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As the human body’s largest organ, it’s no surprise that an endless number of things can go wrong with your skin.
There are the lumps and bumps that can appear out of nowhere, the myriad of shapes and colours of moles, freckles, warts and patches of skin which may turn darker or become dry and crusty.
The key, however, is knowing when it’s something you need to worry about – and when you can safely leave it alone.
That isn’t always straightforward. The skin is overwhelmingly complex, with multiple layers forming a protective barrier against things such as pollution and UV rays. The barrier prevents loss of moisture too.
The skin also has its delicate network of blood vessels, which help supply the layers with oxygen and nutrients. Unsurprisingly, reference books used by doctors to help diagnose skin conditions are as big as encyclopaedias.
There are thought to be about 3,000 skin conditions – not all cancerous. Some are related to sun exposure or normal ageing; others are linked to different health problems.
Dr Harper-Machin is a spokeswoman for the British Association of Plastic and Reconstructive Surgeons
As a consultant plastic surgeon of 20 years, in my own NHS clinic where I regularly remove all types of skin cancer, I’ve probably seen only a fraction of them. While in my private clinic I’ve also operated on all sorts of benign skin complaints for cosmetic reasons as well as for serious cancers like melanoma.
And though there isn’t space here to discuss everything that can go wrong, we certainly can explore the most common things you’ll come up against.
So here is my ultimate guide – which should help you work out what you can do about those problematic skin issues, when to worry and when to seek medical help.
Sometimes it’ll be just about putting your mind at ease, but it could also save your life…
I’VE GOT CRUSTY BROWN PATCHES ON MY SKIN – IS IT CANCER?
Most brown patches on the skin are nothing to worry about. Often they’re linked to an overgrowth of keratin – a protein that helps form the skin’s outer layer and is constantly regenerating.
Too much keratin can cause keratosis, where the excess clogs your pores and leads to bumps or thick, scaly, dry patches.
There are different variants of the condition, and while most are common some are considered precancerous so need to be treated.
The ones you don’t need to worry about are seborrheic keratoses – benign growths affecting half of men and more than a third of women. Ranging in colour from pink to brown to almost black, they may appear waxy and slightly raised – people often say they look like they’ve been stuck on. They can grow, but are harmless and don’t need treatment (though you can have them removed privately if their appearance bothers you).
However, if they appear very dark, get them checked to rule out melanoma, the most dangerous type of skin cancer.
The ones you don’t need to worry about are seborrheic keratoses – benign growths affecting half of men and more than a third of women
More worrisome are actinic keratoses – also called solar keratoses – dry, scaly patches that feel rough, like sandpaper.
Other dark patches that aren’t a concern include liver spots, or age spots – flat areas of darkened skin that resemble large freckles. Once thought to signal liver problems, we now know they’re caused by sun damage, which prompts the skin to produce extra melanin – the pigment that determines skin colour.
More worrisome are actinic keratoses – also called solar keratoses – dry, scaly patches that feel rough, like sandpaper.
About 10 per cent become squamous cell carcinoma (SCC) – more on this later.
These patches are usually 1cm–2.5cm wide and tend to appear on sun-exposed areas such as the face, hands, arms, scalp and legs. They may match your skin or be pink, red or brown.
If there’s one patch and it’s painless, a GP might suggest waiting to see if it disappears. But if there are several, or it’s painful, you’ll be referred to a dermatologist.
Treatment options include prescription creams, minor surgery under local anaesthetic, or cryotherapy to freeze them off.
As with all skin problems, you can protect yourself by wearing at least SPF 30, covering up with a hat and loose clothing, and avoiding the sun between 11am and 3pm.
WHEN SHOULD YOU WORRY ABOUT A MOLE, BUMP OR GROWTH?
Despite what you might think, most moles are absolutely nothing to worry about – from big knobbly ones and unsightly hairy ones to the small red ones.
Almost everyone develops between ten and 45 during childhood and adolescence (though some people are genetically predisposed to have more), and they’re simply growths formed when melanocytes – the cells that produce skin pigment – grow in clusters.
They can be brown, pink, black, tan – even blue – and be wrinkled, smooth, raised or flat. They appear anywhere: trunk, armpits, under nails, between toes.
Most moles are absolutely nothing to worry about – from big knobbly ones and unslightly hairy ones to the small red ones
Most don’t require attention unless you dislike how they look (the NHS won’t remove them for cosmetic reasons, but private clinics will). Some people worry about little red moles, but these are just cherry angiomas – harmless clusters of blood vessels that commonly appear after the age of 30. It’s also normal for moles to change or fade over time.
Some women find that theirs darken or enlarge due to hormonal changes in teenage years, pregnancy or menopause.
So when should you worry?
The main concern is melanoma – the skin cancer that affects 16,700 people a year in the UK and causes more than 2,300 deaths.
Melanomas vary, but a key rule is to watch for any mole that’s changed in size, shape, outline, if it has scabbed or started bleeding.
And don’t be fobbed off if you’re told you’re ‘too young’ to get melanoma. I have treated several children with melanoma – and on my surgical list last week were women in their 30s who’d previously been reassured by GPs.
Pay attention if you’re fair-skinned, have more than 50 moles, or have used tanning beds. A weakened immune system can also raise your risk.
The main cause for concern is melanoma. These vary but a key rule is to watch for any mole that’s change in size, shape, outline, if it has scabbed or started bleeding
VIRAL LUMPS THAT HAVE OVER-THE-COUNTER TREATMENTS
Warts are extremely common growths caused by a viral infection called human papillomavirus, or HPV.
They’re skin-coloured bumps, round or oval-shaped, that appear anywhere but most often on the hands and feet.
They look different from moles, often with a rough, cauliflower-like surface and tiny black dots –clotted blood vessels.
Other types include plane warts – which are flat, yellow and may appear in clusters – or mosaic warts that grows in groups on the bottom of your feet.
Warts on the soles of the feet are known as verrucae but are essentially the same thing.
Warts are extremely common growths caused by the HPV virus. They can be itchy or embarrassing – but the good news is that they aren’t harmful
The good news: they’re not harmful. While some strains of HPV are linked to cervical or head and neck cancers, the strain that causes warts is different.
They can be itchy or embarrassing, but are easily treated with over-the-counter remedies. Various creams, plasters and sprays are available from pharmacies, but treatment may take several months. GPs can also freeze them off.
Skin tags are often mistaken for warts or moles.
These soft, skin-coloured growths tend to appear where the skin folds or rubs – under the arms, around the bottom or on the neck.
See a GP if they bleed, grow or become painful – but removal is considered cosmetic and not offered on the NHS.
SCALY PATCHES WHICH CAN BE MORE DEADLY THAN MELANOMA
While we’re aware that moles can turn cancerous, less obvious are other minor skin complaints that may indicate non-melanoma skin cancers.
A persistent spot that doesn’t clear within several weeks, and may intermittently bleed or crust, should be checked as it could be a basal cell carcinoma – BCC.
Similarly, a scar-like mark that itches.
We often dismiss these signs – blaming glasses, shaving or gardening – because they’re subtle and slow-growing. But unlike acne or minor injuries, they won’t heal.
Thought to start in hair follicles, BCCs are especially common on the nose, which gets a lot of sun and has a high concentration of follicles.
Fortunately, they’re treatable. You may only need a mild chemotherapy cream like Efudix, or an immune-boosting cream. Surgery is an option if creams fail.
A persistent spot that doesn’t clear within several weeks, and may intermittently bleed or crust, should be checked as it could be a basal cell carcinoma – BCC
Squamous cell carcinomas – SCCs – may begin as red, scaly patches but can ulcerate, become lumpy, painful and weepy. They are increasingly common
While BCCs grow slowly, squamous cell carcinomas – SCCs – do not.
These may begin as red, scaly patches but can ulcerate, become lumpy, painful and weepy. They may mimic cysts or infections – I’ve seen patients given several rounds of antibiotics with no effect.
Historically, SCCs have been overlooked when compared to melanomas – but that must change. As melanoma treatment has improved, more of my patients now die from SCCs than melanoma. They’re increasingly common, particularly among the ‘baby boomer’ generation who embraced cheap foreign holidays.
A useful trick: apply Vaseline to dry patches – if the dryness clears, it’s likely benign. But if it persists, is painful or enlarging, press your GP to consider diagnosing SCC. In about 80 per cent of cases, it’s treatable with creams and surgery. But in the other 20 per cent, if not caught early, treatment may no longer be life-saving.
SKIN CONDITIONS THAT DON’T MAKE CANCER MORE LIKELY
Common skin conditions such as eczema and psoriasis can be painful and disfiguring but today there are treatments which can offer relief – so don’t suffer in silence.
Both affect millions, and can cause red, itchy and inflamed dry skin which is linked, in different ways, to an overactive immune system.
Common skin conditions such as eczema (pictured) and psoriasis can be painful and disfiguring but today there are treatments which can offer relief
They can be mistaken for each other, but psoriasis involves thicker scaly patches on the skin, while eczema can look like a rash with bumps, crusty patches and sometimes oozing. The good news is that neither skin condition makes cancer more likely.
In the first instance, emollient and topical steroid creams can hydrate the skin and reduce dryness and inflammation. Exposing the skin to UV light, known as phototherapy, may also be used.
But for severe cases, dermatologists can prescribe tablets or injections which help suppress the immune system.
Don’t panic over face blemishes in pregnancy
Pregnant women might be concerned by brown or greyish patches which can develop on their skin – often on the face.
But this is melasma, a harmless condition which is thought to develop partly because of hormonal changes during pregnancy, but also from taking the contraceptive pill or HRT. Stress can also be a trigger.
It’s thought the changes cause skin cells to over-produce melanin, which alters the colour of the skin in some places. As many as 50 per cent of pregnant women can be affected – and it can be upsetting.
While for some it may go away a few months after giving birth, there is no cure. You should use a high-factor sun cream to prevent new patches, and treatments such as skin lightening creams, laser therapy, chemical peels and tranexamic acid – a drug used to control heavy periods which also blocks melanin production – can improve symptoms.
SMALL ‘SCAB’ WAS A TUMOUR
When Julie Bowie found a small lump on her right leg last year, just above her ankle, she assumed it was an ingrowing hair.
It hurt, and was about the size of a penny – but the 58-year-old hairdresser, from Kent, recalls how within weeks it had formed a scab and then turned into a ‘volcano’.
‘It developed a hole in the middle with sides that were white and puffy, before forming another scab again,’ recalls Julie.
Julie Bowie, 58, a hairdresser from Kent. She found a lump above her ankle which turned out to be a squamous cell carcinoma
It was only when visiting her GP for an unrelated matter in September that she happened to mention the lump.
She was immediately given an urgent referral to a dermatologist, who diagnosed her with a squamous cell carcinoma (SCC) – a type of skin cancer caused by an overproduction of squamous cells, which are found in the top layer of the skin.
Two weeks later it was surgically removed under local anaesthetic.
‘I’m left with a big hole in my leg and I needed a skin graft,’ she says. ‘But I’m lucky and I need no further treatment.
‘I’m on a Facebook group for people with SCCs and they’re not always so fortunate. Some wait for a long time before being diagnosed.
‘As a hairdresser, I’m now always telling people to get various lumps on their heads checked out. Don’t ignore anything that’s unusual.’
Dr Harper-Machin is a spokeswoman for the British Association of Plastic and Reconstructive Surgeons.
Visit bapras.org.uk for patient information guides on benign skin conditions and skin cancer. The charity Skcin (skcin.org) also has information.
