Cosmetic Surgeon of the year finalist 2018

Skin Cancer

Unfortunately, every year I see more cases of skin cancer and increasingly in younger patients. Worldwide there is an increased incidence of skin cancer associated with our changing lifestyles over the last 40-50 years.

I treat hundreds of patients every year with skin cancer both privately and within the NHS. I set up the local skin cancer Multidisciplinary Team Meeting (MDT) at Wexham Park Hospital, some 10 years ago. I am able to offer early diagnosis and definitive treatment ONE STOP SKIN CLINIC of all forms of skin cancer and routinely provide a mole/skin lesion screening service to my private patients at my clinic in Windsor.

We provide a MOLE SCREENING CLINIC every week at which we can see you and remove any suspicious mole or skin lesion on the same day. The excised mole is sent away to be checked by a specialist skin pathologist who will issue a written report within a few days. Moles which become cancerous are known as melanomas and early diagnosis and removal is the best form of treatment. Unfortunately, medical treatment is ineffective in the early stages of this cancer. The spread of melanoma can be widespread throughout the body and is potentially fatal if it has spread to the vital organs, lungs, liver, brain etc

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ACTINIC KERATOSISACTINIC / SOLAR KERATOSES are crusty lesions occurring on chronically light-exposed adult skin. They represent areas of a low risk of progression to invasive squamous cell carcinoma (SCC). Actinic Keratoses are widely considered to be premalignant lesions with low individual potential for invasive malignancy. They present as discrete, sometimes confluent, patches of erythema and scaling on predominantly sun exposed skin, usually in middle-aged and elderly individuals.

Actinic Keratoses are a biological marker of sun damage and hence patients with Actinic Keratoses are at a greater risk of skin cancer than those with none. Patients need to seek a medical opinion if they detect new lesions or changes in old lesions on their skin.

BCCBASAL CELL CARCINOMA (BCC) / RODENT ULCER is a slow-growing, locally invasive malignant skin tumour predominantly affecting caucasians. The tumour infiltrates tissues through the irregular growth of finger-like outgrowths. Metastasis is extremely rare but local tissue invasion and destruction particularly on the face, head and neck occur with time if left untreated.

BCC2BCC is the most common cancer in Europe, Australia and the U.S.A and is showing a worldwide increase in incidence. The most significant causative factors appear to be genetic predisposition and exposure to ultraviolet radiation. The sun-exposed areas of the head and neck are the most com- monly involved sites. Sun exposure in childhood may be especially important.

Following development of a BCC, patients are at significantly increased risk of developing subsequent BCCs at other sites.

The tumour is excised together with a variable margin of clinically normal tissue. The excised tissue can be examined under a microscope to ensure adequate removal has occured.

SCC1SQUAMOUS CELL CARCINOMA (SCC) Cutaneous squamous cell carcinoma is a malignant tumour arising from the keratinising cells of the epidermis or its appendages. It is locally invasive and may metastasise.

SCC2High risk sites include lip, face, ears and legs, chronic ulcers, chronic inflammation or Bowen's disease (pre-malignant skin cancer).Treatment involves complete removal or treatment of the primary tumour and awareness of lymphatic metastases to draining lymph nodes.

Observation for recurrent disease by our specialist clinic should be undertaken

SUPERFICIAL-SPREADING-MELANOMAMELANOMA of the skin is an increasingly common tumour, which often has a slow early growth rate during which curable lesions may be detected and removed. In the UK, melanoma is diagnosed at a mean age of around 50 years but a fifth of cases occur in young adults. So while it is one of the less common forms of cancer, it has a large impact in terms of years of life lost. Melanoma is a malignant tumour, which arises from cutaneous melanocytes. Current UK lifetime risk is about 1:150 for men and 1:120 for women. It is a tumour predominantly of white- skinned people providing strong evidence that sun exposure is causal. The mean age of diagnosis in the UK is around 50 years, but 20% of cases occur in young adults aged 15 to 39 years old.

Melanomas may occur anywhere on the skin but they occur particularly in women most commonly develo pmelanomas on the lower limb (50% of women, 18% of men). Men who develop superficial spreading or nodular melanomas most commonly develop them on the trunk (35% of men, 14% of women). Patients with chronic sun exposure through life commonly develop their melanomas on the head and neck.

What is the relationship between moles and melanoma? Moles are both markers of risk of melanoma and precursors. A long-standing mole which starts to change therefore justifies a check up here at the ONE STOP SKIN CLINIC.

Patients with many moles are at sufficiently increased risk of melanoma (relative risk around 10-fold compared with those with few moles) to merit referral for assessment.

Accurate diagnosis is most likely to result from examination and prompt complete excision of suspicious lesions.

MOLEJunctional moles. These are normal moles which develop from early childhood. The risk of melanoma from any such mole is extremely low but patients should be aware that they should seek advice if there is any change in shape, size or colour


ATYPICAL MOLESModerately atypical moles. These are moles which are behaving atypically in that they are becoming irregular in shape, larger (usually over 5 mm in diameter) and may have variable colours. These moles are more likely to evolve into melanoma and should therefore be reviewed at 3 months for change, although the absolute risk of malignant change is very low.

DYSPLASTIC MOLESeverely atypical moles/melanoma in situ. These moles are evolving into melanoma and show more marked variation in shape and colour. Early melanomas often look inflamed, as can be seen in both these examples. Lesions like these should be referred urgently for biopsy to my ONE STOP SKIN CANCER CLINIC

SUPERFICIAL-SPREADING-MELANOMASuperficial spreading melanomas progressively become more irregular in shape and colour over time. Referral is essential and urgent for excision biopsy.

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