Stafford Skincare
providing specialist dermatology care
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News
Click on the topics below to get more news and information on skincare issues.
Skin Cancer - a simple guide to keeping safe in the sun and checking your own moles.
Skin cancer
There are 3 main types of skin cancer – the most serious is melanoma skin cancer. Below are a few suggestions to help keep you safe in the sunshine or to diagnose melanoma skin cancer. The information has been modified from advice given by the British Association of Dermatologists and Cancer Research UK. Links to their websites for full information can be found on the links page.
Keeping safe in the sunshine – Remember the SunSmart Code:
Spend time in the shade between 11 a.m. and 3 p.m.
Make sure you never burn
Aim to cover up with a hat, T-shirt and glasses
Remember to take extra care with children
Then use factor 15 (or more) sunscreen
Follow the ABCDE rule to check out your moles – if you notice any of the signs below report it to your GP:Asymmetry – the 2 halves of the “mole” may look different in shape
Border – the edges of the “mole” may be blurred or irregular, sometimes the border is notched
Colour – may be uneven with different shades of brown, black & pink
Diameter – most melanomas are bigger than 6mm diameter
Expert – your GP will refer you to a Consultant Dermatologist if he is concerned about your skin
Even if you don’t notice any of the above changes in your moles, always report a NEW mole to your GP or if you have a mole that is:
• Getting bigger
• Changing shape
• Changing colour
• Is itchy or painful
• Bleeds or is becoming crusty
• Looks inflamedBasal Cell Carcinoma
Basal Cell Carcinoma [BCC] is sometimes called a 'Rodent ulcer' and is the most common form of skin cancer. If detected and treated early, most BCC's are 100% curable. Every year BCC affects over 10,000 people in the West Midlands alone.
BCC is very slow growing and, unlike many other cancers, does not spread to other parts of the body. However, if no treatment is given it will slowly destroy the skin and the area just beneath.
It can appear as an open sore or ulcer, which may bleed or form a crust, but will not heal or disappear within 2 - 3 months.
Most skin cancers begin with quite a small change on the skin. BCC is no different but not all the changes look alike. BCC can look like a flat red patch that is rough, dry or scaly. Or it can look like a small, smooth shiny waxy lump, which may eventually crust over and bleed.
BCC can be found anywhere on the body, but are most likely on areas of skin exposed to the sun like your face, head and neck.
BCC can affect any adult but people tend to be aged over 50 years, but more people in their 30's and 40's are developing this form of skin cancer.
Treatment:Once a doctor has decided that an area of skin is abnormal, some or all of it will be removed to be examined under a microscope. The procedure is usually carried out under a local anaesthetic with you awake, at the day case unit or at the out patient clinic. This may be all the treatment you will need.
If the doctor feels other treatment is needed the different treatments available will be discussed with you. The type of treatment will depend on many things such as the size of the affected area and where it is, how old you are, what your general health is like, and whether you have had a BCC before. The treatments which the doctor might discuss with you include:
Surgery: Treatment of BCC normally involves some surgery. Small lumps can be cut from the skin quickly and easily. Other, larger areas may need surgery that is more complicated. In these cases an inpatient stay is required.
Radiotherapy: BCC responds well to radiotherapy. Radiotherapy is a type of xray that is painless and takes only a few minutes. The treatment will normally be given at North Staffs Royal Infirmary or New Cross Hospital and often one visit is enough to destroy all of the cancer cells.
Creams: Sometimes special creams may be used which interfere with the growth of abnormal cells. These creams will normally be used for 3 - 4 weeks. Please read the information leaflet supplied with the cream before use.Photodynamic Therapy: This a treatment where cream is put onto the skin cancer and left under cover for six hours to be absorbed by the abnormal cells. A beam of intense light (not laser) is then directed on the lesion for twenty minutes to destroy the cancer cells. This does not destroy normal cells.
Your doctor will discuss all treatments fully with you and help you decide which is the best treatment for you. If you are unsure or have any questions, ask the doctor or a member of the nursing staff who will be pleased to help you.After treatment for Basal Cell Carcinoma the number of times you will need to visit the Hospital will depend on the treatment you have received, but once your treatment for BCC is complete, you will be seen at an outpatient clinic to finally check the treated area. At this visit you will be given advice on how to keep your skin healthy and what to look for if the condition returns. As most BCCs are curable if treated in time, we would expect this to be your last visit to us.
In some cases, a further appointment approximately six months later may be advised. At this visit to the clinic, we will check that all is still well.
Because you have had BCC, we know that you have sun sensitive skin. Please help yourself by:
• Examining the treated area every 4 - 6 weeks to check that the BCC has not returned. This is very unlikely to happen but it is best to check.• Check the rest of your body for any changes to your skin or new growths - especially in areas exposed to the sun.
• Protect your skin from the sun. This is even more important now that you have been treated for skin cancer.
Remember: If you are worried about new lumps or skin ulcers, see your GP. This is especially important if you have had an open sore or ulcer for over two months that does not heal, is bleeding or is getting bigger.
Bowen’s disease
This is a skin growth confined to the outer layer of the skin. It usually appears as a slowly growing red and scaly patch, on the lower legs, most often in women; about a fifth of women with this disorder have more than one patch. It is thought partly to develop as a result of long term sun exposure. Bowen's disease is not infectious, and often causes no symptoms although the surface crusting may catch on clothing.
The patches grow very slowly and, while they can be a nuisance they do not cause any serious harm. Occasionally they can develop into a true skin cancer. For this reason, dermatologists usually treat or at least keep an eye on Bowen’s disease. A particular problem with treatment of this condition is that it is usually on the lower leg where the skin is often tight (and sometimes quite fragile, especially in older patients) and healing is slow. The size and thickness of the patch, the number of patches, swelling of the legs, and the general state of the skin on the legs may all play a part in deciding the best treatment for each patient.
Bowen’s disease can be treated by freezing, scraping it off the skin (curettage), Photodynamic therapy or surgical removal. In some cases a cream known as 5-fluorouracil (Efudix cream) may be used. Radiotherapy (X-ray treatment) is less commonly used. If the patch is judged to be thin and not troublesome, however, the doctor may simply suggest that it is kept under observation in a clinic or in some cases by the GP.
Treatment details:
Freezing – may cause redness, puffiness, blistering or crusting. Slow to heal. It is usually done in stages for large areas of Bowen’s disease.
Curettage – scraping off the abnormal skin under local anaesthetic. Heals with a scab, like a graze.
Excision (cutting the patch out) – is done under local anaesthetic. Usually involves stitching the skin to heal the area.
Efudix cream – this is a cream which may control or eradicate the disorder. There are various different ways to use this which the doctor who sees you will explain, if this is felt to be the best treatment.
Photodynamic Therapy (PDT) - The diseased skin is first treated for a few hours with a special cream. Then a very intense red light (not laser light) is shone on the area. The abnormal tissue becomes inflamed and is destroyed. Healing is very good with minimal scarring.
Melanoma in-situ
There are 2 types of melanoma in-situ: lentigo maligna and superficial spreading melanoma in-situ.
Lentigo maligna usually presents as a large flat brown freckle on the sun-exposed skin of the face and neck. They often grow slowly over several years and may be 1 – 2 cm in size. They are common in the elderly.
The other type, superficial spreading melanoma in-situ, is usually less than 1 cm in size, flat or slightly raised, and a mixture of browns or dark brown or black in colour. It can occur anywhere on the body, but is most common on the legs of females.
In both cases, the abnormal cells are confined to the top layer of skin, the epidermis. If left untreated, melanoma in-situ can continue to grow and spread both outwards and downwards until it becomes an invasive cancer which could then potentially spread.
Treatment:
Treatment is usually by surgery – the melanoma in-situ is cut out and examined under the microscope to make sure it is completely removed. Provided it has been completely removed no further treatment will be necessary. In a few cases, radiotherapy will be used either alone or together with surgery to treat lentigo maligna.Follow-up:
No further follow-up is needed for patients with completely excised melanoma in-situ.Malignant Melanoma
Three times more people develop a malignant melanoma now than 20 years ago. Around 430 new cases every year in the West Midlands are diagnosed.
What is Malignant Melanoma (MM)?
MM is a type of skin cancer that usually presents as a pigmented mole or lump. It may develop from an existing mole or appear as a new one. It begins in certain cells in the skin called melanocytes which are found in the lower part of the epidermis and produce melanin, the natural pigment that gives skin its colour. When skin is exposed to the sun, these melanocytes produce more pigmentation, so causing the skin to tan.What causes Malignant Melanoma (MM)?
MM occurs when melanocytes become malignant. The cause is not fully known. There is strong evidence that ultraviolet rays from the sun damage the skin and can cause skin cancers, including MM.Where is MM most often found?
MM can be found on a mole on any part of the skin surface but is most commonly found:
• On the legs in women
• On the trunk, especially the back, in men
Rarely, MM is found in other parts of the body such as the eye, mouth, under nails or internallyA major sign of MM is a mole that changes in size, shape or colour. If a mole starts to bleed or ooze then medical opinion should be sought. There may also be a change in sensation.
If a doctor decides I need treatment, what will happen?
All skin areas suspected to be MM are treated with surgery. Surgery involves removing the suspicious mole together with an area of normal looking skin.What happens if MM is confirmed?
If an MM is confirmed by the excision biopsy, any further treatment is determined by a measurement called the Breslow thickness. Cancer cells are measured from the surface of the skin to the deepest cancer cell.If I need further treatment what might this be?
A wider excision with or without a skin graft will be required. This is to reduce the chance of the Melanoma returning on or under the skin where it first appears. The amount of skin removed will depend on the thickness of the Melanoma.If I need further treatment will I need to stay in Hospital?
This depends on the surgery. Some wider excisions can be performed without the need for a skin graft. For others, some skin grafts can be done as a day case procedure using a local anaesthetic with you awake, but a hospital stay may be needed depending on the size and position of the excision.Can Malignant Melanoma spread?
Yes, especially if left untreated.Where can Melanoma spread to?
If not removed early, at a thin stage, cancer cells may grow down from the skin into healthy tissue. If MM becomes thick and deep the disease can spread to other parts of the body. Usually it spreads to the lymph glands and then to internal organs.Will I need any further tests?
Not on a routine basis but further tests may be needed. Tests are done to assess the extent of any spread of the disease. Sometimes tests are also done to see how you are responding to your treatment which may include:• Blood tests to check your general health
• Chest x-rays to check for any sign of spread to the lungs
• FNA (fine needle aspiration) to take a sample of cells from a suspicious lump
• CT Scan (CAT scan) to build up a picture of the inside of the body. It may also show if a tumour has developed elsewhere, as a result of spread of the Melanoma that may not be seen outside the bodyWhat will happen after my treatment is complete?
You will be given your own personal follow-up plan. We will explain any test results, check any wounds and explain how to look after yourself and how to do self-examination. The number of return visits will depend on the treatment and thickness of the Melanoma. This may be shared care between a surgeon and the dermatology team. Your doctor will discuss the treatment plan with you. If you are unsure or have any questions ask the doctor or a member of the nursing team who will be pleased to help you. Do not feel that you have to fully understand everything at once. You will have time to ask us for more information and explanations for things that do not seem clear.
Seborrhoeic Warts
Other common names include Seborrhoeic Keratosis and Basal cell papilloma.
These are harmless skin growths that tend to have a rough surface and vary in colour from light brown to almost black. They usually become noticeable after the age of 40 years and are most often found on the trunk or around the hairline. They are not contagious. They vary in number from only a few to several hundreds in any one person.
Treatment
Although they are harmless, they can itch. Applying a moisturizer will not get rid of them but will make them less rough and less likely to itch. Rubbing them gently with a facecloth / flannel whilst bathing will also help to reduce roughness. If they are unsightly or if they are catching on clothing, they can be removed by cryotherapy (freezing).
Solar (Actinic) Keratosis
What is solar keratosis?
Solar (actinic) keratosis is a skin condition caused by over-exposure of the skin to sunlight over many years. Solar keratoses are usually patches of dry, scaly skin. They can vary from light to dark and can be red, tan, pink, a combination of all these or the same colour as normal skin. They are often flat, but are sometimes raised (bumps), especially when they are on the arms or hands. It is quite common for a whole group of solar keratoses to appear at once and they may join to form a larger lesion, but single patches are normally less than 1cm across. The usual places they appear are the scalp, face, forehead, backs of hands and forearms and, particularly for women, the lower half of the leg.Why does sunlight cause solar keratosis?
Sunlight contains ultraviolet (UV) light / radiation. The amount of UV present in sunlight varies depending on where you live, the time of the year and the time of day. UV light is responsible for the normal ageing of the skin including the development of lines and wrinkles, and it is the main cause of skin cancer. UV radiation can cause damage in both the epidermis (top or outer layer) and the dermis (underneath layer) of the skin. UV damage includes thinning of the skin, hyper-pigmentation (“suns spots”, which are darker-coloured areas), de-pigmentation (lighter-coloured areas) and solar keratosis.Who gets solar keratosis?
Solar keratosis can happen to anybody if they are exposed to a lot of sun for a long time. People who have a fair complexion, blonde or red hair and blue, green or gray eyes are more likely to get it. The elderly are at particular risk because they are likely to have been exposed to the sun for many years. People with a weakened immune system, maybe as a result of chemotherapy, organ transplantation or AIDS, are more likely to develop solar keratosis. Even dark-skinned people are at risk if they over-expose themselves to sunlight without adequate sun protection.Is solar keratosis a rare condition?
No. In the UK alone, more than 230 new patients are diagnosed every day and the number is steadily rising. Solar keratoses are most common in patients of 70 years old or over, with more men than women being affected (60% men, 40% women in the UK).
Will it get better on its own?
Solar keratoses occasionally go away by themselves, especially if a sunscreen is applied on a regular basis. An untreated solar keratosis rarely may progress to become a Squamous cell Carcinoma (SCC), which is a skin cancer.
How are solar keratoses treated?
There are several methods of treating solar keratoses, and your doctor will have selected the most appropriate one for you. These include cryotherapy (freezing), curettage therapy (removing surgically) or treatment with a prescribed medicine such as a cream or gel.Cryotherapy is currently the most common method. This is carried out by applying liquid nitrogen to the damaged area of the skin to literally freeze the solar keratosis and the skin around it. Cryotherapy can cause patients to have some blistering and the skin may change in colour or texture after treatment. Cryotherapy is usually very successful, but only small areas can be treated at a time.
Curettage therapy works along similar principles to remove the damaged skin, but in this case the area is surgically removed. In some cases the patient may experience a little bleeding or scarring afterwards. Like Cryotherapy, Curettage is a very effective method of removing the solar keratoses.
Sometimes, particularly if there is a large area to be treated, your doctor may decide to use a cream; a form of chemotherapy. The cream needs to be applied to the area for several weeks. The cream attacks the area treated, causing the skin cells to die. This action may result in some patients experiencing side-effects such as pain, redness and burning. This sort of treatment is also usually very successful, but only if the full course of treatment is completed.
Alternatively your doctor may decide to use a gel-based treatment. Like the cream, it can be used on large areas of solar keratoses as well as smaller individual patches. The treatment should be applied to the affected areas twice a day for 8-12 weeks. Some patients using the gel may experience local skin irritation, but this is usually mild and may improve soon after starting treatment. This gel has been especially formulated to treat solar keratosis, and works in a different way to the cream.
Will it come back?
Yes, probably. Solar keratosis can be viewed as a sort of ‘Dosemeter’ because it’s a sign that the skin has received enough ultraviolet light to wear down its natural defenses and be more prone to UV damage. The underlying skin damage from many years’ exposure to UV light cannot be reversed. Therefore, although the condition can be treated very successfully now, new solar keratoses are likely to appear over subsequent years d ill need further treatment.(Leaflet modified with permission from Bioglan: Dermatology Dept, MSGH)
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is a skin cancer that occurs within the upper layer of the skin and is common in older people and in people whose skin has been frequently exposed to sunshine. It can appear as a small lump, an ulcer, or a scaly patch.
SCC can be found anywhere on the body, but is most likely on areas of skin more exposed to the sun such as the face, ears, neck, hands and shoulders.
SCCs can also spread to other parts of the body, although this is not common. For this reason you will be given a treatment plan for follow-up appointments. Most people treated for SCC’s are completely cured.
Treatment
Once a doctor has decided that an area of skin is abnormal, some or all of it will be removed to be examined under a microscope. The procedure is usually carried out under a local anaesthetic with you awake, at the day case unit or at the out patient clinic. This may be all the treatment you will need.If the doctor feels other treatment is needed the different treatments available will be discussed with you. The type of treatment will depend on many things such as the size of the affected area and where it is, how old you are, what your general health is like, and whether you have had a skin cancer before. The treatments which the doctor might discuss with you include:
Surgery: Treatment of SCC normally involves some surgery. Small lumps can be cut from the skin quickly and easily. Other, larger areas may need surgery that is more complicated. In these cases an inpatient stay may be required.
Radiotherapy: SCC responds well to radiotherapy. Radiotherapy is a type of xray that is painless and takes only a few minutes. The treatment will normally be given at North Staffs Royal Infirmary or New Cross Hospital and several short visits are enough to destroy all of the cancer cells.
Your doctor will discuss all treatments fully with you and help you decide which is the best treatment for you. If you are unsure or have any questions, ask the doctor or a member of the nursing staff who will be pleased to help you.
After treatment for squamous cell carcinoma the number of times you will need to visit the hospital will depend on the treatment you have received, but you will be asked to attend for check-ups by the skin clinic or your own GP for several years.
If you develop an SCC there is a small risk that you may develop another sometime in the future. Because of this we recommend that you take sensible precautions in the sun. This includes:
• Avoiding the midday sun (i.e. between 11am – 3pm).
• Wearing a hat with a brim to protect your head, neck and ears.
• Wear long sleeves / trousers.
• Remember: sunscreens should be used as an addition for safe sun exposure not the only protection.
Please help yourself by:
• Examining the treated area every 4 - 6 weeks to check that the SCC has not returned. This is very unlikely to happen but it is best to check.
• Check the lymph node site nearest to the area where your SCC has been removed. You will be shown how to do this in clinic. If you are not shown - please ask.
• Check the rest of your body for any changes to your skin or new growths, especially in areas exposed to the sun.
• Protect your skin from the sun. This is even more important now that you have been treated for skin cancer.
Suncare Advice
What are sunscreens?
Sunscreens are preparations that contain substances that protect predominantly against UVB and sunburn. They have limited protection against ultra violet radiation (UVA).What does the star rating system mean?
The star rating system indicates the measure of protection from UVA.
It is advised to use a sunscreen with 4 stars to obtain balanced protection. Sun protection factor (SPF) gives guidance on degree of protection against UVB: ie SPF 5 = 5 times more protection than no sunscreen. Do not use less than factor 15.What sunscreen should I use?
Water resistant and waterproof sunscreens offer better protection for water activities.
Water resistant: maintains SPF rating after 40 minutes in water.
Waterproof: maintains SPF rating after 80 minutes of water activity.
Waterproof sunscreens are considered sweat-proof as well.Studies to date have shown that regular use of sunscreen SPF 17 led to significant reduction of solar keratoses. (Sun damage)
What else can I do to protect myself against sun damage?
Using a sunscreen does not mean safe sunbathing but should be used as an addition for safer sun exposure: avoid the midday sun (ie between 11am – 3pm).Clothing
• Wear a hat with a brim, as this will protect your head, face, neck and ears.
• Slip on clothing to cover your skin, especially areas like your shoulders.
• Some garment labels have UPF (Ultraviolet Protection Factor) which indicates how much UVR is absorbed e.g. UPF 20 allows 1/20th of UVR to pass through.
• Less UVR passes through tightly wove fabrics. Washing closes small gaps.
• Dark colours of same material absorb more UVB than light shades hence higher UVB rating. There is different protection depending on the fabric. ie.
White cotton = UVB 12 White polyester = UVB 16
Black cotton = UVB 32 Black polyester = UVB 34
• Stretching a fabric decreases the UPF.
• Loose fitting garments offer better protection than those worn close to skin.
• Old, threadbare or faded garments may have lower rating.
© K.A.Ward 2009
