Skin Cancers

Approximately 12,000 people are diagnosed every year with non-melanoma skin cancer in Scotland, of which around 3,000 are squamous cell carcinomas (SCC). In addition around 1,200 malignant melanoma are registered per annum. The incidence of both melanoma and non melanoma 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. People 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. Some melanomas will have no major features.

The dermatoscope is a useful tool for trained clinicians screening pigmented lesions as it can increase diagnostic accuracy.

People presenting with a skin lesion suggestive of cancer should normally be referred to a dermatologist, depending on local arrangements.

Urgent suspicion of cancer referral

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 Asymmetry, Border irregularity, Colour irregularity, Diameter increasing or >6mm
  • New growing nodule with or without pigment
  • Persistent (more than four weeks) ulceration, bleeding or oozing
  • Persistent (more than four 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

Good practice points

  • 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
Quick Reference Guideline