Skin Cancer Q&A

Ask the Consultant

Three of our leading skin cancer specialists answer common questions on skin cancer including signs and symptoms, early diagnosis and effective treatments.

Dr Andrew Birnie
Skin cancer is the most common form of cancer in the world. It is typically divided into two main categories; melanoma and non-melanoma skin cancer (NMSC). Melanomas are derived from melanocytes; the cells that produce melanin, which is why they are often deeply pigmented. These are typically the most dangerous, though if caught early the majority do not require further treatment following wider excision. There are a number of types of NMSC, but the two most common are squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). SCCs often grow quickly and a small proportion can spread. BCCs are the most common form of skin cancer but, if treated appropriately, almost never spread.


Dr Robert Herd
Skin cancer can be divided into melanoma and non-melanoma skin cancer. The most serious type is melanoma. If not treated early it can spread and cause serious disease. Basal cell carcinoma is the most common type of cancer and can usually be treated easily if identified early by surgical excision. Squamous cell carcinoma is also a non-melanoma skin cancer and only rarely spreads. It is usually treated by surgical excision.


Dr Sandeep Varma
Skin cancer is the name given to any cancer that arises from a structure of the skin. The three commonest types of skin cancer are Basal Cell Carcinoma, Squamous Cell Carcinoma and Malignant Melanoma.

Dr Andrew Birnie
Skin cancers will usually be noticed as a new or changing lesion on the skin, or a wound that never heals. Skin cancers are not always symptomatic, though some SCCs can be tender to touch.


Dr Robert Herd
Skin cancer appears as a new or changing blemish on the skin. Melanoma is usually brown or black in colour and can be quite irregular in outline and in colour. It can occur on any part of the skin but is most common on the legs of women and the backs of men. Non-melanoma skin cancer most commonly occurs on the head and neck, on sun-exposed areas. Its appearance can vary from being a smooth or scaly lump to a flat, scarred looking patch.


Dr Sandeep Varma
Basal cell carcinoma can bleed then scab, then bleed then scab. Often the lesion looks like it will heal, only for the scab to come off in the shower, on the towel or on the pillow and bleed.

Squamous cell carcinoma grows like a lump often and can sometimes cause pain but it can be a symptomless growing lesion.

Melanoma can be surprisingly symptomless and usually presents as a new mole that grows or a pre-existing mole that changes in size, shape, colour.

Dr Andrew Birnie
People with fair skin and those who have had a lot of uv exposure.

The lighter your skin the greater the risk, so those people who have skin that burns and never tans in the sun are at most risk. There is still some debate as to exactly how uv light is involved in the development of skin cancer, but it is thought that intense periods of sun exposure and burning episodes are the biggest contributor to the development of melanoma. Cumulative uv exposure plays an important role in SCCs.

Typically, skin cancer affects older people, but melanoma is one of the commonest cancers in adolescents and young adults. Increasingly, I am seeing people in their 20s and 30s with BCCs who have used sunbeds.


Dr Robert Herd
The risk factors for all the common skin cancers are skin type and sun exposure. Those with pale skin and those who have had a lot of sun exposure are most at risk. The main risk factors for melanoma are pale skin type, a large number of moles, a history of sun burns and use of sun beds. The pattern of sun exposure that leads to basal cell carcinoma is total sun exposure up to a certain threshold. For squamous cell carcinoma it's total cumulative sun exposure.


Dr Sandeep Varma
Fair skinned individuals with skin that burns easily and tans poorly. Those who have experienced a lot of sun exposure through holidays, work, hobbies, or leisure. Those who have used sun beds or experienced blistering sunburn. Those with lots of moles or freckles. Family history can be important.

Dr Andrew Birnie
Yes, there is definitely a genetic link. Someone with an immediate family member (parent or sibling) who has had a melanoma is probably twice as likely to develop a melanoma than one with no family history.

There are some genetic conditions in which affected individuals develop large number of skin cancers. Fortunately, these are very rare, but if a relative has had a number of BCCs it may well increase an individual's risk of developing one, too.


Dr Robert Herd
A family history of sun exposure gives a small increased risk of skin cancer. It is therefore sensible that these individuals should avoid sun exposure.


Dr Sandeep Varma
People with a family member who has had skin cancer should take extra precaution by keeping a check on their skin for any new moles that grow or change quickly. Be alert for any lumps that grow unusually or bleed or scab. Use sunscreens if they burn and a broad brimmed hat and long sleeved clothing. The sun should also be avoided between 11am and 3pm.

Dr Andrew Birnie
If someone spots a new or changing lesion then they should see their GP. Unless they are confident it is benign, the GP will refer the patient to the local skin cancer clinic or dermatologist. The specialist will then see the patient, take a history and examine them. With melanomas the dermatologist will be looking for asymmetry, an irregular border and variable colours, they may also use a device called a dermatoscope to look more closely at it.

If the specialist suspects a cancer then they will often excise the whole lesion and send it for pathology, though with BCCs and SCCs a biopsy may be taken first to help determine the right form of treatment.


Dr Robert Herd
Skin cancer is detected by seeing a lesion on the skin that is either new or changing. This should then be examined by a doctor, and if skin cancer is suspected, they should be referred to a dermatologist or other specialist. The specialist will then either reassure the patient or perform a biopsy to identify the precise diagnosis.


Dr Sandeep Varma
A history and clinical examination are usually enough to diagnose skin cancer. Dermatoscopy is extremely useful but if there is any doubt then a biopsy can help with the diagnosis.

Dr Andrew Birnie
In most cases for melanoma the appropriate treatment is a wide excision. Certain medication may be an alternative treatment.

BCCs and SCCs are typically excised, sometimes with a more advanced technique called Mohs micrographic surgery, but they can also be treated with radiotherapy.


Dr Robert Herd
Excision of the cancer is a common treatment, with a range of other treatments are available for more complicated and advanced skin cancers.


Dr Sandeep Varma
There are many options, surgical and non-surgical and these depend on the skin cancer. Most skin cancers can be treated under local anaesthetic. There are various medications that can be an alternative appropriate treatment.

Dr Andrew Birnie
I am very proud to be an internationally recognised Mohs micrographic and dermatological surgeon. I have lectured to and taught national and international audiences of both peers, GPs and trainees through the British Society for Dermatological Surgery and international societies.

In 2010 I took a sabbatical to Durban, South Africa, where I helped set up a skin cancer centre, offering free treatment for those who could not afford care, from which I trained the local dermatologists in skin cancer surgery. I also travelled in South Africa teaching in a number of cities.

However, I gain the greatest satisfaction when I see a patient back following significant skin cancer surgery who is delighted with their scar and the treatment they have received.


Dr Robert Herd
I was appointed as Consultant Dermatologist in Glasgow to develop skin cancer services. I started Scotland's first Mohs' micrographic surgery service in 2001. I established the West of Scotland skin Cancer network and introduced the first regional MDT (multi-disciplinary team) for skin cancer in the West of Scotland. I have recently been involved in the development of the "hedgehog pathway inhibitors", a new oral class of drugs for treating advanced basal cell carcinoma.


Dr Sandeep Varma
Mohs Micrographic Surgery Fellowship with Dr Neil Swanson and Dr Ken Lee in the USA 2000-2001

Awarded "Surgeon of Steel" by British Society for Dermatological Surgery

Getting Facial Basal Cell Carcinoma published in the BMJ

Involvement in the International Research on Photodynamic Therapy.

Teaching several Mohs fellows.

  • Man Men's Health Discover engaging articles dedicated to male health. This includes advice, trends and interviews with our top male health Consultants.
  • Woman Women's Health Stay on top of your health with our tips, advice and Q&A’s with leading women’s health Consultants.
  • Runners Health and Wellbeing Get inspired for a healthier you. Find the latest in healthy living and fitness tips, as well as our medical and treatment updates.
  • Man Men's Health Discover engaging articles dedicated to male health. This includes advice, trends and interviews with our top male health Consultants.
  • Woman Women's Health Stay on top of your health with our tips, advice and Q&A’s with leading women’s health Consultants.
  • Runner Health and Wellbeing Get inspired for a healthier you. Find the latest in healthy living and fitness tips, as well as our medical and treatment updates.