Skin Cancer

• A new mole, spot or lesion formed on the skin that looks different from others.
• A sore, scab or lesion that does not heal within a few weeks.
• A spot that itches, bleeds or becomes tender without known explanation.
• A pearly, waxy or translucent growth on the skin.
• A flat, flesh-coloured scar-like lesion.
• Any change in shape, size, colour or texture to an existing mole.

For melanoma, the ABCDE (Asymmetry, Border, Colour, Diameter, Evolving) rule provides a useful framework for self assessment of potentially concerning lesions or moles.

• Basal cell carcinoma (BCC) is the most common form of skin cancer and accounts for approximately 70% of all diagnoses in Australia.
• BCC develops in basal cells within the epidermis of the skin.
• It typically appears on sun-exposed parts of the skin such as the head, neck and hands.
• Basal cell carcinoma usually grows slowly and is unlikely to spread to other parts of the body.

• Squamous cell carcinoma (SCC) is the second most common form of skin cancer, forming from squamous cells in the upper layers of the skin.
• It presents often as a firm, red nodule, a flat lesion with a scaly crust, or a new sore within an existing scar.
• It is more likely to spread to other parts of the body than basal cell carcinoma, particularly if it is left untreated.
• Squamous cell carcinoma (SCC) often develops from precancerous lesions known as actinic keratoses, which appear as rough and scaly patches on sun-damaged skin.

• Melanoma is a dangerous form of skin cancer developing in the melanocytes,
  the cells responsible for producing melanin.
• It accounts for the fewest cases of skin cancer but is responsible for the majority of deaths from skin cancer in Australia.
• It can appear as a new lesion or develop from an existing mole and may occur on any part of the body.
• Early stage detection is critical as melanoma identified here can be assessed and managed before it progresses to deeper layers of the skin.

• Merkel Cell Carcinoma (MCC) is a rare and aggressive form of skin cancer that develops in Merkel cells, found in the top layer of the skin.
• It most commonly presents as flesh-coloured or blue to red nodule, typically on the head, neck or face.
• MCC can grow rapidly and presents a higher risk of spreading to other parts of the body compared to basal or squamous cell carcinoma.
• It is more commonly diagnosed in adults over 60 or those with a compromised immune system.

Non-surgical treatments are typically used for early stage or superficial cancers and may be preferred in cosmetically sensitive locations.
Non-surgical treatments may include:

Topical treatments

• Imiquimod: an immune system response modifier that supports the body’s immune system to help destroy cancerous cells.
• 5-Fluorouracil (5-FU): a topical chemotherapy cream that kills abnormal cells in the top layer of the skin. It is typically used for superficial basal cell carcinoma (BCC) but can also be used to treat squamous cell carcinoma (SCC).

Cryotherapy: freezing the lesion with liquid nitrogen to destroy cancerous tissue.

Photodynamic therapy (PDT): applying a photosensitising agent to the lesion followed by exposure to light. This triggers an inflammatory response that targets and destroys cancer cells.

Surgical treatments may be required for larger, higher risk cancers. Possible surgical options include:

• Curettage and cautery: involves scraping off the lesion and using heat to destroy remaining cancer cells. This also allows for biopsy of the tissue.
• Surgical excision: involves cutting out the cancer along with a margin of healthy tissue. The sample is examined under a microscope to ensure complete removal.
• Moh’s micrographic surgery: This is considered a less invasive surgical treatment for BCC and is commonly used for high-risk or facial lesions. It involves removing the cancer layer by layer while immediately examining each layer under a microscope.
• This technique maximises cancer clearance while preserving as much healthy tissue as possible.

Radiation therapy may be used when surgery is not suitable, such as in elderly patients or when the cancer is located in a difficult-to-treat area like the nose, eyelids, or ears.

It may also be used as an additional treatment after surgery if cancer cells remain.