TYPES OF SKIN CANCERS
There are three types of common skin cancers and many other less common or rare skin cancers.
BASAL CELL CARCINOMA (BCC)
What is Basal Cell Carcinoma (BCC)?
Basal Cell Carcinoma (BCC) is the most common type of skin cancer accounting for 75% of all skin cancers. BCCs are also the least dangerous type of skin cancer and are usually very slow growing taking months to years to become apparent. It is not uncommon for patients to have these lesions which do not heal for a long time and blame them on a scratch, cut, insect bite or other cause when in fact they are not recognised as slow growing BCCs until they seek medical attention.
Who gets Basal Cell Carcinoma (BCC)?
Basal Cell Carcinoma are most common in fair skin individuals with a history of significant sun exposure or sunburns in the past. The sun exposure and significant sunburn could have occured decades ago when we were less aware of the dangers of UV radiation from sun exposure and sun protection was less commonly used.
Basal Cell Carcinoma occur more commonly in older males but can also occur in females and younger individuals. The majority of BCCs appear on the face and head and neck region, although they may also appear on other parts of the body.
An individual who has had a BCC in the past is at a higher risk of developing more BCCs in their lifetime. In general BCCs are not genetically inherited however there are are minority of people with rare inherited syndromes where BCCs can run in families such as Gorlin's syndrome where BCCs are common and start at a young age and can be associated with a number of other medical problems, however this is very rare.
What does Basal Cell Carcinoma (BCC) look like?
Basal cell carcinoma can be "distinct" or "indistinct" in appearance and can have many different surface features. The "distinct" varieties generally are pale, whitish or pink, raised, have fine surface blood vessels, may have a central dimple or pit. On rare occasions BCCs can also be dark or pigmented. They may also be ulcerated and bleed readily.
Other types of BCCs can be "indistinct" and appear scaly, flaky, red or pink and can flat and sometimes mistaken for a patch of eczema.
Basal cell carcinoma can range from a few millimetres in size to a few centimetres and in extreme cases can be very large weighing more than a kilogram.
What are the different types of Basal Cell Carcinoma (BCC) and how are they treated?
There are over 20 known histological subtypes of BCCs. The common types are:
Pearly white or pink in appearance, most commonly on the face, may have surface blood vessels and a central pit or depression and are generally well circumscribed (borders are easily seen with the naked eye). Nodular BCCs are usually curable with surgical excision and reconstruction and carry a very good prognosis for cure.
These are much less distinct lesions that may appear as red, pink or white scaly or waxy patches. They are often much larger than they may appear to the naked eye on the surface of the skin and even under magnification can be difficult to identify the true extent of the cancer. This subtype of BCC carries a worse prognosis and can be harder to clear. This subtype of BCCs can infiltrate to a much larger extent under the skin (growing tentacles that spread wider than what is seen on the surface). It also has a higher chance of invading into local nerves (perineural invasion) which may require special imaging tests in advanced situations and more complex surgery and possibly radiotherapy to treat the cancer.
In some cases we would recommend excision of the lesion and delaying the reconstruction particularly in cosmetically sensitive areas such as the face until the pathologist has tested the cancer specimen to comment on clearance of the cancer. In advanced cases it may take several planned attempts of excision and testing of the tissue to ensure clearance of the tumour before we perform a reconstruction to the area.
This type of BCC is a combination of basal cell and squamous cell cancer in one lesion. It can be of an infiltrating type (like morpheic) where the true extent of the cancer can be difficult to see on the surface and it can infiltrate to a larger extent under the skin. This subtype can be potentially much more aggressive than standard BCCs.
This subtype of BCC is less aggressive and does not necessarily need surgery to treat in the first instance. There are good non-surgical treatment options for this type of BCC. The lesion often appears flat, scaly or flaky and red to pink in colour and occurs more commonly on the neck and trunk region and can cover a larger or multiple areas.
A biopsy will confirm the subtype of BCC, whether it is an invasive (nodular or other type) vs a superficial BCC. When a superficial BCC diagnosis is made, it may be treated non-surgically by means of cryotherapy (luquid nitrogen or "dry ice" treatment), chemotherapy creams (Efudix or Picato) or immunotherapy (Aldara).
How is Basal Cell Carcinoma (BCC) diagnosed?
All skin lesions are generally diagnosed with a combination of clinical history of the lesion, appearance on examination of the lesion with magnifying instruments and sometimes a biopsy is necessary to confirm the type or presence of a skin cancer. Most common BCCs are diagnosed on the basis of history and appearance alone. In some cases we may recommend and perform a biopsy to confirm the suspicion and aid treatment (i.e. superfical type may be treated with creams and invasive types need surgery).
Is Basal Cell Carcinoma (BCC) dangerous and can it spread?
Basal Cell Carcinoma's (BCC's) very rarely spread to other parts of the body (metastasise) however if left untreated they can break the skin, bleed, form an ulcer and if left untreated will continue to invade surrounding and deeper structures such as cartilage particularly around the nose, ear and eyelids.
What is the prognosis (outlook) of BCCs?
Most basal cell carcinomas are curable when treated early with complete excision, particularly when they are small. They are very rarely a threat to life and it is extremely uncommon BCCs to metastasise or spread to other parts of the body.
Advanced or neglected BCCs in some parts of the body, particularly around the eye, ear or nose may invade into these structures compromising them and in extreme cases result in damage to the eye or removal of these organs. In such situations BCCs can invade into nerves (called perineural invasion) which may require more complex surgery and/or radiotherapy treatment.
SQUAMOUS CELL CARCINOMA (SCC)
What is Squamous Cell Carcinoma (SCC)?
Squamous Cell Carcinoma's (SCC's) are growths of abnormal squamous cells and are generally more aggressive than BCC's. Squamous Cell Carcinoma normally grows more rapidly than BCCs, over a period of weeks of few months rather than longer.
SCCs can spread along lymphatic vessels to lymph nodes/glands or other organs and distant parts of the body if not treated early.
Who gets Squamous Cell Carcinoma (SCC)?
Squamous cell cancers usually occur in fair skin people with significant or prolonged sun exposure. SCC's occur most commonly on areas of the skin which a frequently exposed to the sun such as face, ears, lower lip, head and neck region, forearms and back of the hand, and legs, although they can also occur in any other part of the body.
What does Squmous Cell Carcinoma (SCC) look like?
Squamous cell cancers may appear as a red, scaly or ulcerated lesion. It may be fleshy and large and often bleeds. Sometime it may appear like a sore that doesn't heal.
What are the different types of Squamous Cell Carcinoma (SCC) and how are they treated?
Squamous cell carcinoma is usually classifed as superficial or invasive. Superficial SCC, also known as "SCC in-situ" or Bowen's disease affects the top layer of the skin and can often be sucessfully treated with medical / non-surgical means such as chemotherapy or topical creams or superficial surgery. A biopsy is often required to make a diagnosis and ensure that the disease is truly only in the superficial layer.
Invasive SCC can be more aggressive and has potential to grow and spread to other organs via the bloodstream. Invasive SCC is "graded" by its degree of "differentiation". The biopsy report will usually describe the SCC as being well differentiated, moderately differentiated or poorly differentiated. This refers to how aggressive the SCC looks under the microscope and its potential to spread.
How is Squamous Cell Carcinoma (SCC) diagnosed?
The clinical history and appearance of the lesion usually allows a fairly accurate diagnosis of SCC, however a biopsy is often required to confirm the diagnosis.
Is Squamous Cell Carcinoma (SCC) dangerous and can is spread?
Squamous cell cancers are more dangerous or aggressive than BCCs and have potential to invade local tissues and have the ability to spread to other parts of the body if left untreated. Surgery is almost always required for SCC treatment and sometimes post-operative radiotherapy is also recommended in some situations. Early and complete surgical excision of SCCs can provide high cure rates from skin SCCs.
SCCs of the skin and mucosa (wet surfaces such as the lip or lining tissue) can behave differently. Lip and oral mucosa SCCs can behave more aggressively compared to some skin SCCs and treatment recommendations will be made based on the location, grade and type of SCC in each area.
What is the prognosis (outlook) of Squamous Cell Carcinoma (SCC)?
Squamous Cell Carcinoma's (SCC's) are growths of abnormal squamous cells and are slightly more aggressive than BCC's. Unfortunately even though they are slow growing, SCC's can invade local tissues or spread to other parts of the body including lymph nodes and other organs. Overall early and complete removal of SCCs can provide high cure rates. Some SCCs are more aggressive and require wider surgery and possibly radiotherapy after surgery, depending on the pathology findings from the time of surgical excision.
Melanoma is the most serious skin cancer and if not treated early, can spread to other parts of the body, becoming life threatening. About 85 out of 100 people diagnosed with a melanoma will survive however, if it is detected and removed in the early stages.
About half of melanomas start off in a mole that has been present for years. It is important for this reason to have regular checks (by yourself and your GP) to look for any changes to longstanding moles and for appearance of new moles. Benign moles are usually symmetric in a round or oval shape, raised or flat and are tan/brown in colour.
If you notice any changes in moles such as a change in colour, increase in size or irregular shape, then you need to seek a medical examination from your GP or specialist.