Facing a skin cancer diagnosis often raises crucial questions: Will it recur? Can it spread? Is it curable? As an experienced oncologist specializing in skin cancer, I’m here to address these concerns and guide you through your treatment options.
Many of my patients deal with skin cancers in delicate areas like the eyes, nose, or lips – regions most vulnerable to sun damage and aesthetically important. I offer advanced nonsurgical treatments that effectively target cancer while preserving your appearance.
Skin cancer, primarily caused by UV exposure, can also be influenced by genetics, fair complexion, and immune status. Each case is unique, requiring personalized care.
Understanding your specific situation, treatment possibilities, and their potential outcomes is vital. I’m committed to providing you with comprehensive information and expert care. Let’s work together to find the most effective approach for your skin health and peace of mind. Don’t hesitate to schedule a consultation to discuss your concerns and explore your options.
What is non-melanoma skin cancer?
The most frequently occurring skin cancers that I see in my clinic are basal cell carcinoma and squamous cell carcinoma. Even before the patient has sent me their diagnostic reports, I can usually tell which type of skin cancer they have. When booking the appointment, patients with a basal cell carcinoma will often say that they have ‘a skin cancer with a hole in the middle’. Alternatively, if it is a squamous cell cancer they may say ‘I have a skin cancer with crusting’ or even ‘a skin cancer with a horn’.
Basal Cell Carcinoma is the most commonly occurring type of skin cancer, accounting for approximately 80% of all cases. Squamous cell carcinoma is also a common cancer and, is more dangerous in so far as it is more likely to spread.
The treatment priorities and necessary investigations for the two cancers differ. It’s therefore important that we know exactly what we’re dealing with before we embark on a treatment course. If left untreated, over time, a basal cell carcinoma will continue to grow and as it grows, destroy the normal tissues that lie in its path. It is however, incredibly rare for basal cell carcinoma to spread to other parts of the body. Conversely, squamous cell carcinoma has a much higher likelihood of spreading to local lymph nodes or elsewhere in the body. The investigations are required before starting treatment to therefore differ between the two types. For the vast majority of patients I see, the treatment I offer aiming at curing them of their skin cancer.
The importance of early treatment
Caught early, skin cancers are highly treatable. It’s best for treatment to start as soon as possible after the lesion appears for many reasons. Firstly, the earlier skin cancer is detected and treated, the higher the rate of cure. Early tumours are also much less likely to spread to other parts of the body. Once the skin cancer has spread, it makes treatment much more difficult and cure rates are not as good. The smaller the lesion is when we come to treat it, the less impact the treatment will have on your appearance and the cosmetic outcome will be much better.
Because I often treat skin cancers that occur on the face, It’s important to treat the cancer early because if it’s allowed to infiltrate into the eyelid or into the lip, it can significantly affect the function of these tissues, which leads to symptoms that are difficult to manage. It’s tempting to think that if a skin cancer has taken a long time to develop, you can wait for treatment. I urge you to seek treatment with me as soon as you are aware of the skin cancer to give you the best chance of cure, ensuring all treatment options are available to you, and maintaining your looks.
If your cancer has skin cancer has spread or is too extensive to be removed or treated with radiotherapy, I can offer drug treatments including targeted therapy or immunotherapy.
What does skin cancer look like? What are the symptoms of skin cancer?
Basal cell carcinomas and squamous cell carcinomas have different appearances, but it’s important to have a biopsy to confirm the diagnosis as there can be a crossover in appearances of the two.
Basal cell carcinomas classically look like a smooth growth with a raised edge and a dent or a dimple in the middle. Or they can appear as a waxy looking lump or a red patch. Sometimes they can be white/pale/yellow scar-like area.
Squamous cell cancers usually appear as scaly red patches or hard crusty lesions. Sometimes they can be wart like lumps or sores that bleed easily do not heal. If you have a skin lesion like this and you notice a lump in a lymph gland, such as a lymph gland in your neck, it’s important to seek medical attention as soon as possible.
I’m often asked if skin cancer is painful. Skin cancers are not usually painful. The most common symptoms are of a change in appearance of the skin or itching. If the skin cancer grows very rapidly or ulcerates, then it could cause local pain or tenderness.
What can you expect at your skin cancer appointment?
Most patients I see are referred by dermatologists with a skin cancer diagnosis. I work closely with various skin experts, including plastic surgeons.
In our meeting, we’ll discuss your previous investigations and results. I’ll explain treatment options, focusing on non-surgical approaches, and we’ll choose the best course together based on your priorities and overall health.
My goal is to cure your cancer where possible. In cases where the cancer has spread, we’ll discuss the best options to control it while maintaining your quality of life.
Once we’ve decided on a treatment plan, I’ll personally manage your care at a centre that can start promptly. All appointments will be as long as needed for you to feel confident in your decision. You’re welcome to bring someone for support.
Treatment is typically outpatient-based. I’ll tailor the number of treatments to give you the best chance of cure with optimal cosmetic outcomes.
You’ll meet a clinical nurse specialist for support throughout your treatment. We’ll discuss sun protection and skin care during and after radiotherapy.
After treatment, we’ll stay in close contact to manage side effects and ensure proper healing. Once early side effects settle, we’ll create a personalised follow-up plan based on your recurrence risk and future assessment needs.
What are the non-surgical options to treat skin cancer?
For curative treatment of skin cancer, I primarily use external beam radiotherapy, either superficial X-rays or electrons. These target the skin effectively without deep penetration, minimising side effects.
Treatment planning begins with defining the area to treat and shielding normal skin and other body parts. Precision is crucial for optimal cancer eradication and minimal visible skin changes. I’ll ensure sensitive structures, like the eye lens, are protected to prevent long-term side effects.
Radiotherapy is given in multiple ‘fractions’ to damage the cancer while allowing normal skin to heal. I’ll recommend the number of treatments before we start.
For selected patients unable to undergo external beam radiotherapy, I offer Rhenium-SCT. This alternative can potentially cure your skin cancer in a single treatment.
We’ll discuss the pros and cons of both options before making a decision together.
For advanced skin cancers, I offer drug treatments including vismodegib for basal cell carcinoma and immunotherapy for squamous cell carcinoma (Cemiplimab). In some cases, I used chemotherapy to treat skin cancer.
Why would you choose radiotherapy over surgery for skin cancer?
Radiotherapy is a valuable treatment option for Basal Cell Carcinoma and Squamous Cell Carcinoma, especially in cases where surgery might not be possible – either because of the tumour or your general health making surgery high risk. Some of the advantages of radiotherapy over surgery for treating skin cancer include:
Non-Invasive Treatment
Radiotherapy is a non-invasive treatment method, which means it doesn’t require any incisions, injections, or physical removal of tissue. This can be particularly beneficial for patients who are not good candidates for surgery due to other health issues or those who prefer to avoid surgical procedures for any reason
Keep your looks
Radiotherapy can be an excellent option for treating skin cancers located in cosmetically sensitive areas, such as the face, ears, or neck. Unlike surgery, which might leave scars or require reconstructive procedures, radiotherapy can treat the cancer without significantly altering your appearance.
Suitable for Difficult-to-Treat Areas
Some skin cancers are located in areas that are difficult to treat surgically due to their size, location, or proximity to vital structures. Radiotherapy can effectively target these areas without the need for complex surgical interventions.
Less Impact on Function
Radiotherapy minimises the risk of affecting the function of nearby structures. For example, skin cancers close to the eyes or mouth can be challenging to remove surgically without affecting the how the eye lids or lips work. Radiotherapy can treat the cancer while preserving the function of these areas – reducing the risk of things like long term watery eye.
Pain-Free Treatment
Radiotherapy is generally painless during administration. Patients might experience some side effects after treatment, but the procedure itself does not involve the discomfort associated with surgery and post-operative recovery.
Lower Risk of Infection
Since radiotherapy is non-invasive, there is no risk of surgical wound infections, which can be a concern with surgical treatments. This can be particularly advantageous for patients with compromised immune systems or those at higher risk of infections.
Effective for Recurrence Prevention
Radiotherapy can be used effectively to treat skin cancers that have recurred after previous surgeries. Also, it can target residual cancer cells that surgery might have missed, reducing the likelihood of further recurrences.
Skin Cancer Case Studies
Mrs AZ
The first thing that Mrs AZ to me when she came into my clinic room, before she’d even sat down, was ‘My granddaughter is getting married in August and I can’t have this thing on the end of my nose in the photos!’
She went on to tell me how she’d been ignoring the crusty lesion on the tip of her nose for at least 6 months before finally seeing her GP. The week before she came to see me, she’d been to see a plastic surgeon who informed her that, unfortunately, to effectively remove the skin cancer, she’d have to lose the end of her nose. This news had hit her hard.
At the age of 79, the thought of losing the tip of her nose was unappealing – even with the best reconstruction on offer.
She’d spent her life outside – she enjoyed the great outdoors and was a passionate rambler and gardener. As a child, she’d grown up in Egypt as her father was in the army. From middle age, she’d been an antiques dealer and spent 5 days each week working at outdoor trade events. In her heart, she knew that the non-healing ulcer, that she first thought was a persistent pimple, could be a skin cancer, but it took her a long time to seek help.
She eventually saw a dermatologist who took a biopsy that confirmed that it was a basal cell carcinoma.
Mrs AZ was understandably anxious and upset when she came to see me. She thought that her only option was disfiguring surgery. Thankfully, I was able to offer her an attractive alternative.
Over the course of two weeks, she received 10 radiotherapy treatments. She attended the hospital for less than 30 minutes each time. She was able to carry on with her life as normal throughout the treatment. She drove herself to her treatment each day.
As predicted, she experienced some tiredness in the period immediately after the radiotherapy finished. She also had a predictable skin reaction – the skin at the site of the skin cancer became red and sore towards the end of treatment and for a couple of weeks afterwards. Eventually the skin formed a scab which repeatedly came off until new, healthy skin appeared from underneath. As she was forewarned about this temporary change in her appearance, she was able to schedule her social activities around it. I saw her regularly during this period. For a short time, I recommended some dressings to cover the treated skin at night – just to make it more comfortable while she slept and to protect her pillowcases.
By the time I saw her 6 weeks after the treatment had finished, the skin had completely healed. The skin where the cancer had been had a slightly different texture to the skin around it, but nothing that was obvious or immediately apparent. She was over the moon with the appearance of her nose – not only had the cancer gone, she hadn’t lost the cartilage and skin of the tip of her nose.
When she came to see me in the September of that year, I was pleased to see her confident smile in the photographs she brought from her granddaughter’s wedding. It was clearly a proud day for her – a day she could enjoy without worrying about her appearance.
Patient testimonials
James Wilson’s way of looking after me was attentive, friendly, reassuring, and was totally focused on my needs. He took the time to listen and understand my concerns and gave me a real sense that I had a choice in how my treatment would proceed. I knew he genuinely cared.
– Mr EO (received radiotherapy for skin cancer)
I feel very lucky to have Dr Wilson as my clinical oncologist and I have enjoyed meeting him. He struck me as extremely able and he was very happy to explain my treatment to me in detail. Overall, I had the impression that my radiotherapy treatment was meticulously planned and executed.