Skin cancer – How is it diagnosed?

Over the past decade, there has been a steady increase in the number of patients diagnosed with skin cancer. This rise could be due to greater awareness from campaigns or an actual increase in prevalence due to environmental or other factors. 

Skin cancer is not a single entity; there are many different types. The most common type is basal cell carcinoma, followed by squamous cell carcinoma. Fortunately, melanomas, which tend to have a worse prognosis, are relatively uncommon compared to the other two types. Other types of skin cancers require specialist input for diagnosis.

Self-examination 

Our skin, being an external organ that protects the body, can be visualised without special equipment. Once a suspicious growth is detected, it’s crucial to see a dermatologist for confirmation and treatment. 

Since basal cell carcinoma, squamous cell carcinoma, and melanoma originate from the epidermis (the outermost layer of the skin), they are usually visible at an early stage before they can spread to other parts of the body. Therefore, dermatologists recommend regular self-examinations of the skin.

Self-examination is easiest after a bath or shower and should take no more than 10 minutes. Perform the inspection in a well-lit room with a full-length mirror and use a handheld mirror to view hard-to-see areas. A partner can assist with difficult-to-see areas, such as the back and scalp. Normally a once-monthly self-check and a yearly check-up with a dermatologist is the norm.

What to look out for

Skin cancers can be heterogeneous and can show up in many colours, shapes, and sizes. Therefore, you should be vigilant and should not just assume that it’s benign by comparing it to pictures online. Some of the more common ways in which skin cancers can appear include:

• A rough or scaly area on the skin, especially in sun-exposed areas, which may be sensitive, form a crust, and even bleed.
• A sore that has formed an ulcer and is not healing over time.
• A new, expanding, or changing growth or spot on the skin.
• A lesion that looks like a wart.
• A mole that is irregular in shape and colour, with indistinct borders.

ABCDE rule

Moles can be checked using the asymmetry, border, colour, diameter, evolving (ABCDE) rule. However, not all melanomas arise from moles; most melanomas develop from previously normal-looking skin and appear as a dark patch or growth. Any new or recently changed lesions should be considered suspicious.

Asymmetry – Check for any irregular shapes.

Borders – Examine if the lesion has well-defined edges.

Colour – Observe if the colour is uniform or if it exhibits different shades.

Diameter – Monitor for any increase in size beyond 6mm.

Evolution – Pay attention to any changes in the lesion’s appearance over time.

Visit a GP or dermatologist

If you have a suspicious skin lesion, consult a general practitioner with experience in skin cancer or go directly to a dermatologist. Dermatologists have the expertise and special equipment to analyse suspicious lesions closely. They can perform a biopsy (a skin sample) for further analysis, If necessary.

Biopsy

Many dermatologists can diagnose skin cancer immediately and promptly excise abnormal growths for analysis. This will be done in their rooms with a sedative. Most basal cell and squamous cell carcinomas are cured without further investigations or treatments. However, melanomas require staging, and treatment is administered according to international protocols.

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