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Untested skin cancer apps endangering the public

In the scramble to bring successful apps for the diagnosis of skin cancer to market there is a concern that a lack of testing is risking public safety, according to researchers at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018).

The researchers, led by the University of Birmingham, reviewed the medical literature on skin cancer apps to explore the number of apps on the market, ascertain how accurate they are, and what the benefits and limitations of these technological solutions are. Examples of apps include tele-dermatology (which involves sending an image directly to a dermatologist), photo storage (which can be used by individuals to compare photos monthly to look for changes in a mole), and risk calculation (based on colour and pattern recognition, or on fractal analysis).

The researchers found that some of these apps have a comparatively high success rate for the diagnosis of skin cancer. Teledermatology correctly identified 88 per cent of people with skin cancer and 97 per cent of those with benign lesions. Apps which use fractal theory analysis algorithms (detecting irregularities in a fractal pattern) were the next most successful category, these correctly identified 73 per cent of people with skin cancer and 83 per cent of people with benign lesions. These types of technology have huge potential, as in the UK 50 per cent of dermatology referrals relate to skin cancer. Early diagnosis results in up to 100 per cent five-year survival, compared with 25 per cent in women and 10 per cent in men diagnosed at a later stage. Technology that can help with triaging would help alleviate pressure on dermatology departments and could also increase survival rates.

However, the researchers point to three major failings with some of the apps: a lack of rigorous published trials to show they work and are safe; a lack of input during the app development from specialists, to identify which lesions are suspicious; and flaws in the technology used, namely how the photos are analysed.

The researchers explain that without specialist input, the apps may not recognise rarer or unusual cancers. Even where the technology is efficient, if it has not been combined with specialist input from a dermatologist, it may not pick up on all red-flag symptoms.

In terms of technology, an area where colour and pattern recognition software apps seem to particularly struggle currently, is in recognising scaly, crusted, ulcerated areas or melanomas which do not produce pigment (amelanotic melanomas). This increases the number of false negatives and delays treatment.

Some apps that compare images on a monthly basis or ‘advise’ users to seek dermatologist review, based on a risk calculation, are not able to differentiate between finer details which would be identified using a dermatoscope (a magnifier that can be handheld or attached to a phone), or in person when touched by a dermatologist. If the app is based on advising patients whether to seek professional advice, then they may advise wrongly as they have not correctly identified finer details which may point to a more sinister lesion.

There are also certain criteria that an app cannot always register, in clinic this person would be advised that the mole should be removed, however, an app may not be able to provide such personalised advice.

Maria Charalambides from the University of Birmingham’s College of Medical and Dental Sciences, who conducted the literature review, said:

“Future technology will play a huge part in skin cancer diagnosis. However, until adequate validation and regulation of apps is achieved, members of the public should be cautious when using such apps as they come with risk. Any software that claims to provide a diagnostic element must be subject to rigorous testing and ongoing monitoring. Apps specifically based on patient education of skin cancer can offer public health benefits in terms of how to stay safe in the sun, or the warning signs to look out for. But as per the British Association of Dermatologists recommendations, most apps cannot currently substitute dermatologist review when it comes to actual diagnosis.”

Matthew Gass of the British Association of Dermatologists, said:

“These new technologies for the diagnosis of skin cancer are exciting, but the varying quality available makes it a difficult landscape for people to navigate. These apps are not a replacement for an expert dermatologist, but they can be a useful tool in the early detection of skin cancer. We urge people who are thinking about using these apps to research how they work and to be cautious regardless of their recommendations. If a patch of skin such as a mole is changing in shape or size, not healing or just doesn’t seem right, go and see your GP regardless of what any app tells you.”

Skin cancer is the most common cancer in the UK and rates have been climbing since the 1960s. Every year over 230,000 new cases of non-melanoma skin cancer (NMSC) – the most common type – are diagnosed in the UK. In addition to NMSC, there are approximately 16,000 new cases of melanoma every year, resulting in around 2,285 UK deaths annually.

Sun protection tips:

1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.
2. Avoid direct sun exposure for babies and very young children.
3. When it is not possible to limit your time in the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses, can give you additional protection.
4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming, sweating or towelling to maintain protection.

Checking for skin cancer:

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCDE rules describe a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a dermatologist. Your GP can refer you via the NHS.

Asymmetry - the two halves of the area may differ in shape or colour
Border - the edges of the area may be irregular or blurred, and sometimes show notches
Colour - this may be uneven. Several different shades of black, brown and pink may be seen
Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor
Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a dermatologist. Your GP can refer you via the NHS.

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body but are most common on areas of skin that are most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged such as old scars, ulcers, burns, X-ray damage or persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They may appear gradually on the skin and will get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally
- A scaly or crusty patch of skin that looks red or inflamed
- A flesh coloured, pearly lump that won’t go away and appears to be growing in size
- A lump on the skin which is getting bigger and that may be tender or sore
- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

-Ends-
Notes to editors:

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Meeting.

The conference will be held at the EICC Edinburgh from July 3rd to 5th and is attended by approximately 1,300 UK and international dermatologists.

To interview Maria Charalambides, contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681, or contact the press office on +44 (0) 7789 921 165.


About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk

About the University of Birmingham
The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries

BT08
Use of dermatology apps: a cause for concern or the future of healthcare provision?

M. Charalambides1 and S. Singh2
1Birmingham Medical School, Birmingham, U.K. and 2Worcester Royal Hospital, Worcestershire, U.K.

In the U.K., 50% of dermatology referrals relate to skin cancer. Early diagnosis results in 100% 5-year survival, compared with 25% in women and 10% in men diagnosed at a later stage. With 6.3 billion smartphone subscriptions estimated to be in use by 2021, the field of telemedicine and specifically teledermatology has begun a period of evolving growth and there is now widespread availability of skin cancer-related dermatology apps. The aim of this review is to explore the range of apps available, evaluate the benefits and limitations of such apps and assess their role in the effectiveness of teledermatology. Search engines, including Pubmed and Medline, have been used to view the literature. A variety of apps are available for public download. The best method for melanoma diagnosis was those who sent the image directly to a dermatologist for analysis (88% sensitivity, 97% specificity). The second most effective apps (73% sensitivity and 83% specificity) use fractal theory analysis algorithms. In the U.K., the use of store-and-forward teledermatology has been proposed as a service delivery model to manage capacity demands. The benefits of teledermatology include education, encouragement of personal responsibility and provision of equitable services to remote areas. Teledermatology is an effective triaging tool, ensuring patients are seen in the most appropriate setting at first appointment via the 2-week-wait, alleviating NHS pressures. This leads to timely treatment. Limitations include the lack of rigorous U.K. published trials supporting a safe, efficient service. There is a lack of validation, regulation, scientific and speciality input of apps. Currently, colour and pattern recognition software apps are unable to recognize scaly, crusted, ulcerated areas or amelanotic melanomas, increasing false negatives and delaying treatment. The experience of the teledermatologist influences the accuracy of apps and the possibility of user error in taking a quality photograph remains. As inferred by the BAD, teledermatology apps have benefits when integrated in care as a first step in early detection. Encryption of images and patient consent are essential. Concerns regarding accountability for inaccurate diagnoses made by apps should be addressed. Further U.K.-based research into efficacy and economic viability of teledermatology apps is required. According to NICE, patients with potential skin malignancy should be seen in person by specialists. Therefore, apps can currently supplement but not substitute standard medical care.
 

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Study finds new evidence that atopic eczema develops in the womb

Researchers have found new evidence that atopic eczema develops before birth and is linked to a child’s growth in the womb and shortly after birth, according to a new study being presented at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018).

The study found that infants with eczema demonstrated altered patterns of growth during pregnancy, including impairment in growth of length starting in early pregnancy, prior to eczema becoming evident. The findings suggest that growth is impaired prior to the start of the disease process and its treatment, and that there are important influences acting during pregnancy on this common skin condition.

Within the Southampton Women’s Survey, a mother-offspring study, 1759 infants had serial measurements of their length, head and abdominal circumference during pregnancy at 11, 19 and 34 weeks, at birth, and at ages 6 and 12 months, and were assessed for eczema at ages 6 and/or 12 months.

Evidence of faltering growth in length from 11 weeks’ of pregnancy and shorter femur length, smaller abdominal circumference and a higher head to abdominal circumference ratio at 34 weeks’ gestation were associated with 20% or greater increased risks of eczema at age 6 months. Infants who had had a larger head circumference in early pregnancy and a declining abdominal growth velocity from 19 to 34 weeks of pregnancy had a 33% greater likelihood of eczema at age 12 months.

One possible explanation for these findings is “brain sparing” responses where the growth of the head and brain takes priority over the growth of the rest of the body. One organ that could be affected is the thymus, which is important in regulating the immune system, and this could result in an imbalance in immune cells and chemicals producing the inflammatory response seen in atopic eczema.

Dr Sarah El-Heis, the study’s lead researcher from the University of Southampton and the MRC Lifecourse Epidemiology Unit, said:

“Infants with eczema have an increased risk of impaired growth, which is a clinical concern that underpins recommendations to monitor growth in all infants with eczema. A number of reasons for the impaired growth have been proposed and include effects of the inflammatory process, topical corticosteroid treatment or an inappropriately restrictive diet. However, we have shown that infants with eczema at age 6 and 12 months have altered growth patterns before they are born and before eczema becomes evident, suggesting that there are important influences acting during pregnancy.”

Nina Goad, of the British Association of Dermatologists, said:

“Research into this common disorder has taken some interesting turns in recent years, with discoveries relating to birthweight, maternal socioeconomic status and even maternal mood during pregnancy impacting on risk factors. What is becoming clear is that there is no one, simple answer to why some babies develop eczema, and instead there is a complex interplay of factors, some of which are genetic and some of which are environmental. This study provides more data to help scientists explore the possible causes and how they may relate to one another.”

Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. One in every five children in the UK is affected by eczema at some stage. It may also start later in life in people who did not have eczema as a child.

The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever and food allergy. These conditions are all linked by an increased activity of the allergy side of the body’s immune system. ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which can sometimes become weeping, blistered, crusted, scaling and thickened.

For more information on eczema, see the British Association of Dermatologists’ Patient Information Leaflet.

-Ends-
Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.

The conference will be held at the Edinburgh EICC from July 3rd to 5th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk.

About us:
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk

The Medical Research Council (MRC) is at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Thirty-two MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms. The Medical Research Council is part of UK Research and Innovation. https://mrc.ukri.org/

Developmental influences and the risk of atopic eczema during infancy.
S. El-Heis,1 S. Crozier,1 E. Healy,2 S. Robinson,1,3 N. Harvey,1,3 J. Baird,1,3 H. Inskip,1,3 C. Cooper1,3,4 and K. Godfrey1,3,5
1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K, 2Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, U.K., 3NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, U.K., 4NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, U.K. and 5Institute of Developmental Sciences, University of Southampton, Southampton, U.K.

Evidence that atopic eczema partly originates in utero is increasing, where genetic predisposition and environmental exposures act together in determining the risk of developing this multifactorial condition. This research examined early life developmental influences on infantile atopic eczema at ages 6 and 12 months. In the well-characterized preconception Southampton Women’s Survey mother–offspring cohort, infantile atopic eczema was ascertained by trained research staff using modified U.K. Working Party Criteria for the Definition of Atopic Dermatitis. In cohort subsamples, data were available that enabled analyses of maternal stress and low mood (n = 3008), maternal serum nicotinamide and related tryptophan metabolite concentrations (n = 497), and fetal/infant growth patterns (n = 1759) in relation to infantile eczema. Maternal preconception perceived stress affecting health [OR 1.21 (95% CI 1.08–1.35), P = 0.001] and stress in daily living [OR 1.16 (1.03–1.30), P = 0.014] were associated with an increased risk of offspring atopic eczema age 12 months; this was independent of maternal postpartum mood and stress. Infants whose mothers had higher levels of nicotinamide during pregnancy had a lower risk of eczema at age 12 months [OR 0.69 (0.53–0.91) per SD change, P = 0.007]; findings were similar for the related metabolite anthranilic acid [OR 0.63 (0.48–0.83), P = 0.001]. Fetal and infant linear, head and abdominal size and growth velocity standard deviation scores were derived from anthropometric measurements at 11, 19 and 34 weeks’ gestation, birth and ages 6 and 12 months. Shorter femur length, smaller abdominal circumference and higher head to abdominal circumference ratio at 34 weeks’ gestation were associated with increased risks of eczema at age 6 months (eczema odds ratio per standard deviation (OR/SD) increase 0.81 (0.69–0.96), P = 0.017; 0.78 (0.65–0.93), P = 0.006; 1.37, (1.15–1.63), P = 0.001, respectively). A lower velocity of linear growth from 11 weeks’ gestation to birth was associated with eczema age 6 months (0.80 (0.65–0.98), P = 0.034). Infants with atopic eczema age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks’ gestation (0.67 (0.51–0.88), P = 0.003). The findings demonstrate impacts of maternal psychological well-being and micronutrient status on infantile atopic eczema. The impaired linear growth of infants with atopic eczema was shown to commence in utero, prior to the clinical onset of the condition. The findings provide new evidence that atopic eczema partly originates during prenatal development, and point to potential interventions to optimize maternal health beginning prior to conception to ultimately reduce the risk of infantile atopic eczema. Conflict of interest: KMG has received reimbursement for speaking at conferences sponsored by companies selling nutritional products and is part of an academic consortium that has received research funding from Abbott Nutrition, Nestec and Danone.
 

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Photographic evidence highlights shortcomings of moisturisers containing SPF

Moisturisers with sun protection factor (SPF) provide less sun protection than the equivalent strength sunscreen in real-world scenarios, and people are more likely to miss areas of their face when using them, according to a new study being presented at the British Association of Dermatologists’ Annual Meeting in Edinburgh (3rd-5th July 2018). Doctors are warning people not to rely on moisturisers with SPF for their main sun protection needs, particularly if spending extended periods in the sun.

Using a specially modified camera that only sees UV light, the researchers from the University of Liverpool assessed how effectively people apply sunscreen and sun protection factor (SPF) containing moisturiser to their face. When an area of skin is successfully covered, the product absorbs the UV light and this area appears black in the photos – the lighter the area the less successful the absorption.

Over two separate visits, people were asked to apply sun protection, in the first visit sunscreen, and in the second moisturiser with SPF. Pictures were then taken with the modified camera to see how effectively people applied the two products.

Analysis of the photos showed that when applying moisturiser people missed 16 per cent of their face on average, whereas when applying sunscreen this dropped to 11 per cent. When just the high-risk eyelid areas were analysed sunscreen users missed 14 per cent compared with 21 per cent with moisturiser. The eyelid area is a common site for skin cancers.

In addition to this, the study suggests that people do not apply the moisturiser as thickly as sunscreen, and therefore do not receive the full benefits of the SPF. The photos of people using the moisturiser are noticeably less dark on average, this indicates that the product is absorbing less UV light.

On average men were significantly better at applying the products than women, other groups that proved better at it were people with darker skin tones and older participants.

Participants were asked to rate their perceived ability to apply the products before and after viewing the images. For sunscreen, perceived ability dropped from 90 per cent positive to 42 per cent, and moisturiser from 85 per cent to 38 per cent, indicating that participants were not aware of their failure to achieve adequate coverage.

Mr Austin McCormick, Consultant Ophthalmic and Oculoplastic Surgeon, and one of the researchers, said:

“This research is very visual and fairly easy for people to understand: the darker the image, the more sun protection people are getting.

“We expected the area of face covered with moisturiser to be greater than sunscreen, in particular the eyelids because of the perception that moisturiser stings the eyes less than sunscreen. In fact we found the opposite: the area of the face covered effectively was greater with sunscreen than moisturiser. In addition, where it was applied, the moisturiser provided less UV protection than sunscreen.

“Although skin moisturiser with SPF does provide sun protection, our research suggests that it’s not to the same degree as sunscreen. We do recommend moisturisers and makeup that contain UV protection – it is better than no protection at all, but for prolonged periods in the sun we recommend the application of sunscreen with high SPF.”

Matthew Gass of the British Association of Dermatologists, said:

“Unfortunately, moisturiser with SPF just doesn’t perform particularly well in real world situations compared to sunscreen. Although it may say factor 30 on the box, this study is just further evidence that lab testing conditions for these products don’t reflect how they are used.

“Another important thing to take away from this research is that people often miss areas of their face when applying sun protection, a good way to prevent this from becoming an issue is to wear sunglasses and reapply sunscreen regularly. This should help protect the bits you miss from being exposed to excessive sun.”

When products are tested for their SPF, they are tested at a density of 2 mg per cm². SPF used in moisturisers is tested the same way as sunscreens, so an SPF 15 moisturiser should provide an SPF of 15, however, as this study demonstrates, they are likely to be applied a lot more thinly than sunscreen, and less uniformly. Applying less SPF will reduce the protection to a higher degree than is proportionate – for example, only applying half the required amount can actually reduce the protection by as much as two-thirds.

It is also worth noting that moisturisers containing an SPF may not contain any UVA protection and as a result will not protect against UV ageing, and are less likely to be rub-resistant and water resistant.

-Ends-

Notes to editors:

If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference.

The conference will be held at the Edinburgh EICC from July 3rd to 5th and is attended by approximately 1,300 UK and worldwide dermatologists.

For more information please contact the media team: comms@bad.org.uk, 0207 391 6084. Website: www.bad.org.uk

Study:

Application of SPF moisturizers is inferior to sunscreens in terms of percentage coverage of facial and eyelid area

E. Lourenco, H. Pratt, K. Hamill, G. Czanner, Y. Zheng and A. McCormick

University of Liverpool, Liverpool, U.K.

In recent years, the popularity of SPF containing moisturizers has steadily increased. Indeed, as reported SPFs are equivalent to sunscreens, more users are turning to moisturizers for their sun-protection needs. However, there has been little research into moisturizer application habits compare to using sunscreen in terms of coverage achieved. Previously, we have demonstrated that during sunscreen application, users have a tendency towards missing or incompletely covering the eyelid and medial canthus regions. We aimed to determine if these tendencies differed in SPF moisturizer users. A study population of 60 (14 men, 46 women, age 18–57) were exposed to UV light and photographed using a tripod mounted, UV-sensitive DSLR camera on two separate visits. At visit one, images were acquired before and after applying SPF30 sunscreen, while at visit two, SPF30 moisturizer was used instead. Images were processed for facial landmark identification followed by segmentation mapping of hue saturation values to identify areas of the face that had been missed. Analyses revealed that application of moisturizer was significantly worse than sunscreen in terms of the area of the whole face missed (11.1% missed with sunscreen 16.1% for SPF moisturizer P < 0.001 paired t-test). This difference was primarily due to decreased coverage of the eyelid region (14.3% sunscreen, 21.1% moisturizer P < 0.001), face excluding the eye area; 9.7% missed with sunscreen, 12.4% SPF moisturizer (P < 0.001). Secondary analyses demonstrated significantly better coverage in men, people with darker skin tones and older participants. Upon study completion, we asked participants to rate their perceived ability to apply the products before and after viewing the images, sunscreen dropped from 90% positive to 42%, and moisturizer from 85% to 38%, indicating that participants were not aware of their failure to achieve adequate coverage. Together these data indicate, that despite potential advantages moisturizers have in terms of increased frequency of application, the areas of the face that are at higher cancer risk are likely not being adequately routinely protected, and importantly, participants are unaware that they are at risk.

Sun protection tips:

1. Spend time in the shade during the sunniest part of the day when the sun is at its strongest, which is usually between 11am and 3pm in the summer months.

2. Avoid direct sun exposure for babies and very young children.

3. When it is not possible to limit your time in the sun, keeping yourself well covered, with a hat, T-shirt, and sunglasses, can give you additional protection.

4. Apply sunscreen liberally to exposed areas of skin. Re-apply every two hours and straight after swimming, sweating or towelling to maintain protection.

Checking for skin cancer:

There are two main types of skin cancer: non-melanoma, the most common, and melanoma, which is less common but more dangerous. The following ABCDE rules describe a few changes that might indicate a 'melanoma', which is the deadliest form of skin cancer. As skin cancers vary, you should tell your doctor about any changes to your skin, even if they are not like those mentioned here. If your GP is concerned about your skin, make sure that you are referred to a dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Asymmetry - the two halves of the area may differ in shape or colour

Border - the edges of the area may be irregular or blurred, and sometimes show notches

Colour - this may be uneven. Different shades of black, brown and pink may be seen

Diameter - most melanomas are at least 6mm in diameter. Report any change in size, shape or diameter to your doctor

Evolution – if you see progressive changes in size, shape or colour over weeks or a few months, you must seek Expert help.

If in doubt, check it out! If your GP is concerned about your skin, make sure you see a dermatologist, the most expert person to diagnose a skin cancer. Your GP can refer you via the NHS.

Non-melanoma skin cancer

Non-melanoma skin cancers can occur on any part of the body, but are most common on areas of skin that are most often exposed to the sun such as your head and neck (including lips and ears) and the backs of your hands. They can also appear where the skin has been damaged by X-rays, and on old scars, ulcers, burns and persistent wounds.

Non-melanoma skin cancers vary greatly in what they look like. They tend to appear gradually on the skin, and slowly get bigger over time. They will not go away on their own without treatment. Some possible signs include:

- A scab or sore that won’t heal. It may also bleed occasionally

- A scaly or crusty patch of skin that looks red or inflamed

- A flesh coloured, pearly lump that won’t go away and appears to be growing in size

- A lump on the skin which is getting bigger and that may be scabby

- A growth with a pearly rim surrounding a central crater, a bit like an upturned volcano

About us:

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.bad.org.uk  

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