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TYPES OF SKIN CONDITIONS

There are 3 main types of non-melanoma skin cancer (NMSC), actinic keratosis (AK), basal cell carcinoma (BCC) and Bowen’s disease.

Actinic keratosis (AK)

Actinic keratosis is commonly known as light or solar keratosis, skin lesions that usually take the form of coarse or crusty changes to areas of the skin which have been over-exposed to the sun. The areas primarily affected are the face, nose, ears and scalp. People with skin that is sensitive to the sun are more predisposed to developing actinic keratosis, as they have less natural protection against the sun. People whose immune system is permanently impaired also have a higher risk of developing the disease.

Although actinic keratosis is a non-invasive non-melanoma skin cancer it is regarded by healthcare professionals as a tumour condition requiring treatment. This is because it may progress to a more aggressive form of skin cancer known as squamous cell carcinoma. A study has shown that around 65 percent of cases of squamous cell carcinoma may begin as actinic keratosis.1

Actinic keratosis can appear in very different ways, for example as patches or areas of skin with a rough or scaly surface. The affected areas are mostly reddish, sometimes also reddish –brown, yellowish or skin coloured. The size of the lesions usually varies between one millimeter to around two centimetres. However, keratosis may be much larger beneath the surface, especially in people who have several lesions.

Basal cell carcinoma (BCC)

This cancer develops from basal cells in the deepest layer of the upper skin (epidermis). Diagnosed most often in individuals of middle or old age basal cell carcinoma is found most commonly in areas of skin exposed to the sun including the face, forearms and head.  However, basal cell carcinoma can develop on your back or lower legs.

Basal cell carcinoma may start as a small lump that gets bigger. The edges usually have a shiny or pearly look. The middle is usually depressed (sunken). Sometimes the middle becomes an ulcer, a sore hole. Or sometimes there is a crust in the middle. They do not usually hurt unless knocked. But they can be itchy and may bleed if scratched. If the basal cell carcinoma is not treated they can get bigger, wider and deeper. They can affect other types of tissue such as cartilage or even bone. Early treatment reduces the risk of other types of tissue being affected.

It is very rare for a basal cell carcinoma to spread to other parts of the body, but it is possible to have more than one basal cell cancer at any one time.

Bowen’s disease

These commonly show themselves as red scaly patches, which usually occur on light exposed areas for example lower legs, arms and face. These areas have abnormal skin cells.  Very rarely these abnormal cells develop into a low grade form of cancer.

TOP TIPS

Sunscreen protection

Many cosmetics and skincare products now include SPF 15 for everyday protection, whatever the weather. For general sun protection you should wear a sunscreen with
a high sun protection factor (SPF 30 is recommended ). Look out for sunscreens with “broad-spectrum” on the label, which means it protects against the sun’s UVA and UVB rays. Remember to put it on at least 15 minutes before going outside. Reapply sunscreen at least every 2 hours or more often if you’re sweating or swimming.

Avoid hottest part of the day 

Avoid being out in the sun when it is at its hottest from 10 a.m. to 2 p.m.

Know your skin 

Check your skin regularly so you know what’s normal for you and to notice any changes or new growths.

Don’t use tanning beds!

Cover up

Wear wide-brimmed hats, long-sleeved shirts and trousers when out in the sunshine

Best practice

Protect your child’s skin and practice the safe sun tips together

Eye protection

Wear sunglasses with total UV protection.

TREATING NMSC

There are a number of treatment options available to people with non-melanoma skin cancer (NMSC).  The treatment option is an individual choice to suit your needs.  You will be informed by your healthcare professional team but you should also feel confident to ask questions to ensure you get the best treatment for yourself.

Our community PDT service enables non-melanoma skin cancer patients to be treated in a community setting, which has led to a reduction in elective outpatient procedures and potential CCG savings of up to £400,000 per annum.2

Skin condition treatment options

PHOTODYNAMIC THERAPY (PDT)

Photodynamic therapy is an effective treatment option giving excellent cosmetic results as it preferentially destroys the damaged cells. PDT involves applying a photosensitising drug to the affected area.  Once this has been absorbed a red light is shone onto the area to be treated, which triggers a reaction in the damaged cells causing them to die.  After some initial inflammation the skin then repairs itself leaving you with healthy looking skin.

Side effects can include locally where the drug is applied, skin reactions, pain and swelling.

PDT can be delivered with a large light in a hospital and in some cases with a stick on plaster, (Ambulight), which can be taken home to complete the treatment.

Step 1

The application of a gel or cream containing the photosensitising agent is applied to the skin lesion.

Step 2

Absorption of the drug into the eperdrmis (the outer layer of the skin) and then subsequent conversion of the drug to an active photosensitiser, typically this takes 3 hours.

Step 3

Followed by controlled exposure of light via an external source. The external light source induces a photoactive reaction which activates the drug and destroys the skin cancer cells.

References:
1.Feldman SR, Fleischer AB, Jr. Progression of actinic keratosis to squamous cell carcinoma revisited: clinical and treatment implications.Cutis 2011;87(4):201-7
2. Community PDT Cost Model, Data on file. Spirit Healthcare June 2014.

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