Types of CancerNavigation
Skin cancer is the most common cancer in Ireland, with over 13,000 new cases diagnosed every year. The National Cancer Registry of Ireland (NCRI) expects this number to double by 2040. It is a disease of skin cells and nine out of every 10 cases are caused by UV rays from the sun or sunbeds. Over exposure to UV rays, which leads to tanning, redness or burning of the skin, causes damage to skin cells. While much of this damage is repaired some remains and can lead to skin cancer later in life (Irish Cancer Society 2022).
Early detection is also vital. If spotted early up to 90% of cases are curable. In the case of melanoma skin cancer, spotting it early can save your life. For this reason it is important to get to know your skin, check it every month for changes and speak to your doctor if you are worried. Click here for a self check skin chart.
Your Skin Cancer Team
The Skin Cancer Team is a wide multidisciplinary team that work together to provide you with the care and treatment you need during your cancer journey. There is a weekly meeting by members of the team called the MDT where pathology and radiology are reviewed and treatment plans are made based on the results of these, in keeping with international guidelines. Consultants work across the RCSI Hospital Group and patients are seen and treated in a number of centres, including Beaumont Hospital, Our Lady of Lourdes Hospital Drogheda, Connolly Hospital Blanchardstown.
The Team consists of:
- Consultants in Plastic Surgery, Dermatology, Radiology, Pathology, Radiation Oncology, Medical Oncology.
- Clinical Nurse Specialists and Advanced Nurse Practitioners
- Allied Health Professionals including Social Work, Physiotherapy and Occupational Therapy.
Dermatology Consultants – Provide diagnostic and early surgical management or other treatment of skin cancer patients.
Plastic Surgery Consultants – Provide diagnostic, early and more advanced surgical management of skin cancer patients.
Radiology Consultants – If you have a large, complex or advanced cancer you may have to have x-ray scans such as CT or MRI. The Radiology Consultant will examine your scans and attend the skin cancer MDT to discuss their findings.
Histopathology Consultants – Examine tissue sent to the lab from biopsies and excisional surgeries, and attend the skin cancer MDT to discuss the findings of this examination. This tells us the type of cancer cells found (the diagnosis) and how advanced a cancer is (staging).
Radiation and Medical Oncology Consultants – If you have more advanced skin cancer you may need radiotherapy or medical oncology treatment. Your Doctor will discuss this with you and refer you to the appropriate specialist.
Skin Cancer Nurse Specialists and Advanced Nurse Practitioners – provide support, advice and information throughout your cancer journey. You will meet them during your visits to hospital and they will provide you with contact details so that if you have questions about your treatment or supports that you need you can get information and advice from them.
Allied Health Professionals – These include Social Work, Physiotherapy, Occupational Health and Psycho Oncology. Referrals can be made to these services if you have need of them which is related to your cancer.
Referrals and Appointments
Beaumont RCSI Cancer Centre is one of the eight designated cancer centres in Ireland. Our centre provides a high quality symptomatic and familial risk service. Our clinics have been streamlined to provide the most effective and efficient service for patient care. The skin cancer service provides a rapid diagnostic service by triaging patients with malignant melanoma, basal cell and squamous cell carcinomas rapidly through the service. Special surveillance of patients with organ transplantation is in place to prevent, detect early on and treat any skin cancers in this at-risk group.
Referrals to the Skin Cancer Service are made by
- General Practitioners via Healthlink of if they don’t have access to Healthlink, via firstname.lastname@example.org
- By Consultant to Consultant referral.
Referrals are triaged by consultants when they arrive, as either urgent, soon or routine, and patients are referred to the appropriate clinic, e.g. pigmented lesion clinic, dermatology or plastics clinic.
What is Skin Cancer?
Skin cancers are generally named after the cells in the skin where they grow. There are two main groups of skin cancer:
Non-Melanoma Skin Cancer
These are the most common types of skin cancer and include basal cell and squamous cell carcinomas. They tend to grow in areas of the body that have been exposed to the sun and are more common in older people.
Melanoma Skin Cancer
Melanoma is a rarer form of skin cancer but greater numbers of people are being diagnosed with it each year. It is also a disease that affects young people.
Melanoma is one of the most serious forms of skin cancer but if spotted early, it is very treatable. If not, it can spread to other parts of the body and cause serious medical issues.
Investigations for Skin Cancer
Investigations for Skin Cancer
Biopsy of a Skin Lesion
A biopsy is a sample of tissue taken from a skin lesion when there may be a skin cancer. Usually the most suspicious part of the lesion is taken and sent for histopathological analysis.
Excision of a Skin Lesion
This is a minor surgical procedure removing the entire skin lesion and sending it for histopathological analysis. It is sometimes called an excisional biopsy.
All biopsies and excisions are sent to the laboratory for examination by a pathologist to confirm that it is a skin cancer and determine the type of skin cancer. If your cancer has spread to the deeper levels of the skin your Doctor may send you for further tests to stage the cancer. The cancer cells may also have other tests such as immunohistochemistry markers or genetic mutations done to help decide on your treatment.
Wider excision of Skin Cancers
Some cancers require a wider or deeper excision following the first biopsy of excision, depending on the Pathologists report and discussion at the skin cancer Multidisciplinary Team Meeting.
Sentinel Lymph Node Biopsy:
This is sometimes used in melanoma skin cancer. A sentinel lymph node biopsy (SLNB) is a surgery that removes the sentinel lymph node. A sentinel lymph node is the first lymph node which the cancer is likely to spread to. This is then examined under a microscope to see if it contains any cancer cells. It is used to see if a melanoma has spread to the lymph nodes from the original site. Cancer cells are most likely to travel in an orderly way to the sentinel node first before spreading to other nearby lymph nodes. In some cases there may be more than one sentinel lymph node. It is often carried out at the same time as wider excision of the melanoma skin lesion/scar and requires a general anaesthetic, but usually as a day case procedure. Please Click here for more information.
If your skin cancer is complex or not at an early stage cancer, your Doctor will arrange for you to attend for radiology scans to check the extent of the cancer and if it has spread to other parts of the body. The type of scan you have will depend on the location and how advanced the cancer is.
- CT Scan – The type of CT will depend on the location of the cancer
- MRI – The type of MRI will depend on the location of the cancer
- PET Scan – A full body scan which is most commonly used in more advanced melanoma.
The treatment you have will depend on the type of cancer that you have and how advanced it is. When you are first seen you will meet your Consultant. skin cancer team member and/or Specialist Nurse. They will review your skin lesion and decide the most appropriate treatment for you. Some of the common treatments for pre-cancer or early non-melanoma skin cancers are:
Non Surgical Treatments
An area of pre-cancer/cancer cells are destroyed by a method of freezing using liquid nitrogen.
Topical cream chemotherapy
Cream is placed directly on your skin to kill the cancer cells. This can only be used at the early stage of skin cancer.
Cream that contains an immunotherapy drug that is placed directly on your skin. This helps the body’s immune system to attack the cancer cells. This can only be used at the early stage of skin cancer.
A treatment using a light-sensitive cream and a light to destroy skin cancer cells. This can only be used at the early stage of skin cancer.
Surgery of Skin Cancers
An excision is when the entire lesion is surgically removed. This is usually done under local anaesthetic as a day case, but may require a general anaesthetic if more advanced or complex. More advanced/complex cancers may also require complex reconstruction and occasionally an inpatient stay. Your Doctor will provide you with more information regarding this when they see you in clinic.
Wide Local Excision
If your skin cancer is a melanoma or for certain types of non-melanoma skin cancers, you will have a wide local excision after the initial lesion is excised. The scar from the previous excision, with a margin of healthy tissue will be fully removed to ensure that all cancer cells are excised. For more information about wide local excision Click here.
Reconstruction with Skin Grafts or Skin Flaps
In some cancers that are large or in certain locations (such as the nose, eyelid, scalp), it may not be possible or advisable to suture the wound closed and a reconstruction will be required. This is usually done at the same time as the excision by the plastic surgeon. Common reconstructions include skin grafts and skin flaps.
Skin grafts involve covering the wound with skin taken from another part of your body (the donor site). They can be full-thickness or split thickness skin grafts
Full Thickness Skin Grafts
Full Thickness Skin grafts are where the entire thickness of the skin is taken from another part of the body to match the colour, texture and thickness of the skin lesion removed. They are usually done in the face with skin grafts taken from behind or in front of your ear or neck.. The donor site where the full-thickness skin graft is taken from is sutured closed.
Split Skin Grafts
Split skin grafts are used for larger areas removing only the upper portion of the skin as a thin sheet . These are usually taken from the thigh with special instruments. The donor site is usually covered with a dressing for about 10-14 days.
In some situations, a skin flap may be used to reconstruct the defect after removal of the skin cancer. This is a more complex surgery where skin and a subcutaneous fatty layer is moved usually from an adjacent area to resurface a defect rather than using a skin graft. The area where the skin flap was moved from is usually sutured closed. A skin flap tends to give more padding and often a much better colour and contour reconstruction than a skin graft will, or is used where a skin graft will not heal. The choice of whether reconstruction is needed and which type can be discussed with your plastic surgeon at the clinic or before the surgery.
Such excisions and reconstruction are most commonly done at the same time under local anaesthetic as a day case but may require a general anaesthetic if more advanced or complex and occasionally an inpatient stay is needed
For information on caring for your wound after surgery click here.
Lymph node surgery can be a staging procedure (Sentinel Node Biopsy) or a treatment procedure (Removing Lymph Nodes / Lymph Node Clearance)
Sentinel Node Biopsy – See above under Investigations for Skin Cancer
Removing Lymph Nodes (Lymph Node Clearance or Dissection)
If the cancer has spread to nearby lymph nodes, the Doctor may decide to remove that group of lymph nodes, for example in the axilla, the groin or the neck. This has usually been discussed at the skin cancer Multidisciplinary Team Meeting. This surgery is performed under general anaesthetic and usually requires an inpatient stay and a drain inserted. The stitches will be removed about 7-10 days after surgery.
For some surgeries such as lymph node clearance surgery, it may be necessary to put a drain in the wound for some time afterwards, to prevent a build-up of fluid the body naturally produces in the early stages of healing. If your drains are not removed while you’re in hospital, you may be discharged with the drain in place. You will be shown how to look after it before you leave hospital. For more information on caring for your drain Click here.
Radiotherapy is where high-energy rays are used to shrink or destroy the skin cancer. It can be an option for people with multiple skin cancer sites, people who cannot have surgery or people whose cancer has spread to their lymph nodes. For more information about Radiotherapy click here.
Immunotherapy treatment helps your immune system to work better in order to overcome and destroy cancer cells. This treatment can help the immune system recognise and clear cancer cells from the body and attack the cancer cells directly. There are different types of immunotherapy treatment. This treatment can cause side effects, such as inflammation. Your doctor and nurse will explain your treatment to you in more detail and inform you about likely side effects.
Beaumont Daffodil Centre
The Daffodil Centre is a supportive cancer information service provided by the Irish Cancer Society, that is located in the main entrance hall in Beaumont Hospital. For more information click here.
Phone: 01 7974880
ARC Cancer Support
For more information about ARC Cancer Support click here.
Phone: 01) 215 0250
Have you thought about quitting smoking?
If you do smoke, it is never too late to quit. If you would like advice on how to do this please speak to any of our doctors or nurses.
Beaumont Quit Smoking advisors 01 8092941
Quit line 1800 201 203 or try the website QUIT
National Cancer Helpline Phone: 1800 200 700