Skin: Key Points

Melanoma

Incidence:	4000 cases p.a. in England & Wales (1992) Note: The incidence is increasing markedly (approx 6% p.a.).
Age:	Affects all adult age groups.

• Risk factors:
• excessive U.V. exposure
• fair skin, poor ability to tan
• large number of benign melanocytic naevi
• family history

• Commonest locations:

women	:	50% on lower leg
men	:	33% on back

• Biopsy : It is not recommended that patients with suspected melanoma are biopsied in a general practice setting. Patients should be referred with the lesion intact to the local specialist.

Squamous Cell Carcinoma

Incidence:	9000 – 10,000 p.a. (estimate) Note: The incidence is increasing markedly (approx 6% p.a.).
Age:	Rare in patients aged < 60 years unless immunosuppressed.

• Risk factors:
• lifetime excessive sun exposure
• multiple small actinic keratoses
• fair skin
• poor tanning ability
• transplant recipients

• Commonest locations:

both sexes	:	face
		back of hands
men	:	scalp and ears
women	:	lower legs

• Cancers tend to be larger (> 1 cm) than actinic keratoses and have a palpable component deep to the skin surface.

Basal Cell Carcinoma

• Very common, but metastasize very rarely, so there is no reason to refer urgently.

• Location : majority are on the face, particularly around the inner canthus and nose.

• Appearance: Slowly growing red pearly nodule on skin surface. Later may break down with crusting to give the classic ‘rodent’ ulcer.

• The slow growth and low metastatic potential of these lesions mean that they do not need to be seen within 2 weeks. Nevertheless patients with suspected basal cell carcinoma should be seen by a specialist within 3 months.