Early Detection

Install

Early Detection

close up of an eye

early detection

Skin cancer is the only cancer we can physically see developing in its early stages. If detected and treated early enough, skin cancer is almost always curable. Learning how to spot the signs and symptoms, put simply, can save lives. Use the menu above to shortcut to content topics or scroll through our comprehensive guide.

The Importance Of
Skin Surveillance

THE IMPORTANCE OF CHECKING YOUR SKIN ONCE A MONTH FOR SIGNS OF CHANGE AND KEEPING TRACK OF ANY CONCERNS CANNOT BE UNDERESTIMATED. THIS APP IS DESIGNED TO HELP YOU DO EXACTLY THAT.

Skin cancers seldom hurt and are much more frequently seen than felt. The sooner a skin cancer is identified and treated, the better a person’s chance of avoiding surgery, or in the case of a serious melanoma, potential disfigurement or even death.

It is therefore not only important to learn how to spot the early signs and symptoms of the various forms of both melanoma and non-melanoma skin cancer, but to regularly check your skin for signs of change and to seek professional advice, whilst keeping track of anything that concerns you.

The Skin Checking section of this app is designed to help you and remind you to conduct full body self examinations monthly, so that you become more familiar with your skin and gain confidence in identifying any potential abnormalities.

The step-by-step guide takes you through the necessary process of conducting a thorough self examination, with tips and advice to help keep track of suspicious lesions and seek professional advice with any concerns.

The Early Diagnosis section of this app will guide you through what action you should take if you are concerned about a lesion or mole and help you feel confident that appropriate action has been taken by a qualified healthcare practitioner.

The Lesion Tracker enables you to track, monitor and compare changes to lesions using close-up photography and self-management tools. In addition you can conduct a self-assessment of any lesion for features suggestive of the various forms of both melanoma and non-melanoma skin cancer with the lesion assessment tool which provides comprehensive advice and signposting based on the outcome of your assessment.

The first step however, is to learn about on the various forms of skin cancer as this will help build your knowledge and confidence in spotting the early warning signs when conducting your monthly self examinations.

Introduction
To Skin Cancer

SKIN CANCER IS THE OUT-OF-CONTROL GROWTH OF ABNORMAL SKIN CELLS CAUSED BY UNREPAIRED DNA DAMAGE THAT TRIGGERS MUTATIONS. AROUND 90% OF ALL SKIN CANCER CASES ARE CAUSED BY OVER-EXPOSURE TO ULTRAVIOLET RADIATION.

Skin cancer can be divided into two main groups; Non-Melanoma Skin Cancer (NMSC) and Melanoma. There are various types of skin cancer that fall within these categories as well as pre-cancerous skin lesions that have the potential to develop into skin cancer. Throughout this early detection guide, you will learn about the early signs and symptoms of these various forms of skin cancer to help you feel more confident in recognising suspicious lesions when checking your skin for signs of change.

The advice and images used throughout this guide are intended to help you spot the early warning signs of skin cancer. However, it’s important to acknowledge that skin cancers can vary dramatically in size, shape, colour, surface characteristics and symptoms. Therefore if you spot ANYTHING of concern, it is extremely important to visit your GP or dermatologist immediately for professional clinical assessment.

To find out more about what to do if you spot a suspicious lesion or mole and the referral process used within UK general practice, visit the Early Diagnosis section of this app.

Skin Cancer
In Skin of Colour

IT’S A COMMON MISCONCEPTION THAT PEOPLE WITH DARKER SKIN TONES ARE IMMUNE TO SKIN CANCER. INDIVIDUALS OF ALL SKIN TYPES, FROM ALL ETHNICITIES CAN DEVELOP SKIN CANCER AND SHOULD CHECK THEIR SKIN MONTHLY FOR THE EARLY WARNING SIGNS.

The term ’skin of colour’ refers to diverse skin colours which includes people of Asian, African, Latino, Middle Eastern and Native American descent.

Non-melanoma skin cancer in people with skin of colour:

Basal cell carcinoma (BCC) is the most commonly diagnosed cancer not only in Caucasians, but also in Hispanics, Chinese, Japanese and other Asian populations. Squamous cell carcinoma (SCC) however, is the most commonly diagnosed skin cancer among African Americans and Asian Indians.

Melanoma skin cancer in people with skin of colour:

Whilst melanoma is less common in people with these skin types, it is unfortunately often associated with greater morbidity and mortality. This is because there is a general misconception that people with darker skin tones are immune to skin cancer and because the early signs and symptoms are often more difficult to detect.

When melanoma does occur, the most common places a tumour may develop include areas of lighter skin, such as:

  • Mucous membranes, such as inside the mouth
  • Under the nails (subungual melanoma)
  • The palms of the hands, the soles of the feet and the lower legs (acral lentiginous melanoma)
  • The anogenital region (the area around the groin and anus)

It is imperative that all skin types check their skin regularly (once a month) for the early signs and symptoms of both melanoma and non-melanoma skin cancer and seek immediate advice from a qualified healthcare practitioner with any concerns.

Pre-Cancerous
Skin Lesions

IN ADDITION TO NON-MELANOMA AND MELANOMA SKIN CANCERS, IT’S WISE TO LOOK OUT FOR PRE-CANCEROUS SKIN LESIONS THAT ARE SLOW GROWING WITH THE POTENTIAL TO DEVELOP INTO CANCER.

There are 2 main types of pre-cancerous skin lesions: Actinic (or Solar) Keratosis and Intra-Epidermal Carcinoma (also known as Bowen’s Disease or Squamous Cell Carcinoma (SCC) in-situ). Both are more likely to affect maturer skin that has accumulated sun damage over longer periods of time, most commonly affecting areas of skin most frequently exposed to the sun.

Actinic (Or Solar) Keratosis

Actinic (Or Solar) Keratosis exampleActinic (Or Solar) Keratosis example
  • Pre-cancerous skin lesions that are slow growing with the potential to develop into cancer.
  • Commonly found on areas frequently exposed to the sun such as the head, neck, back of hands & forearms.
  • Usually appear as small brown, pink or whitish, scaly, red, single or multiple rough spots, smaller than 1cm in diameter.
  • They can feel rough and cause soreness, irritation, discomfort or pain, or may just pose a cosmetic nuisance.

Intra-Epidermal Carcinoma
(Bowen’s Disease / Scc In-Situ)

Intra-Epidermal Carcinoma exampleIntra-Epidermal Carcinoma example
  • Pre-cancerous skin lesions that are slow growing with the potential to develop into cancer.
  • Most commonly found on the head, neck and lower limbs.
  • Presents as an asymptomatic (producing or showing no symptoms) scaly, red, pink or salmon coloured patch or plaque.
  • The borders may be irregular and/or blurred.
  • May be flat, scaly, crusted, eroded, ulcerated, velvety or warty.
  • Due to asymptomatic nature lesions may become very large.

Non-Melanoma
Skin Cancer

NON-MELANOMA SKIN CANCER IS THE MOST COMMON FORM OF CANCER IN THE UK, 1 IN 3 MEN AND 1 IN 4 WOMEN WILL DEVELOP NON-MELANOMA SKIN CANCER IN THEIR LIFETIME. IT IS THE MOST COMMON FORM OF CANCER WORLDWIDE.

The term non-melanoma distinguishes these more common types of skin cancer from the less common skin cancer known as melanoma, which are often more serious.

Non-melanoma skin cancer (NMSC) refers to a group of cancers that slowly develop in the upper layers of the skin. Several types of skin cancer fall within the broader category of non-melanoma skin cancer, with the most common types being Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC).

Basal Cell Carcinoma is by far the most common form of NMSC, accounting for around 75-80% of cases and Squamous Cell Carcinoma accounting for the remaining majority.

NMSC treatment depends on the type of cancer. Skin cancer treatment usually involves surgery to remove the cancer cells. As many NMSC are found on sun-exposed areas such as the face and head, surgery to remove the cancer if detected at later stages can cause disfigurement so early detection is key.

Basal Cell Carcinoma (Bcc)

  • The most common type of non-melanoma skin cancer.
  • Majority occur on sun exposed areas (head, face, neck, ears etc).
  • Slow growing and rarely spread anywhere else on the body.
  • They can appear in different sizes and shapes.
  • Large or neglected BCCs can cause extensive local invasion and disfigurement due to surgery.
Basal Cell Carcinoma exampleBasal Cell Carcinoma exampleBasal Cell Carcinoma exampleBasal Cell Carcinoma exampleBasal Cell Carcinoma exampleBasal Cell Carcinoma example

LOOK OUT FOR THE FOLLOWING SIGNS AND SYMPTOMS:

A persistent, non–healing sore is a very common sign of an early BCC. Look out for an open sore that bleeds, oozes, or crusts. It can remain open for a few weeks, only to heal, then open up and bleed again.

A pearly, shiny bump or nodule, sometimes clear and often pink, red, or white. The bump can also be tan, black, or brown, especially in dark haired people and can therefore be confused with a normal mole.

A pink growth with a rolled, slightly elevated border and an indentation in the center. As the growth enlarges, tiny blood vessels may develop on the surface.

A patch of reddish irritated skin, frequently occurring on the face, chest, shoulders, arms, or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no discomfort.

A white, yellow or waxy scar-like area that often has poorly defined borders whilst the skin itself appears taut. This warning sign may indicate the presence of an invasive BCC that could be much larger than it appears on the surface.

Squamous Cell Carcinoma (Scc)

  • Squamous Cell Carcinoma is the second most common type of non-melanoma skin cancer.
  • The majority occur on sun exposed areas i.e. the face, neck, ears, lips, and forearms.
  • SCCs can appear in different sizes and shapes and grow at variable rates with varied appearance.
  • They rarely spread, but if left untreated they will increase in size and can spread to other sites.
  • They can cause discomfort, become disfiguring and in rarer cases become life threatening.
Squamous Cell Carcinoma exampleSquamous Cell Carcinoma exampleSquamous Cell Carcinoma exampleSquamous Cell Carcinoma exampleSquamous Cell Carcinoma exampleSquamous Cell Carcinoma example

LOOK OUT FOR THE FOLLOWING SIGNS AND SYMPTOMS:

Squamous Cell Carcinoma typically appear as persistent, thick, rough, scaly patches that are slow growing, often hurt and can bleed if bumped, scratched or scraped. They often look like warts and sometimes appear as open sores with a raised border and a crusted surface that can be painful.

Small, hard white or skin coloured lumps.
SCCs often first appear on the skin like this.

A persistent, scaly red patch with irregular borders.
These can sometimes crust or bleed.

An elevated growth with a central depression
A growth of this type may rapidly increase in size.

An open sore that bleeds and crusts.
Sores like this can persist for weeks.

A wart-like growth that crusts and occasionally bleeds.

Please note in addition to the above that pain and tenderness is a useful symptom in recognising SCCs.

Merkel Cell Carcinoma (Mcc)

Merkel Cell Carcinoma (MCC) is technically considered a non-melanoma skin cancer, however, like melanoma it is an aggressive skin malignancy associated with immunosuppression and UV exposure. Unfortunately, unlike the most common types of skin cancer, MCC develops rapidly over weeks or months. It can spread to other parts of the body such as the lymph nodes, lungs, liver or bones. Although MCC is very rare, it is a serious form of skin cancer, but with early detection, many cases can be treated successfully. It is therefore worth knowing the signs and symptoms, as early diagnosis and treatment are vital.

Merkel Cell Carcinoma exampleMerkel Cell Carcinoma example

MCCs are often found on areas of the skin that get the most direct sun - such as the head, neck, arms and legs - but they can appear anywhere on the body.

MCC grow quickly and usually appear as a shiny pink, red or bluish lump. The lumps are often less than 2 cm in diameter (although they can be larger). The skin over them is usually firm (not broken) and they don’t hurt.

Melanoma
Skin Cancer

THE LITERAL TRANSLATION OF MELANOMA IS ‘THE BLACK TUMOUR’. IT IS THE MOST SERIOUS AND POTENTIALLY LIFE THREATENING FORM OF SKIN CANCER, EARLY DETECTION IS VITAL.

Melanoma begins in melanocytes – the cells that produce the pigment melanin that colours the skin, hair and eyes. Melanocytes also form moles, where melanoma often, but not always develops. These cancerous growths develop when unrepaired DNA damage to skin cells trigger mutations that lead the skin cells to multiply rapidly and form malignant tumours.

As with all skin cancers, melanoma can often be seen on the skin, making it easier to detect in its early stages. But, if left undetected, melanoma can spread to distant sites or organs. Once melanoma has spread to other parts of the body it is referred to as ‘metastatic melanoma’ at this stage it becomes very difficult to treat and prognosis is poor, so early detection, diagnosis and treatment is vital.

Melanoma often arises from otherwise normal appearing skin (about 75%) or from within a mole or freckle, which starts to grow larger and change in appearance. According to Cancer Research UK, 1 in 36 UK males and 1 in 47 UK females will be diagnosed with melanoma skin cancer in their lifetime.

  • THERE ARE 6 MAIN TYPES OF MELANOMA:
  • 1. Superficial Spreading Melanoma
  • 2. Nodular Melanoma
  • 3. Lentigo Maligna Melanoma
  • 4. Acral Lentiginous Melanoma
  • 5. Subungual Melanoma
  • 6. Amelanotic Melanoma

Superficial Spreading Melanoma

Superficial spreading melanoma is by far the most common type of melanoma accounting for around 70% of all cases. They most commonly appear as a new mole, or an existing mole or freckle that changes in size, shape and/or colour. They most commonly appear on the trunk in men and on the legs in women, but can be found anywhere on the body. It is important therefore to conduct full body examinations monthly to keep track of any changes that could indicate the early warning signs.

THE ‘ABCDE’ OF MELANOMA

The ‘ABCDE’ OF MELANOMA is a common screening tool used to compare the characteristics of normal moles versus melanoma. These photographs show examples of Superficial Spreading Melanoma and should help you to identify a melanoma from a normal/healthy mole. However, not all melanoma look like these and some may be very small, so it is important to seek immediate professional advice if you notice any new, unusual marks or changes that have lasted more than a few weeks.

A = ASYMMETRY

When one half of the mole does not match
or look like the other half of the mole.

Example Melanoma

Example Melanoma

Healthy Mole

Example Healthy Mole

B = BORDER

When the borders of the mole are uneven
irregular, ragged or have blurred undefined edges.

Example Melanoma

Example Melanoma

Healthy Mole

Example Healthy Mole

C = COLOUR

When the colour changes or varies throughout. Red, blue
and black colourations are particularly serious signs.

Example Melanoma

Example Melanoma

Healthy Mole

Example Healthy Mole

D = DIAMETER

When the largest diameter is greater than 6mm
(but please be aware that it could be smaller).

Example Melanoma

Example Melanoma

Healthy Mole

Example Healthy Mole

E = EVOLVING

Changes in appearance, size and/or sensation in a new or
existing mole is the biggest indicator of a melanoma.

Example Melanoma

Example Melanoma

Healthy Mole

Example Healthy Mole

WARNING

Melanoma can be very small, they are often dark/black and smooth,
but can also lack pigmentation (amelanotic melanoma).

Example Melanoma

Example Melanoma

Amelanotic Melanoma

Amelanotic Melanoma

Nodular Melanoma

Nodular melanoma is the most aggressive form of melanoma, found in around 20% of cases. However, it does not follow the ABCDE of melanoma rule. Nodular melanoma are more even in shape and colour. The tumour is recognised when it becomes a bump (which can vary in colour) and is usually invasive by the time of diagnosis.

The most common sites for nodular melanoma to present are on sun-exposed areas such as the head and neck, also often found on the trunk in men and legs in women - but it can appear in other areas of the body. They grow fast, downward and become quickly invasive (within months) so early detection is vital.

Nodular melanoma are usually black, but occasionally are blue, grey, white, brown, tan, red or skin tone. The images here show some examples, but if you detect any lump on the skin that is growing quickly - you must seek immediate professional assessment from your GP and/or dermatologist.

THE ‘EFG’ OF NODULAR MELANOMA

Because nodular melanoma have very different and distinctive characteristics to those of more common melanoma, a great way to remember what to look for is the ‘EFG’ screening tool.

E = ELEVATED

Look out for an elevated lump or bump
that is usually uniform but can vary in colour.

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

F = FIRM TO TOUCH

Nodular melanoma are firm to touch
and more even in shape than other melanoma.

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

G = GROWING

Any lump or bump that is growing quickly / persistently
should be seen immediately by your GP or dermatologist.

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

WARNING

Whilst nodular melanoma are usually dark/black, they can
also lack pigmentation and be red, pink or skin tone.

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

Nodular Melanoma

Lentigo Maligna Melanoma

Lentigo maligna melanoma develops from lentigo maligna, which is sometimes called hutchinson’s melanotic freckle. Lentigo maligna stays on the outer surface of the skin (in situ). When it starts growing beneath the skin’s surface, it becomes lentigo maligna melanoma.

Lentigo maligna grows slowly and is usually harmless, but it can spread aggressively. The visual symptoms of lentigo maligna melanoma are very similar to those of lentigo maligna. Both appear as a long-standing brown patch, similar to a freckle or age spot. They have a smooth surface, an irregular shape and are usually a shade of brown which can develop darker areas (in rarer cases they can be pink or skin coloured).

Both lentigo maligna and lentigo maligna melanoma are generally larger than other types of melanoma (at least 6 mm wide) and can grow to several centimeters. Most occur on sun exposed areas such as the face, neck or forearms.

LentigoLentigo

To help identify a lentigo maligna melanoma use the ‘ABCDE’ of melanoma screening tool in addition to changes in sensation and behaviour.

THE ‘ABCDE’ TOOL: Asymmetric / Border irregularity / Colour variation / Diameter > 6mm / Evolution
SENSATION: Be aware of any changes in sensation, such as becoming itchy and/or stinging.
BEHAVIOUR: Changes to the behaviour - becoming hard, lumpy, bleeding, oozing, crusting.

Acral Lentiginous Melanoma

Unlike other melanoma, Acral Lentiginous Melanoma (ALM) develops on the palms of the hands and more commonly on the soles of the feet. ALM can appear as a new mole, patch of discoloured skin OR a changing spot in or connected to an existing mole. ALM can advance faster than other melanoma, becoming quickly invasive. As people with skin of colour are less prone to other forms of melanoma, ALM is the most common melanoma in people with darker skin.

ALM often appear as a black discolouration, but can be very subtle such as an ill defined patch of light brown-grey, discoloured skin that can look like a stain or a bruise (that’s not caused by trauma / won’t heal). In rarer cases ALM can also lack pigmentation (Amelanotic Acral Lentiginous Melanoma) which may appear as a reddish and/or orange patch of skin or non-healing ulcer that won’t heal.

Acral Lentiginous MelanomaAcral Lentiginous Melanoma

In addition to the ‘ABCDE’ of melanoma, look out for a slowly enlarging flat patch of discoloured skin. ALM often have a smooth surface at first, later becoming thicker with an irregular surface that may be dry or warty.

THE ‘ABCDE’ TOOL: Asymmetric / Border irregularity / Colour variation / Diameter > 6mm / Evolution
DISCOLOURATION: Ill-defined patch with single or variable pigmentation (brown, blue-grey, black and red) may be subtle and appear like a stain or bruise that won’t heal.
EVOLUTION: Growing, changing in shape or changes to surface characteristics, becoming thicker, dry, warty, ulcerated or bleeding.

Subungual Melanoma

Unlike other types of melanoma that grow in surrounding skin, subungual melanoma begins in the nail matrix - part of the nail bed that protects the skin beneath.

Subungual melanoma is very uncommon. It accounts for only 0.7 percent to 3.5 percent of all malignant melanomas worldwide. However this form of melanoma occurs in all racial groups, with around 30 to 40 percent of cases appearing in people of colour. Subungual melanoma is rare, but it is deadly if left untreated.

SubungualSubungual

Signs and symptoms of subungual melanoma include:

  • A nail pigmentation.
    • Can be light or dark brown, or have variable pigmentation (more than 1 colour).
    • Can appear like a patch, smear or smudge.
    • Can appear like a bruise (not caused by trauma / that will not heal or move up as the nail grows)
  • Pigmentation or darkening of the skin next to the nail.
    • Nail pigmentation can expand to, or first appear in the skin surrounding the nail.
  • A light brown, dark brown or black coloured band or streak.
    • Usually linear and vertical.
  • A nodule underneath the nail.
    • May appear with or without a pigmented band.
  • A non-healing sore.
    • A sore, ulcer or wound that won’t heal despite therapy
    • (In rarer cases sublingual melanoma can lack pigmentation)
  • Nail brittleness, cracking and/or bleeding
    • (Usually at the site of a pigmented lesion).
  • Separation of the nail from the nail bed.
    • Not obviously caused by trauma / accident.
  • Evolving in size and/or shape.
    • Getting bigger and/or changing in shape.

Amelanotic Melanoma

Amelanotic melanoma often go undetected due to the fact they lack melanin, the dark pigment that gives most moles and other forms of melanoma their colour. They can also mimic signs and symptoms of non-melanoma skin cancers such as basal or squamous cell carcinoma, or may be mistaken for scars or cysts.

AmelanoticAmelanoticAmelanotic

Whilst amelanotic melanoma is relatively uncommon fatality rates tend to be higher because they often go undetected for longer and are therefore commonly diagnosed at later stages.

Any subtype of melanoma can be amelanotic, so both the ‘ABCDE’ and ‘EFG’ tools apply. They can appear flat and irregular, indicating an amelanotic superficial spreading melanoma, or elevated and firm to touch, indicating an amelanotic nodular melanoma.

Due to the lack of pigment, whilst amelanotic melanoma are classically described as skin-coloured, a substantial proportion appear as red or pink.

Take Action
Check List

IF YOU DEVELOP ANY OF THE FOLLOWING SIGNS OR SYMPTOMS YOU MUST VISIT YOUR GP OR DERMATOLOGIST FOR IMMEDIATE CLINICAL ASSESSMENT:

Seek immediate advice from your GP or dermatologist if a new or existing skin, nail or mucosal (lips, inside the mouth and nose and genitalia) pigmented or non-pigmented spot, lump, lesion, mole or freckle:

  • Gets bigger and/or changes in shape, particularly getting an irregular outline.
  • Changes colour, gets darker, becomes patchy or multi-shaded.
  • Becomes elevated, firm to touch and is growing.
  • Starts to itch, gets painful, starts bleeding, gets crusty or becomes inflamed.
  • Looks or is behaving differently to the rest of your moles or skin lesions.
  • Is evolving in any way, such as: changes in size, symmetry, surface characteristics or symptoms

Early Diagnosis

early diagnosis

If you are concerned about a suspicious lesion or mole, seeking immediate advice from a qualified healthcare practitioner is vital. This section of the app helps guide you through: taking appropriate action, the referral criteria used in UK general practice, the process used by skin specialists to diagnose skin cancer and an overview of treatment and staging.

Taking Action
With Concerns

IF DETECTED, DIAGNOSED AND TREATED EARLY ENOUGH, ALMOST ALL SKIN CANCERS ARE CURABLE. SO, IF IN DOUBT, GET IT CHECKED OUT AS SOON AS POSSIBLE.

If you are concerned about a lesion or mole then you should get them checked as soon as possible by a doctor. You should first make an appointment to see your GP who will perform a skin check, examine any lesions or moles of concern and if needed, refer you to a skin specialist / dermatologist for professional clinical assessment. Alternatively you may wish to have concerns checked privately by a consultant dermatologist.

MAKING AN APPOINTMENT WITH YOUR GP
It’s a good idea when making your appointment to ask if there is a doctor at your practice that has a specialist interest in skin cancer. Some GPs have more knowledge about skin cancer than other GPs who may have had very little training in this subject.

Some GPs with a specialist interest in skin cancer will be trained to use a dermatoscope - a hand-held instrument, a bit like a magnifying glass that is used to examine the area very closely. This does not hurt or affect your skin.

DURING AN APPOINTMENT WITH YOUR GP
Your doctor should be familiar with your history and during your appointment they will talk to you about risk factors and your family history to help them determine your level of risk for the development of skin cancer. If you have used this app to generate your own risk assessment, you can show it to your doctor to help communicate your level of risk.

If you have taken photographs of your suspicious lesion or mole you should show them to your doctor to help communicate your concerns along with any notes you have made with regards to dates, sizes and changes in appearance or sensation.

It is important that you feel satisfied with the outcome of your GP appointment. Unfortunately most GPs have very little training in dermatology, so it is not uncommon for skin cancers, including melanoma (the most serious form) to be misdiagnosed.

To help you assess your level of satisfaction based on the outcome of your appointment, it’s useful to understand the referral process that GPs use to determine whether or not you should be referred to a dermatologist for appropriate clinical assessment. This process is outlined below using the weighted 7-point check list.

If you decide that you are not happy with the outcome of your appointment, you should either; make another appointment to discuss your concerns further; ask to see a different doctor for a second opinion; or consider booking a private consultation with a dermatologist.

The Weighted
7-Point Checklist

DOCTORS ARE ADVISED TO USE THE WEIGHTED 7-POINT CHECKLIST WHEN CONSIDERING REFERRAL TO A SKIN SPECIALIST FOR PROFESSIONAL ASSESSMENT.

When making referral decisions, your doctor may use the weighted 7-point checklist which has been recommended by NICE (National Institute for Health and Care Excellence) for routine use in UK general practice, as follows:

All suspicious pigmented skin lesions that score 3 points or more using this check list should be referred urgently (within 2 weeks) to a dermatologist for professional clinical assessment.

MAJOR FEATURES OF THE LESION (2 points each):

  • Change in size
  • Irregular shape
  • Irregular colour

MINOR FEATURES OF THE LESION (1 point each):

  • Largest diameter 7mm or more
  • Inflammation
  • Oozing
  • Change in sensation

Patients should also be referred urgently (within 2 weeks) if dermoscopy suggests melanoma skin cancer and if a pigmented or non-pigmented skin lesion is suggestive of nodular melanoma or other forms of rarer skin cancers.

Your GP should also refer you if you are taking medicines or have a medical condition that lowers your immune system.

Squamous Cell Carcinoma (SCC)
If a SCC is suspected, an urgent cancer pathway referral (for an appointment within 2 weeks) should be made by you GP.

Basal Cell Carcinoma (BCC)
If a BCC is suspected a routine referral (non-urgent referral) should be made, unless your doctor is particularly concerned that a delay in treatment may have a significant impact due to factors such as lesion size or location - for example larger lesions on the face or close to the eye.

Despite this guidance, please be aware that in the UK there is a huge shortage of dermatologists who are under a great deal of pressure to cope with increasing numbers of NHS referrals. If you are experiencing delays, or want to see a specialist sooner, you may wish to consider booking a private consultation.

Due to demand, booking a private consultation with dermatology services local to you, may or may not decrease your waiting time, so you would need to research this before making a decision. However there are other options available that can significantly speed up this process and even remove the need to first visit your GP - such as the My Skin Doctor App.

Please note: In England an urgent referral means that you should see a specialist within 2 weeks. However this 2 week time frame does not form part of the waiting times for Scotland, Wales and Northern Ireland. Wherever you live, you are seen as quickly as possible and you should ask your GP when you are likely to get an appointment.

MY SKIN DOCTOR
PATIENT-LED APP

GET EXPERT, SWIFT AND EFFICIENT TRIAGE, WITHIN THREE WORKING DAYS, FROM A TEAM OF LEADING EXPERT CONSULTANT DERMATOLOGISTS.

In 2020 Skcin partnered with My Skin Doctor and the UK’s largest dermatology practice to launch the self-pay version of their patient-led App which allows UK patients (regardless of their postcode) to access dermatology services immediately – without first having to wait to be referred to a dermatologist by their GP.

The My Skin Doctor App allows users to take and upload photographs of any skin condition to a growing team of experienced Consultant Dermatologists who provide expert, swift and efficient triage, with patients receiving a personalised care plan including a diagnosis (where possible), information about their condition and an effective treatment plan within 3 working days! Furthermore, this information is simultaneously communicated to the patient’s GP and included in patient records.

With a 100% Clinical Governance record, 100% GP satisfaction and fully GDPR compliant, My Skin Doctor is meeting current and future patient needs, whilst ensuring quality of care is not compromised and access is equitable across the UK.

A self-pay consultation of a suspect lesion, mole or other skin condition costs £75, £5 of which is donated to Skcin to support our vital work undertaken to prevent skin cancer and promote early detection across the UK.

To download the app or find out more visit: https://www.myskindoctor.co.uk/

Skcin and My Skin Doctor
App StoreGoogle Play

Confirming
Diagnosis (NMSC)

OVERVIEW OF DIAGNOSIS AND TREATMENT
FOR NON-MELANOMA SKIN CANCER (NMSC)

When you are referred to a skin specialist (a dermatologist or specialist plastic surgeon) by your GP, they should be able to confirm the diagnosis by carrying out a physical examination. If you have used the risk assessment tool within this app, it’s a good idea to share this information with them.

They may also perform a biopsy, a minor surgical procedure where either part or all of the tumour is removed and studied under a microscope. This is usually carried out under local anaesthetic. A biopsy allows the specialist to determine the type of skin cancer you have and whether there is any chance of it spreading to other parts of your body.

Basal Cell Carcinoma (BCC)
If you are diagnosed with basal cell carcinoma (the most common form of all skin cancers) and the tumour has been removed and tested, further tests aren’t usually required as it’s very unlikely that the cancer will spread.

Squamous Cell Carcinoma (SCC)
If you are diagnosed with squamous cell carcinoma (the second most common form of skin cancer), further tests may be needed because in rarer cases it can spread to other parts of the body.

Treatment for non-melanoma skin cancer
Surgery is the main treatment for non-melanoma skin cancer. This involves removing the cancerous tumour and some of the surrounding skin. Other non-surgical treatments for non-melanoma skin cancer as well as pre-cancerous skin lesions include: cryotherapy, anti-cancer creams, photodynamic therapy (PDT), radiotherapy, chemotherapy and/or electrochemotherapy. Overall, treatment is successful for at least 9 out of 10 people with non-melanoma skin cancer.

Confirming
Diagnosis (MM)

OVERVIEW OF DIAGNOSIS, STAGING AND TREATMENT
FOR MALIGNANT MELANOMA (MM).

Diagnosis of melanoma is relatively uncommon and can only be confirmed after a full professional assessment, appropriate biopsy, histological examination and specialist interpretation. If your dermatologist or skin specialist suspects a melanoma they may remove the mole (excision biopsy) and send it for examination by a histopathologist (a specialist who examines tissue) to check whether it is cancerous.

A biopsy is usually carried out under local anaesthetic. If a melanoma is confirmed another operation is usually required, most often performed by a plastic surgeon or dermatologist to remove a wider area of skin.

Staging of melanoma
‘Staging’ is the process of determining the size / depth of the melanoma and if / how far it has spread. It is used to determine how serious the cancer is and how best to treat it.

When the melanoma is removed, the depth of the tumour will be examined. This is the depth (measured in mm) from the surface of the skin at which the cancer cells are present at the time of surgical excision.

The earliest stage melanomas are stage 0 (melanoma in situ), and then range from stages I (1) through IV (4). Some stages are split further, using capital letters (A, B, etc.).

As a rule, the lower the number, the less the cancer has spread and the higher the number, the more the cancer has spread. Within a stage, an earlier letter means a lower stage. Most melanoma are less than 1mm thick and are less likely to grow back or require further treatment.

Further tests and treatments.
Further tests will be carried out if there is a concern the cancer has spread into other organs, bones or bloodstream. Patients with melanoma will be cared for by a team of specialists that should include: a dermatologist, a plastic surgeon, an oncologist, a pathologist and a specialist nurse.

When helping patients decide on their treatment, the team will consider: the type of cancer, the stage of the cancer and the patient’s general health. The team will then recommend what they believe to be the best treatment option.

The NHS have further information on the treatments for the various stages of melanoma.

Knowledge
Is Power!

THE KEY TO EARLY DIAGNOSIS,
IS

EARLY DETECTION AND
PREVENTION

IS ALWAYS BETTER
THAN CURE.
USE
THIS APP TO
LEARN MORE
AND TAKE
CHARGE
OF YOUR SKIN
HEALTH AND

SURVEILLANCE!

Remember, the sooner a skin cancer is identified and treated, the better a person’s chance of avoiding surgery, or in the case of a serious melanoma, potential disfigurement or even death.

Equally, when it comes to skin cancer, prevention is better than cure and the good news is that around 90% of cases are preventable by adopting simple sun safe practices.

Please use the various sections within this app that have been developed to empower you to take charge of your personal and your family’s skin health and surveillance as follows:

  • PREVENTION: Learn about the risks associated with UVR, how it affects our skin and how to prevent skin cancer by adopting sun safe strategies.
  • UV INDEX: Check the current and daily peak UVI, and the two day UV forecast for any location across the globe. Set SMS alerts to advise you when the UVI reaches 3+, when it reaches it’s daily peak and set 2 hourly sunscreen reminders.
  • RISK ASSESSOR: Understand your personal level of risk for the development of skin cancer based on your skin type, medical conditions, family history of skin cancer, lifestyle, history of sun exposure and sun protection habits.
  • EARLY DETECTION & DIAGNOSIS: Use this section of the app to learn about the various forms of melanoma and non-melanoma skin cancer, how to spot the early signs and symptoms when conducting your monthly examinations, what to do if you spot a suspicious lesion and how to ensure you receive appropriate action from a qualified healthcare practitioner.
  • SKIN CHECKER: Learn how to conduct thorough, full body self examinations and set reminders when your next monthly examination is due.
  • The Lesion Tracker enables you to track, monitor and compare changes to lesions using close-up photography and self-management tools. In addition you can conduct a self-assessment of any lesion for features suggestive of the various forms of both melanoma and non-melanoma skin cancer with the lesion assessment tool which provides comprehensive advice and signposting based on the outcome of your assessment.

Spotted A
Skin Cancer?

IF YOU SPOT A SKIN CANCER THAT HAS LEAD TO A CONFIRMED DIAGNOSIS BY A DERMATOLOGIST DUE TO THIS APP - PLEASE, PLEASE, PLEASE, LET US KNOW!

Everything we do at Skcin is aimed at preventing skin cancer and raising awareness of early detection by empowering people to take charge of their own skin health and surveillance. The only way we can evaluate the impact we are generating is if you tell us.

So, if you have used this app and subsequently had any form of skin cancer officially diagnosed as a result, please do get in touch with your story. You can remain anonymous if you wish or provide contact details if you are willing to share your story to raise awareness and help us in our mission.

To get in touch either: contact us here
or via the home page by selecting the ‘Feedback’ icon. Thank you.


SKCIN ARE WORKING NATIONALLY TRAINING EYES TO SAVE LIVES

In 2017 Skcin developed the first of our two unique national accreditation programmes designed to provide the Hair, Health & Beauty Industry and Allied Healthcare Professionals with bespoke, nationally accessible training to introduce and/or develop their knowledge of skin cancer prevention and early detection.

The many thousands of professionals who work across these industries see their client’s / patient’s skin up close, on a regular basis and often in places they can’t see themselves. This places these industry professionals in a powerful position to become the first line of defence in combatting the UK’s most common and fastest rising cancer.

Skcin’s MASCED (Melanoma and Skin Cancer Early Detection) training programmes teach professionals how to: detect suspicious lesions, how to approach their client’s / patient’s with any concerns; how to confidently advise they seek appropriate action from a qualified healthcare practitioner and how to extend their knowledge of skin cancer prevention across their client / patient communities.

The online training programme is backed up by quality printed resources to be kept in-salon or clinic for easy reference.

MASCED PRO training programme

The MASCED PRO training programme for Allied Healthcare professionals has been reviewed and is supported by the:

  • British Association of Dermatologists
  • British Association of Skin Cancer Specialist Nurses
  • British Dermatological Nursing Group
  • Endorsed by the Royal College of Podiatry
  • Accredited by The British Society of Dental Hygiene & Therapy

The MASCED programme for hair, health and beauty industry professionals has been reviewed and is supported by:

  • Habia (Hair and Beauty Industry Authority) endorsed provider worth 3 CPD points
  • BABTAC (British Association of Beauty Therapy & Cosmetology)
  • The Federation of Holistic Therapists
  • BBC (British Beauty Council)
  • NHBF (National Hair and Beauty Federation)

“I’ve referred 8 clients to their GP / dermatologist since completing your course. 5 were skin cancers. Mainly Melanomas. They wouldn’t have gone if I hadn’t encouraged them to go. They were on the chest area, the back and a leg. All have been so grateful.
Your course has saved their lives”.

Anyone working across any of these industries can join our growing army of over 10,000 MASCED professionals working to combat skin cancer nationwide.

To find out more or register visit: MASCED.UK

BACK TO TOP