Skin Cancer Checks and Diagnosis in London

Understanding skin cancer

Skin cancer arises when DNA damage accumulates in skin cells and normal control mechanisms fail. Because the skin is our largest organ and directly exposed to sunlight, its cells—keratinocytes in the epidermis and melanocytes that produce pigment—are particularly vulnerable to UV radiation. Although the umbrella term “skin cancer” is used, different cancers behave very differently. Basal cell carcinoma (BCC) grows locally and very rarely spreads; squamous cell carcinoma (SCC) can invade deeper tissues and occasionally metastasise; melanoma is less common but potentially life‑threatening if not treated early.

In the UK, rates have risen in recent decades due to lifestyle changes, travel to sunny climates, and ageing populations. The good news is that almost all skin cancers are visible on the skin—meaning early recognition and prompt treatment can be highly effective.

Types of skin cancer

Basal cell carcinoma (BCC)

BCC accounts for the majority of skin cancers. Typical signs include a pearly, translucent bump with visible blood vessels (telangiectasia); a non‑healing sore that bleeds or crusts; or a scar‑like flat, shiny area. BCCs grow slowly and rarely spread to lymph nodes, but they can invade surrounding tissues, so treatment should not be delayed.

Squamous cell carcinoma (SCC)

SCC often appears as a scaly, crusted lesion, a firm tender nodule, or a slowly enlarging wart‑like growth—frequently on sun‑exposed sites such as the ears, scalp, face, and backs of hands. Actinic keratoses and Bowen’s disease (SCC in situ) are early, precancerous forms on chronically sun‑damaged skin. SCC has a greater risk of spread than BCC, especially when arising on the lips/ears, in scars, or in immunosuppressed patients.

Melanoma

Melanoma develops from melanocytes and can arise de novo or from an existing mole (naevus). Classic warning signs are summarised by ABCDE—Asymmetry, Border irregularity, Colour variation, Diameter > 6 mm, and Evolution (change). Another helpful tip for fast‑growing nodular melanomas is the EFG rule: Elevated, Firm, and Growing. Melanoma can spread to lymph nodes and organs; however, if detected early—when thin (low Breslow thickness)—surgical removal is usually curative.

Other rarer tumours

Less common skin cancers include Merkel cell carcinoma (a fast‑growing neuroendocrine tumour), cutaneous lymphoma (cancers of skin‑homing lymphocytes), and adnexal tumours (arising from sweat/oil glands). These require specialist multidisciplinary care.

Causes and risk factors of Skin Cancer

• Ultraviolet (UV) radiation: The principal cause. Both chronic cumulative exposure (e.g., outdoor work) and intermittent intense exposure leading to sunburn (e.g., holidays) increase risk. Tanning beds emit concentrated UVA/UVB and significantly raise melanoma risk.
• Skin type: Fair skin, light hair/eyes, and skin that burns easily carry higher risk. Albinism and certain genetic conditions amplify susceptibility.
• Personal and family history: Previous skin cancer or melanoma, multiple or atypical moles, or a first‑degree relative with melanoma.
• Immune suppression: Organ‑transplant recipients and people on long‑term immunosuppressants have a markedly increased SCC risk.
• Age and sex: Risk increases with age; certain types show sex‑ and site‑specific patterns (e.g., BCC on the nose in older men; melanomas on legs in women, back in men).
• Environmental/occupational exposure: Arsenic exposure, ionising radiation, chronic scarring or ulcers increase SCC risk. PUVA therapy history and previous radiotherapy are additional factors.
• Genetic syndromes: Familial atypical multiple mole melanoma (FAMMM), xeroderma pigmentosum, Gorlin syndrome, and others confer very high lifetime risks.

Warning signs and symptoms of Skin Cancer

Skin cancer can look very different from case to case. Seek assessment if you notice:

• A new or changing lesion that looks different from your other moles (“the ugly duckling”).
• ABCDE changes in a mole: asymmetry, border irregularity, colour variation (including white, blue, black, or multiple shades), diameter > 6 mm, and evolution.
• Non‑healing sores that bleed, crust, or fail to close after 3–4 weeks.
• Pearly bumps, scar‑like flat patches, or shiny pink growths (typical of BCC).
• Firm, scaly, tender nodules or rapidly growing wart‑like lesions (typical of SCC).
• Persistent redness or irritation in a sun‑damaged patch; recurrent crusting on the ears, scalp, or lips.

How skin cancer is diagnosed

At Skinhorizon, diagnosis begins with a thorough consultation and full‑skin examination. We use dermoscopy—a specialist magnifying light—to analyse structures and colours within a lesion that are not visible to the naked eye. If cancer is suspected, a biopsy confirms the diagnosis:

• Excisional biopsy (preferred for suspected melanoma): removal of the entire lesion with a narrow margin.
• Punch or shave biopsy for selected NMSC or large lesions to guide treatment.

For confirmed melanoma or high‑risk SCC, further tests may be considered to stage the disease—such as ultrasound of regional lymph nodes, sentinel lymph node biopsy (for intermediate‑thickness melanoma), and occasionally CT/PET scans. The key histological measurements include Breslow thickness (depth), ulceration, mitotic rate, and margins.

Treatment options

Management is personalised based on the cancer type, size, site, and patient factors. Our goal is complete removal, cure, and the best possible cosmetic outcome.

Surgical treatments

• Standard surgical excision: The most common and effective treatment for BCC, SCC, and melanoma. The lesion is removed with a safety margin of healthy skin and sent to pathology to confirm complete clearance. For melanoma, a wide local excision is performed after the initial diagnostic biopsy, with margins determined by Breslow thickness.
• Mohs micrographic surgery: A specialised technique used particularly for facial BCC/SCC, recurrent tumours, or lesions with ill‑defined edges. Tissue is removed in stages and examined immediately under a microscope to ensure all cancer cells are cleared while preserving as much healthy tissue as possible.
• Curettage and cautery or cryotherapy: Options for selected superficial BCCs or Bowen’s disease when surgery is less suitable. These have good cure rates for specific indications.

Non‑surgical and topical therapies

• Topical immunotherapy/chemotherapy: Imiquimod (stimulates local immune response) and 5‑fluorouracil (chemotherapy cream) can treat some superficial BCCs, actinic keratoses, and Bowen’s disease.
• Photodynamic therapy (PDT): A light‑activated treatment after application of a photosensitising cream—effective for superficial lesions with excellent cosmetic outcomes.
• Radiotherapy: Considered for non‑surgical candidates or difficult sites; also used as adjuvant therapy in selected SCC cases.

Systemic therapies for advanced disease

• Immunotherapy for melanoma and advanced SCC: Checkpoint inhibitors (e.g., anti‑PD‑1 antibodies) can stimulate the immune system to attack cancer cells and have significantly improved survival in advanced melanoma. They may also be used for advanced or metastatic cutaneous SCC.
• Targeted therapy for melanoma: For tumours with specific mutations (e.g., BRAF V600), combinations of BRAF and MEK inhibitors can be highly effective.
• Hedgehog pathway inhibitors for advanced BCC: In rare, inoperable or metastatic BCC, drugs targeting the Hedgehog pathway may be appropriate under specialist care.

Prognosis

BCC has an excellent prognosis when treated; recurrence risk is low with appropriate surgery, though patients may develop new lesions over time. SCC generally has a high cure rate when detected early, but high‑risk features (size > 2 cm, depth > 2 mm, ear/lip location, perineural invasion, immunosuppression) increase the chance of spread—necessitating closer follow‑up. Melanoma prognosis depends strongly on thickness and ulceration; thin melanomas (< 1 mm) have a very high survival rate when treated promptly, whereas advanced disease requires multidisciplinary care.

Prevention and self‑care

• Sun protection, year‑round: Seek shade between 11am–3pm, especially April–September. Wear a wide‑brimmed hat, UV‑protective sunglasses, and long sleeves.
• Broad‑spectrum SPF 30–50+ sunscreen: Apply generously 15–30 minutes before going out and reapply every two hours or after swimming/sweating. Don’t forget ears, scalp (if thinning), hands, and lips (use SPF lip balm).
• Avoid sunbeds: Artificial tanning devices significantly increase melanoma risk and cause premature skin ageing.
• Self‑examination: Check your skin once a month in good light—front and back, sides, scalp, between toes, and soles. Use mirrors or a partner to inspect hard‑to‑see areas.
• Know your moles: Photograph and monitor. Look for the ABCDE signs and the “ugly duckling”.
• Protect children: Childhood sunburns strongly influence lifetime risk. Use shade, clothing, and appropriate sunscreens for kids; never use sunbeds for under‑18s.
• Healthy habits: Stop smoking (improves wound healing and reduces SCC risk), maintain a balanced diet, and manage chronic conditions.

High‑risk groups and special situations

• Organ‑transplant recipients & immunosuppressed patients: Require regular dermatology surveillance; SCC risk is markedly elevated. Rigorous sun protection and early treatment of precancers (actinic keratoses) are vital.
• Fair‑skinned individuals with outdoor occupations/hobbies: Consider annual skin checks and targeted education on protective clothing and sunscreens suitable for work conditions.
• People with many or atypical moles: Baseline total‑body photography and dermoscopic mole mapping can help detect change early.
• Pregnancy: Most diagnostic and surgical procedures are safe; timing and anaesthetic choices are individualised. Urgent excision of suspected melanoma should not be delayed.
• Skin of colour: Skin cancer can occur on less sun‑exposed sites (palms, soles, nail beds). Any new dark line within a nail (longitudinal melanonychia) or changing lesion merits prompt review.

Follow‑up and surveillance

After treatment, we create a personalised follow‑up plan. For BCC and low‑risk SCC, a clinical review at intervals ensures early detection of new lesions. High‑risk SCC and melanoma require structured surveillance schedules, including lymph node checks and, when indicated, imaging. We also provide education on scar care, sun protection, and self‑examination to reduce recurrence and catch any new problems early.

When to seek urgent medical advice

• A new, rapidly changing or bleeding mole, or one that itches and looks different from your other moles.
• A non‑healing sore or ulcer persisting beyond three to four weeks.
• A tender, enlarging nodule on sun‑exposed skin, especially on the ears, lips, or scalp.
• A new dark streak in a nail, particularly if irregular or widening.

Your first visit — what to expect

1. History: We explore your concerns, lesion evolution, sun exposure, sunbed use, previous skin cancers, family history, and medications (especially immunosuppressants or photosensitisers).
2. Examination: Targeted assessment of the lesion plus a full‑skin check. Dermoscopy is used to evaluate suspicious features with precision.
3. Investigations: If cancer is suspected, we discuss and arrange a biopsy. For confirmed melanoma/high‑risk SCC, we consider staging tests and liaise with multidisciplinary teams where appropriate.
4. Management plan: We outline treatment options—surgical and non‑surgical—covering benefits, risks, scarring, cosmetic outcomes, and recovery timelines. For melanoma, we plan the wide local excision and discuss sentinel node biopsy when indicated.
5. Prevention & follow‑up: Personalised sun‑safety advice, mole‑monitoring strategies, and a surveillance schedule. We provide clear safety‑netting guidance on when to contact us.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 22 August 2025