Skin cancer is the commonest malignancy in the UK and in many other European populations, with the number of cases exceeding those for all other malignancies combined. The bulk of the diagnosis and management of skin cancer is undertaken by dermatologists, with the development of dermatological surgery and Mohs surgery changing the clinical landscape. But for every case of suspected skin cancer we see, we will be referred between 5 and 25 other cases. As ever in dermatology, clinical skills remain paramount, with investigations playing a limited role (it is not practical to biopsy everything….).
This is a very brief introduction to the subject. I remind you of the role of UV and DNA repair, and how pigmentation, latitude, and body site are key determinants of cancer rates, as well as immunological status. I briefly outline the main classification of skin cancer, into melanoma, and non-melanoma skin cancer. I outline the differences in epidemiology and case fatality between these main types.
The clinician's approach (skincancer909 one minute video series)
Précis of the video
This is a video from the skincancer909 one minute series. It explains how clinical practice is — in part — about attaching semantics to images, and why understanding the concept of signal to noise is fundamental to how we think about skin cancer diagnosis.
The assessment of a pigmented lesion is a core dermatological skill. Is it a melanoma, or an ordinary nevus? If it is dark brown, does this mean it is melanocytic, or can keratinocytic lesions look brown (and where do they get the melanin from, then?).
If you think something ‘might‘ be a melanoma, how do you proceed? Is an incisional biopsy OK, or do you need to do a wide local excision straight away? What size margins should you take, and what do you need to ask of your dermatopathologist?