Skin Lesions, moles and skin cancer

Skin lesions may require removal because:

1. they are suspicious for cancer (excision biopsy is performed – the lesion is excised and sent to the pathologist for evaluation);
2. they are catching on things, eg, hairbrush, belt, bra strap;
3. they are simply unsightly, in which case the lesion is exchanged for a scar, usually a fine, pale line. This should be an improvement over the lesion that is currently there.

Benign skin lesions include moles, or naevi, keratoses and many others. Moles are very common – the average adult has over 30 of them. They develop with age. They are usually pigmented, brownish, (but not always) and may be flat or raised.

Skin cancer is the commonest form of cancer, accounting for 40% of all cancers. It usually occurs in light skinned individuals and is related to UV exposure from the sun. It is important to know your skin and report any new or changed lesions to your doctor.

Suspicious pigmented lesions

A pigmented lesion is regarded as suspicious if it displays the above features. If suspicious it warrants an excision biopsy: the lesion is excised in its entirety and sent to the pathology laboratory for examination. The result may come back as benign in which case it is treated. If it comes back as malignant, further treatment and investigation may be required.

Skin Cancer – there are 3 main types:

The rodent ulcer or basal cell carcinoma is the most common form of skin cancer occurring in about 75% of cases. This usually presents as a non healing nodule or ulcer which can be felt and which may have tiny red blood vessels around its outside.

Treatments include cytotoxic creams such as effudix, freezing with liquid nitrogen, curettage and surgery. Surgical treatment is often best. Once the lesion is completely excised then the cancer is cured.

Squamous cell carcinoma is similar to basal cell carcinoma and occurs in 15% of cases. SCC may arise in chronic wounds or old scars such as burn wound scars. The treatment is as for BCC – usually surgery.

Malignant melanoma is the dangerous type of skin cancer, but fortunately only makes up about 5% of skin cancers. Malignant melanoma may present in a variety of different ways, most commonly as a pigmented lesion which has suspicious features as documented above.

 

Updated 9 November 2022