Treatment

There are a range of treatments which will be tailored to treat your skin cancer. The specialist team will discuss the benefits, risks and side-effects of the treatments being offered prior to proceeding. Throughout  your care, procedures, surgery and treatment will not be carried out without your consent.

Skin cancer can be treated in a number of ways, or a combination of:

• Surgery
• Tropical creams
• Radiotherapy
• Immunotherapy
• Targeted therapy

Some skin cancers can be treated in the clinic (these include curettage and cautery, cryotherapy and excision) and some skin cancers can be treated with a cream. Other patients are booked for excision at one of the Northern Trust hospitals.

Patients requiring plastic surgery will be referred to the Ulster Hospital in Dundonald.

Radiotherapy for skin cancer is given in the Cancer Centre at Belfast City Hospital.

Immunotherapy is sometimes given for skin cancer, and is given in the Cancer Centre at Belfast City Hospital.

Treatment for each skin cancer is different.

Non-melanoma skin cancer

Most non-melanoma skin cancers are treated by surgery. This involves removing (excising) the skin cancer including a margin of normal skin around it. This technique is usually done under local anaesthetic. The wound can normally be closed with stitches but sometimes in larger and more complex skin cancers a graft or skin flap is required.

In some cases Mohs’ micrographic surgery may be necessary. This is a specialised type of surgery, also known as margin control excision, performed under local anaesthetic. It is particularly useful for basal cell cancers which do not have a clear edge, are at difficult sites on the face or when the basal cell cancer has come back again. This technique aims to make sure that all the tumour is removed while preserving as much normal skin as is possible.

For more information on the treatment of non-melanoma skin cancer including surgery, visit the Macmillan Cancer Support website.

Melanoma

The main treatment for melanoma is surgery. After biopsy, when the diagnosis has been confirmed, a second surgery or wide local excision is usually required. This is to make sure all the melanoma has been removed and to decrease the likelihood of the melanoma recurring. If a large area is removed a skin graft may be required. If the melanoma has spread to the lymph nodes then surgery to removed the affected lymph glands may be needed.

Occasionally other treatments are used after surgery if there is high risk that the melanoma may come back.

If a melanoma comes back after treatment and spreads to other organs then other treatments may be used either alone or in combination to try to shrink the tumour and control symptoms.

For more information on treatment of melanoma skin cancer including surgery, visit the Macmillan Cancer Support website.

Follow-up

On completion of skin cancer treatment many patients can be discharged with advice on checking their skin; others will continue on an outpatient review programme. The main reason for this is to make sure that the skin cancer has not come back or spread elsewhere and to provide the patient with support and information. Review appointments are also a good opportunity to discuss any worries or problems. At these appointments the patient will be seen by a member of the skin cancer multi-disciplinary team.

Self-examination of your skin

In general, patients who have already had a skin cancer are at a greater risk of developing another skin cancer. They are also more at risk of developing a recurrence at the site where the tumour was before. Therefore it is important to check the skin for changes once a month.

When carrying out a skin assessment it is important to check monthly in good light, check head to toe, including the soles of your feet and between your toes and nails. Asking for help or taking photographs of hard to see areas such as your back is also useful.

You should look for a rough or scaly crusty area, a rapidly growing lesion, a wound that never heals, changes to the size, shape or colour of any moles, a new mole, or one that looks different to others on the body.

The ABCDE guide is a useful tool:

Fore more information on the signs and symptoms a patient should look out for and for a quick guide to self-examination of your skin, visit the Melanoma UK website.

If any new symptoms are noticed, or if there are any worries between outpatient visits, the patient should discuss these with their GP who will arrange for an earlier appointment if necessary.

Self-examination of your lymph nodes

Skin cancer can on occasions spread into the lymphatic system. That is why as part of your examination your Doctor or Skin Cancer Clinical Nurse Specialist will examine your lymph nodes but it is important that you check them in between appointments and after you have been discharged. Lymph nodes are small bean shaped nodules which make up part of the lymphatic system and help fight infection.

Checking the lymph nodes once a month is sufficient and this can be done at the same time as you check the skin for any changes. Your doctor or nurse will show you which lymph nodes to check and how to do this. There is also a Youtube video which illustrates checking lymph nodes which you may find beneficial:

https://www.youtube.com/watch?v=AmSrD7-jt_8