Skin Cancers
Approximately 12,000 people are diagnosed every year with skin cancer in Scotland, of which around 1,200 are malignant melanoma and 3,000 are squamous cell carcinomas (SCC). The incidence of skin cancer is rising.
Risk factors for all skin cancer types include excessive sunlight exposure, sun bed use, fair skin and susceptibility to sunburn. For melanoma, a large number of benign melanocytic naevi and family history are risk factors. For SCC, multiple small actinic keratoses, high levels of previous UV-A photochemotherapy and immuno-suppression are also risk factors. Patients with multiple atypical naevi and a strong family history may have an increased risk of developing skin cancer. Skin cancers are very infrequent in people with dark skin and in children under 15 years.
Guides for assessment include the 7-point checklist and the ABCD (Asymmetry, Border irregular, Colour irregular, Diameter increasing) checklist SIGN Guideline 72 (Withdrawn Feb 2015/Under Review) – Cutaneous Melanoma. Some melanomas will have no major features.
The dermoscope is a useful tool for trained clinicians screening pigmented lesions as it can increase diagnostic accuracy.
- Lesions which are suspicious for melanoma should not be removed in primary care. All excised skin specimens should be sent for pathological examination.
- Lesions suspicious of basal cell carcinomas (BCC) may not require urgent referral, except those invading potentially dangerous areas.
- Referrals should be accompanied by an accurate description of the lesion (including size, pain and tenderness) and photos if possible, subject to clinical governance arrangements, to permit appropriate triage.
A patient presenting with a skin lesion suggestive of cancer should normally be referred to a dermatologist, depending on local arrangements.
Lesions on any part of the body which have one or more of the following features:
- change in colour, size or shape in an existing mole
- moles with ABCD (Asymmetry, Border irregular, Colour irregular, Diameter increasing or >6mm
- new growing nodule with or without pigment
- persistent (more than 4 weeks) ulceration, bleeding or oozing
- persistent (more than 4 weeks) surrounding inflammation or altered sensation
- new or changing pigmented line in a nail or unexplained lesion in a nail
- slow growing, non-healing or keratinising lesions with induration (thickened base)
- any melanoma or invasive SCC or high risk BCC diagnosed from biopsy
- any unexplained skin lesion in an immuno-suppressed patient
- BCC invading potentially dangerous areas, for example peri-ocular, auditory meatus or any major vessel or nerve
The department operates a photo triage system for Skin Cancer referrals. Please phone one of the numbers below to make an appointment for your patient with the Medical Photography department before making a referral. (Please do not delay the referral if there is a difficulty making the appointment)
Hairmyres Hospital: 01355 585497
Monklands Hospital: 01236 712129 or ask for Radio Page 527
Wishaw General Hospital: 01698 366443
Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 72 (Withdrawn Feb 2015/Under Review) – Cutaneous Melanoma
Clinical Lead (Vacant)
Review Date April 2017