treatment options besides conventional surgical excision, I may recommend that you have an incisional or punch biopsy. This involves taking a small representative sample of the lesion away for analysis. This is sent to the laboratory for examination under a microscope with special staining as required to give us a definitive diagnosis that can more accurately guide the right treatment. In many instances however, I will suggest that we proceed directly to a wide local excision of your lesion and reconstruction as appropriate, achieving both diagnosis and treatment in a single sitting.

What are the possible treatment options?

There is a plethora of techniques used in the management of skin cancer including (but not limited to):

• cryotherapy: this involves freezing a skin lesion, aiming to ablate it with cycles of intense cold and thawing e.g. with liquid nitrogen
• topical chemotherapy: this involves applying creams that contain agents that destroy the cancer cells e.g. 5-fluorouracil
• curettage & cautery: this involves scraping the lesion and burning the base in cycles
• electrochemotherapy: a chemotherapeutic drug is administered intravenously and cycles of electric current are administered to the lesion to enable “electroporation” and selective uptake of the drug, maximising local effect
• radiotherapy: under the direction of an oncologist, the tumour is irradiated either as primary treatment or as an adjunct to surgery
• chemotherapy: cytotoxic drugs may be given in cancers that have metastasised (spread) and/or are locally aggressive
• immunotherapy and targeted therapy: these are more advanced chemotherapy options that are used in metastatic and/or locally aggressive tumours and are tailored towards the genetic profile of your tumour

In 2018 I undertook a Training Interface Group (TIG) Fellowship in the Management of Skin Cancer at Leeds Teaching Hospitals NHS Trust, one of only two units in the United Kingdom to offer the placement. This enabled me to be part of a leading Specialist Skin Cancer MDT (SSMDT) working alongside specialists in Plastic and Reconstructive Surgery, Dermatology and Clinical Oncology. As such, I understand that there is no “one size fits all” approach and try to make sure I see the whole patient and not just the skin cancer to decide on the right treatment.