Skin Cancer

Problem: Skin cancer is one of the most common types of cancer in the UK. As a
persons age increases so does their risk of developing skin cancer. There has
been a drastic increase in the number of people diagnosed with skin cancer
throughout the years resulting in deaths. This represents a
major public health challenge.
Cancer is a group of various diseases, there are over 200
different types.1Cancer develops when the DNA, containing
genetic information in a cell is damaged or changed; this
produces mutations which affects the growth and division of
the cells.2In unaffected cells- the cells divide in a controlled
manner however, in affected cells the body is not able to repair
Figure
the damage so the abnormal cells carry on dividing in an unregulated manner
1
and develop in to a tumour which can spread to other tissues in the body. 1(Figure
1 shows a skin cancer cell under an electron microscope).
When this process occurs in the skin, the
malignant cells can invade other tissues in the
Figure
skin - leading to skin cancer. Skin cancer is
2
detectable in its early stages because the
tumour develops in cells in the epidermis (the
outermost layer of the skin). Therefore, these
tumours can be easily detected. Early
detection and treatment is key to survival. 11
There are three main types of skin cancers:
Basal cell cancer, squamous cell cancer and
melanoma. These can be divided into two
broad categories non-melanoma and
melanoma. Melanoma is much more dangerous than non-melanoma, and causes
the vast majority of skin cancer deaths.3 One in fifty five people will be
diagnosed with melanoma in their lifetime. The rate of many common cancers
has been decreasing, but melanoma has been increasing. Between the years
1997 to 2004 the number of melanoma cases increased by 45% 21
Skin cancer can be caused by many factors; the most common being ultraviolet
(UV) light from the sun and sunbeds. Such rays are very powerful and are able to
damage the DNA in skin cells and if this causes specific mutations it can lead to
the build-up of cancerous cells in the skin. UV light from the sun causes skin
cancer over a long period of time.
To determine whether or not skin cancer has increased dramatically throughout
the years in the UK, epidemiological studies have been performed. These studies
use data from local and national cancer registries and also from reporting of
death certificates. Therefore, data on the number of cases of skin cancer that
occur in the UK and the deaths they cause are gathered together and presented
in graphs and data tables. These results allow epidemiologists to see trends in
1

the incidence of skin cancers and help them to inform the government and public
health bodies on the need for specific actions. For example, evidence on an
increase in melanoma in a population might lead to public health campaigns
warning of the risks of UV light exposure. 29

Figure 3.4

Figure 3 shows how the diagnosis of skin cancer (melanoma) increases with age
between the years 2006-2008. It shows data specifically in the UK. This graph
contains two different types of information - Average number of cases per year
which is represented as a bar chart and Rates per 100,000 population which is
represented as a line graph.
The Number of Cases per Year
Figure 3 shows that between the ages of 0-14 there were no cases of skin cancer
for males and females - which shows that the younger a person is the less likely
he/she is to develop skin cancer. The number of cases for males and females
increased along with the age, the number of female cases rapidly increased from
the age group 30-34 to 35-39 where it increased by approximately 150 cases.
The number of male cases rapidly increased from the age groups of 55-59 to 6064 where it increased by approximately 165 cases. The age group for males 6064 was the first time the number of cases per year was higher than the females,
this age group was also where the graph had reached its highest value for both
genders. After 60-64 the number of cases started to decrease for males and
females as the age of diagnosis increased, this trend continued for males
however for the females it decreased up until the age group 80-84 where the
number of cases was just over 375, when the female age of diagnosis was 85+
the value slightly increased to approximately just over 400.

Generally the bar chart showed that as a persons age increases so does their
risk of suffering from skin cancer but only up to a certain age, in this case the
trend continued till the age group 60-64 which supported this conclusion
however after that the number of cases per year decreased.

Figure 4
skin

shows that
Figure 4.5

cancer
has

increased rapidly from 1975 to 2008.

Females
have
the highest rate per
100,000 throughout
the graph which suggests that they
are more prone to skin
cancer. Rates have increased from approximately 4.5 to 16.5/100,000 which is a
difference of 12 cases/100,000. The rate per 100,000 for males remains much
lower than for females. In 1975 males had a low figure - approximately
3/100,000 and by 2008 their figure had increased to 16/100,000 which is a
difference of 13 cases/100,000. It is clear that the curves for females and males
started off quite wide apart in 1975 but have come together by 2008, this may
reflect different patterns of sun exposure in men and women over this time
period. Factors that might have increased the risk of skin cancer include the use
of sunbeds, greater availability of foreign holidays and also the cultural wish to
have a sun tan.
The overall trends for both genders show a steady increase in the rate of skin
cancers. However, between 1988 and 1993 there was an apparent dip in the rate
of skin cancers in both males and females. This might be a reflection of a period
of reduced sun exposure 20-30 years earlier or perhaps due to other factors,
such as a drop in the efficiency of cancer registries in seizing the data on the
incidence of skin cancers during this period (e.g. because of economic cuts
affecting jobs due to recession).

Figures 3 and 4 are taken from the Cancer Research UK website. This is the
worlds largest independent cancer research charity 22and is widely recognised for
its authoritative and reliable websites that provide valid information and
statistics on cancer. I feel that my data provided from this website is reliable as
it is a well known charity amongst the public.

Figure 5.15

The map In Figure 5 shows the distribution of

skin cancer in Europe. The black arrow
shows that the incidence of skin cancer is
greater the further a country is towards the
North-West of Europe. Citizens of those
countries with high rates of skin cancer (e.g.
Scandinavia and UK) tend to have lighter
skin colour and are, therefore, more
vulnerable to the harmful effects of UV light
than those people who live in the South of
Europe (e.g. the Mediterranean).

This information confirms the rapid increase in skin cancer in the UK and
highlights the potential problem it represents to the people living here. Clearly,
this problem requires a range of possible solutions in order to prevent it from
damaging peoples health and threatening their lives.

Solutions
New treatments for skin cancer have been developed
rapidly in recent years. Harpal Kumar, chief executive
of Cancer Research UK stated "There has been
undeniable progress in the treatment of skin cancer
over the last 40 years and many more people are
surviving the disease. 13 There are many solutions to
treat skin cancer such as7:
Surgery
Photodynamic therapy
Chemotherapy

Effective solutions:
4

Surgery
this type of treatment has different forms, for example:
Figure 6.15

Excision
This form of surgery is the simplest
which is commonly used to treat small
cancer- mainly melanoma. Figure 6 shows
how the tumour is removed, it involves
removing the lesion - along with healthy
looking skin known as the safety margin
and also tissue and fat from under the tumour. The healthy looking skin is
removed to ensure that the cancer has not spread anywhere else so that
this process can carry on.
The tissue sample will be sent to the laboratory to determine if any of the
safety margin has been affected which would lead to the surgery
becoming unsuccessful, which may result in further surgery to remove
more tissue. This form of surgical treatment has its own advantages: it
provides an opportunity to see if any other parts of your skin have been
affected, the process is done in one session unlike other cancer treatments
and also the cure rate is considerably high. 8

Mohs Surgery
This form of surgery is very specialised, it is the most effective type of
surgery for the nonmelanoma group (basal cell and squamous cell cancer).
This process shown in figure 7, involves removing the lesion- piece by
piece, each piece is then examined under a microscope as soon as each
Figure 7.15
layer of the skin has been cut
off. The layers are cut off till no
sign of cancer has been
identified under the microscope.
This procedure is similar to
excision however it aims to
remove as little healthy skin as
possible.9 By using Mohs
surgery, surgeons are able to
spare more of the healthy skin
and this provides a superior
cosmetic result. 23
The site at which the surgery
has taken place will heal very well - well enough that it is unnoticable in
some cases.

Photodynamic Therapy (PDT)

Photodynamic therapy is another form of effective treatment for skin cancer, but
only for the nonmelanoma group, it avoids the use of surgery and surgical
scars.14 This procedure shown in figure 8 uses a light sensitive drug known as a
5

photosensitising agent, an example of this is Photofrin which is used to damage

Figure 8.15
abnormal tissues; it usually has no impact on
normal tissues in the body. The drug is injected into
the
cells; which is then absorbed by the cancer cells.
Light is shone on the affected area to activate
the drug which then leads to the cancer cells
being destroyed.14 This form of treatment is an
alternative to surgery; however the process only
works if the cancer is not too deep in the skin
because the light would not be able to
penetrate deep in the skin.
PDT is a very effective treatment and is preferred
the other form of treatments of skin cancer,
however after the treatment there are
precautions, for example, the cured area is
more sensitive to strong light therefore it should
be protected for a couple of days. It may also
cause swelling in the cured area but is only
temporary.

Figure
9.15

to

Figure 9 shows the structure of the photosensitising

drug Photofrin. This drug is appropriate for the
process because the maximum absorbance of the
wavelength is above 600nm therefore it can
absorb more light rather than haemoglobin.16

Figure 9.15
Advantages of PDT:
The use of PDT has many advantages to treat skin cancer, it is less destructive to
the skin; unlike surgery, no layers of the skin are being cut off, therefore no
visible scars will be produced in the process so people will feel more confident
about themselves. Photodynamic therapy is a fast, pain-free procedure requiring
as little sedation as possible; this procedure has been proven to be relatively
safe.24This process to cure the cancer only takes about one to two sessions to
complete therefore it is a rapid procedure unlike any other treatment which is
why many people choose this form of treatment.
Disadvantages of PDT:
The use of PDT also has its disadvantages, it an expensive procedure and also
has a lower cure rate compared to surgery. PDT can only cure basal cell and
6

squamous cell cancer- not melanoma. 17 The treatment contains side-effects: It

may cause photosensitivity for approximately 30 days because the
photosensitising drug injected during the procedure may still be present in the
body so the treated patients must avoid bright light or direct sunlight. However if
the patient is exposed to these lights it may cause swelling and sunburn. The
laser light used to shine on the skin to activate the drug is unable to pass
through more than 3cm of tissue.12

Social Implications
Even though, these solutions are very effective in curing skin cancer; they do
have some social implications. The main social
implication from the use of surgery is that it results
in the creation of surgical scars on the skin which
could be very traumatic to the patient and may
cause emotional side-effects. People may start to
feel conscious about themselves which may harm
their confidence and intervene with their social life
as they start to feel they are somewhat different
from others. Surgical scars also have a psychological
effect- it can affect relationship building with others and social withdrawal, scars
may lead the public to conjure unnecessary cruel comments which can cause the
treated patient to be paranoid and also create social phobia, they may feel
embarrassed and are not able look people in the eye. Any form of treatment
may make a patient feel they are different from others. 18
Economic Implications
The occurrence of skin cancer and the effects of its treatment also have
economic implications. The cost of treating skin cancer varies depending on its
type. Basal cell and squamous cell cancers, which are less dangerous than
melanoma, may cost around 1000 to treat (by surgery, PDT or radiotherapy).
However, the large and increasing number of cases is likely to place a significant
strain on the healthcare budget.19In contrast, melanoma, which is the deadliest
form of skin cancer, may require extremely complex treatment which includes
expensive drugs that may cost many thousands of pounds. These treatments
are often not affordable in the NHS and are not approved by the National
Institute of Health and Clinical Excellence (NICE). Skin cancer can also have an
impact on peoples work life. Thus, sufferers may not be able to work meaning
that they have reduced financial income and may have to rely on benefits. In
addition, if they are not working, the government will not receive tax from them
and this reduces the money available to fund schools and the National Health
Service.19
Alternative Solutions
There are alternative methods used to cure skin cancer:
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 Radiotherapy
Radio therapy is a good alternative solution for skin cancer, it is
particularly useful in areas where surgery may be difficult to treat or may
cause disfigurement, such as the face.25 This procedure involves the use of
high energy X- and Gamma rays produced in
specialised radiotherapy machines. These rays can
Figure
penetrate tissues and can be focussed on tumour
10.15
containing areas. The rays hit the DNA of
cancer cells and cause breaks in the doublestranded DNA helix. If sufficient damage is
caused on the tumour cells, they are unable to
repair it and die.26 The key to using this treatment
effectively in treating skin cancer lies in
targeting the radiation selectively to sites where
the
cancer. In addition, the normal tissues are better
able
than cancer cells to repair DNA damage from the
procedure, therefore the patient is more likely to survive.
This treatment is very effective because the high energy X- and gamma
rays shown in figure 10, used during the procedure is aimed at the site of
the tumour, thus, causes as little damage as possible to the normal cells,
however possible side effects of this treatment are: sickness, itchy skin,
weight loss, and red soreness.27
New Drug Treatments
In the last 2 years there has been a significant improvement in the
treatment of melanoma by the use of new drugs. Two drugs that have
recently been approved for use in Europe include vemurafenib and
ipilimumab, these drugs can also be used in the later stage of melanoma.
The first of these drugs (vemurafenib) targets a gene that
is mutated and shuts off its function. This has the effect
of killing melanoma cells. Dr Antoni Ribas, a professor of
haematology /oncology expressed These results tell us
that this drug is having a very big impact, and this
change the way we treat metastatic melanoma.27
The second drug (ipilimumab) acts by waking up the
immune system to the presence of melanoma and allows
the bodys own natural defences to attack and destroy tumours. This drug
can benefit around 2,000 patients suffering from melanoma in the UK. Dr
Paul Lorigan, Senior Lecturer in Medical Oncology at NHS Foundation Trust
explained After years of no progress in the treatment of this terrible
illness, we have now made a stride forward. 28
The best known solution to skin cancer is by preventing it from occurring. There
are many techniques used nowadays that help prevent skin cancer.

Sunscreen: This is a lotion, gel or spray used to prevent skin cancer. This type
of method is the most common solution in preventing cancerous cells from
developing in the skin. Sunscreen is applied to the skin that is exposed to the
sun; it can absorb the UV rays emitted and also reflect the harmful light rays. 20
Less Exposure: This is another method used to prevent skin cancer. The less
skin exposed to the sun, the less likely a person is going to develop the cancer.
Evaluation of References:
Source 4:
I used this source
(http://info.cancerresearchuk.org/cancerstats/types/skin/incidence/) in order to
find data on my problem. I believe that this source provides valid and reliable
information and data because it is from the Cancer Research UK which is a wellknown awareness charity based organisation which was created in 2002. The
purpose of this organisation is to reduce the number of deaths due to cancer and
is also funded by the public. The source is reliable because it contains data on
the increase in skin cancer which also agrees with other sources such as the BBC
and other web sources therefore I used this source to gain my data, and to also
come up with investigations (referred to in the text) as to why there were some
dips in the trend on the graph.
Source 19:
I used this source Phone communication with a Specialist in Skin Cancer, Dr K.
Harrington from The Royal Marsden Hospital in order to gain knowledge about
the economical implications about the increase in the skin cancer throughout the
years as well as alternative solutions and to what effect it has on the NHS and
also on peoples lives. I believe that this source is both reliable and valid because
the information I gained was from a Specialist in skin cancer, Dr. K. Harrington,
from the Royal Marsden Hospital who mainly specialises in Radiotherapy. The
Royal Marsden Hospital is a well-known cancer treatment hospital and is one of
the first NHS foundation trust that was founded by Dr. Williams Marsden.
Bibliography:
1. http://www.macmillan.org.uk/Cancerinformation/Aboutcancer/Whatiscance
r.aspx
Date Used: 05/03/12
2. http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer
Date Used: 05/03/12
3. http://www.skincarephysicians.com/skincancernet/whatis.html
Date Used: 05/03/12
4. http://info.cancerresearchuk.org/cancerstats/types/skin/incidence/
Data on how Skin Cancer increases with age, Date Used: 08/03/12
5. http://info.cancerresearchuk.org/cancerstats/types/skin/incidence/uk-skincancer-incidence-statistics#Trends

6.
7.

8.

9.

Data on how Skin Cancer has increased throughout the years, Date Used:
08/03/12
http://www.skincancer.org/skin-cancer-information/skin-cancerfacts#melanoma
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Skin/Treating
skincancer/Treatmentoverview.aspx
Information on the type of treatments, Date Used: 11/03/12
http://www.skincancer.org/skin-cancer-information/melanoma/melanomatreatments/surgical-excision
Explains procedures of Excision and advantages, Date Used: 11/03/12
http://www.laserskinsurgery.com/Mohs-Micrographic-Surgery--Skin-Cancer
Date Used: 13/03/12

10.http://cancerhelp.cancerresearchuk.org/type/skincancer/treatment/photodynamic-therapy-for-skin-cancer
Date Used: 13/03/12
11.http://www.youtube.com/watch?v=-nz7UTY8u6c Video about skin cancer and benefits of Mohs surgery. (1:27)
12.Book read, Title: The Cancer Directory by Dr Rosy Daniel, page
87.
Date Used: 13/03/12
13.http://www.bbc.co.uk/news/health-14184866 Information about the rise in skin cancer and treatments, Date Used:
16/03/12
14.http://www.freedomhealth.co.uk/medical-services/photodynamic-therapypdt-for-skin-cancer-london/184/
Information about Photodynamic Therapy and how it is carried out, Date
Used: 16/03/12
15.http://www.google.co.uk/images/
16.http://www.unc.edu/~eagreer8/Photodynamic_Therapy.html
Date Used: 16/03/12
17.http://www.skincancercollege.com/Default.aspx?tabid=189
Information about Photodynamic Therapy, Date Used: 19/04/12
18.http://ezinearticles.com/?The-Psychological-Effects-of-Physical-Scars-onIndividuals&id=2181160
This website shows the effects of scars and the social implications, Date
Used: 22/03/12
19.Phone communication with a Specialist in Skin Cancer, Dr K.
Harrington from The Royal Marsden Hospital.
I asked questions about the economic implications of skin cancer, as well
as alternative solutions.
Date Consulted: 28/03/12
20.http://www.patient.co.uk/health/Cancer-of-the-Skin-Prevention.htm
This website explains the ways to prevent skin cancer, Date Used:
30/03/12
21.http://www.dailymail.co.uk/health/article-517677/Skin-cancer-casesincrease-46-cent-just-seven-years.html
Date Used: 30/03/12

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22.http://en.wikipedia.org/wiki/Cancer_Research_UK
This website provided information about Cancer Research UK and showed
how reliable data is on the website, Data Used: 31/03/12
23.http://www.skinsurgery.co.nz/Skin_Surgery/What_are_the_benefits.html
Date used: 31/03/12
24.http://www.cancercenter.com/esophageal-cancer/photodynamictherapy.cfm
Date Used: 31/03/12
25.http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Skin/Treating
skincancer/Radiotherapy.aspx
Date Used: 06/05/12
26.http://en.wikipedia.org/wiki/Radiation_therapy
This website explained the procedures of Radiotherapy and how it helps
cure skin cancer, Date Used: 06/04/12
27.http://www.bbc.co.uk/news/health-17128925
Date used: 07/04/12
28.http://www.dailymail.co.uk/health/article-2028632/Ipilimumab-Skin-cancerdrug-extend-life-4-years-real-advance-1870s.html
Date Used: 07/04/12
29.http://www.soph.uab.edu/epi/academics/studenthandbook/what
Information about epidemiology and who it is carried out, Date Used:
07/04/12

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