Diagnosing skin cancer (non-melanoma)

Monday 1 February, 2016

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On this page: Recognising a skin cancer | Skin biopsy | Prognosis | Staging | Which health professionals will I see? | Skin cancer clinics | Key points


Recognising a skin cancer

Normal, healthy spots on the skin usually have a smooth edge and an even colour. Skin cancers don’t all look the same, but there are signs to look out for, including:

  • a spot that is different from other spots on the skin
  • a spot that has changed in size, shape, colour or texture
  • a sore that doesn’t heal
  • a spot that bleeds.

There is no screening program for skin cancer, so it’s important to get to know your skin. Checking yourself every three months, or as recommended by your general practitioner (GP), will help you notice any new or changing spots.

How to check your skin

In a room with good light, undress completely and use a full-length mirror to check your whole body. If you are on your own, use a handheld mirror to check areas that are difficult to see.

Pay particular attention to your face, neck, shoulders, arms, back of your hands, back, legs, the bottom of your feet and between your toes.

If you notice anything new or different on your skin, make an appointment with your GP or dermatologist straightaway. Skin cancers that are found and treated early need less invasive treatment and have a better outcome (prognosis).

Visit the SunSmart website for more information about checking your skin.

Smartphone apps

A number of smartphone apps allow you to photograph your skin at regular intervals and compare photos to check for changes. While these apps may be useful tools to remind you to check your skin, they should not be relied on to identify skin cancer. If you notice a spot that causes you concern, make an appointment with your GP or dermatologist straightaway.

Skin biopsy

If you notice any changes to your skin, your doctor will examine you, paying particular attention to any spots you have identified as changed or suspicious. If the doctor thinks you may have a skin cancer, they will usually take a tissue sample (biopsy) to confirm the diagnosis. A biopsy is a quick and simple procedure and is usually performed in the doctor’s office.

You will be given a local anaesthetic to numb the area, and the doctor will take a small piece of tissue from the spot or cut it out completely in a procedure called an excision. Often they will use stitches to close the wound and help it heal.

The tissue that is cut out will be sent to a laboratory, where a pathologist will examine it under a microscope. The results will be available in about a week.

If all the cancer is removed during the biopsy, this will probably be the only treatment you need.

Prognosis

Prognosis means the expected outcome of a disease. Your treating doctor is the best person to talk to about your prognosis. Most keratinocytic skin cancers are successfully treated if found early.

Staging

Staging is a way to describe the size of the skin cancer and whether it has spread. BCCs rarely spread and usually only need staging if they are very large. SCCs may require staging as they are able to spread, although this is uncommon.

Usually a biopsy is the only information a doctor needs to determine the stage of a skin cancer. The doctor may also feel your lymph nodes to check for swelling, which can be a sign that the cancer has spread.

Which health professionals will I see?

If you have a suspicious spot on your skin, there are a number of health professionals you may see.

General practitioner (GP)

Your GP knows your medical history and can examine your skin, including areas that are not exposed to the sun.

GPs can treat skin cancers using some types of surgery and by prescribing topical treatments. They may refer you to a dermatologist or surgeon if necessary.

Dermatologist

A dermatologist is a specialist doctor who is trained in preventing, diagnosing and treating skin diseases, including skin cancer.

You need a referral from a GP to see a dermatologist – without a referral, you will have to pay the full cost of the consultation and will not receive a refund from Medicare.

When you make the appointment, ask the receptionist about the cost of each procedure and how much will be refunded by Medicare, and check if there is a waiting list. If there is a spot on your skin of particular concern, your treatment should not be delayed. In this situation, your GP can request an earlier appointment.

Many public hospitals in large cities have dermatology outpatient clinics where care can be provided for free. Your GP can refer you.

In areas where there may not be a dermatologist, you may be able to see a visiting dermatologist or a general surgeon.

Surgeon

Some skin cancers are treated by a general surgeon, surgical oncologist or plastic surgeon:

  • general surgeon – can manage most skin cancers and perform reconstructive techniques, such as skin flaps and grafts
  • surgical oncologist – can manage complex skin cancers, including those that have spread to the lymph nodes
  • plastic surgeon – is trained in complex reconstructive techniques for areas that are difficult to treat, such as the nose.

Skin cancer clinics

Skin cancer clinics offer a variety of services and fee arrangements. They are usually operated by GPs who have an interest in skin cancer, although some are run by specially trained dermatologists.

Clinics may not necessarily offer a higher level of skill than your GP. In deciding whether to attend a skin clinic, it is important to find out about the services offered and the expertise of the staff.

Choosing a skin clinic

There are four main points to consider when choosing a skin clinic:

  • the qualifications and experience of the medical staff, including whether they are members of a professional association relevant to treating skin cancer
  • what you will have to pay – some clinics bulk-bill for the initial consultation but require up-front payment for further appointments or surgery (which may not be refundable by Medicare); others require up-front payment for all appointments
  • the diagnostic and treatment services offered
  • the information and follow-up provided.

Cancer Council does not operate or recommend any specific skin cancer clinics, and does not recommend specific specialists.

Key points

  • Although not all skin cancers look the same, signs include a spot that is different from other spots on the skin, a spot that has changed in size, shape, colour or texture or bleeds, or a sore that doesn’t heal.
  • Your GP can examine your skin and treat some skin cancers. They can also refer you to a specialist, such as a dermatologist or surgeon.
  • Your doctor will do a biopsy to determine whether the spot is cancerous. A biopsy is when tissue is cut out and examined under a microscope. You may have stitches to close up the wound.
  • The biopsy results will be ready in about a week. In some cases, a biopsy will be the only treatment.
  • A dermatologist is a specialist doctor trained in preventing, diagnosing and treating skin diseases, including skin cancer. You will need a referral from your GP to see a dermatologist.
  • You can make an appointment to see a dermatologist without a referral, but you will have to pay the full cost of the consultation and you will not get a refund from Medicare.
  • General surgeons and surgical oncologists are trained to perform surgery to treat skin cancer. In some cases, a plastic surgeon may be the treating specialist.
  • Some people go to a skin cancer clinic that is operated by a GP with an interest in skin cancer or, sometimes, by a dermatologist.
  • When choosing a skin cancer clinic, consider the staff’s qualifications and experience, the costs, and the services and information offered.

Reviewed by: Prof H Peter Soyer, Chair in Dermatology, Director, Dermatology Research Centre, The University of Queensland School of Medicine, Head, South-West Cluster, Deputy Head, School of Medicine, Director, Dermatology Department, Princess Alexandra Hospital, QLD; Christine Archer, Melanoma and Skin Cancer Specialist Nurse, Canberra Region Cancer Centre, ACT; Irena Brozek, Research and Development Officer, Cancer Programs, Cancer Council NSW; A/Prof T Michael Hughes, Surgical Oncologist, Associate Professor of Surgery, Sydney Adventist Hospital Clinical School, The University of Sydney, NSW; Dr Simon Lee, Head of Surgery, The Skin Hospital, Dermatologist, Sydney Skin, NSW; A/Prof Jonathan Stretch, Plastic Surgeon, Melanoma Institute Australia; Mark Strickland, SunSmart Manager, Cancer Council Western Australia, WA; Dr Tony Tonks, Plastic and Reconstructive Surgeon, Canberra Plastic Surgery, ACT; Leslie Tortora, Cancer Information and Support Service, Cancer Council Victoria, VIC; Dr April Wong, Poche Fellow, Melanoma Institute Australia; Robert Wood, Consumer.