Skin Cancer Service - Plymouth Hospitals
Information
for Patients
Skin Cancer Service
Plymouth Hospitals NHS Trust
Issue 08/09
Review 08/11
A-134/Onc/Skin/RD/Information for
Patients
Derriford Hospital
Derriford Road
Plymouth
PL6 8DH
Tel: 0845 155 8155
www.plymouthhospitals.nhs.uk
Plymouth Hospital NHS Trust
Introduction
Your Hospital Team
Skin Cancer Service
This set of information leaflets is designed to provide you and
your family with information about skin cancer and its treatment.
At each stage of your treatment the relevant information will be
added to your set.
There are blank pages included for you to write down any
questions you have. Any member of the skin cancer team will
be happy to answer them for you either at your clinic
appointment or over the telephone.
There is a space for any member of the skin cancer team to
write down comments or changes to your treatment so you have
an up to date record of your planned care.
We would appreciate any comments you have regarding this
information and how beneficial it has been for you.
Acknowledgement
The authors would like to thank MARCS Line and the Wessex Cancer
Trust for reference materials used in the creation of this document.
Introduction
Skin Cancer Service
Plymouth Hospital NHS Trust
Your personal details
Your Hospital Team
Skin Cancer Service
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Hospital Address
Derriford Hosptital,
Derriford Road,
Plymouth
DEVON, PL6 8DH.
Tel: 08551558155
Your Personal Details
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
The Skin Cancer Team at Derriford Hospital
Your Hospital Team
The Plymouth Skin Cancer Multidisciplinary Team (MDT) has a large team
of specialists dedicated to providing first class care to patients with skin
cancer. The team includes:
Consultant Dermatologist
Secretary number
Dr Toby Chave (Lead Clinician MDT) 01752 763058
Dr Jane Parrish (Associate Specialist) 01752 763058
Dr Urzula Brudnik 01752 763057
Appointments 01752 439936
Consultant Plastic Surgeon
Mr Duncan Mackenzie 01752 431519
Mr Rob Morris 01752 431515
Mr Anthony Fitton 01752 431515
Mr David Camp 01752 431517
Mr Lachlan Currie 01752 431516
Mr Krish Kumar (Associate Specialist) 01752 431518
Mr Jacob Manushakian 01752 431517
Surgeon Commander Rory Rickard RN 01752 431515
Appointments 01752 439937/431184
Consultant Oncologist
Dr Martin Highley 01752 763994
Skin Cancer Nurse Specialist
Ruth Devlin 01752 439800
Consultant Histopathologist
Dr Dean Harmse
Consultant Radiologist
Dr P Suresh
Biopsy Nurse
Diana Morgan
The Team meet weekly, every Tuesday afternoon, to agree individual
treatment plans. Following the meeting, you will be seen in the clinic by
your Consultant where your treatment plan will be discussed with you and
your family. A copy of the treatment plan will be sent to your GP.
The Skin Cancer Team at Derriford Hospital
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Skin Cancer Nursing Service
Ruth Devlin is our Skin Cancer Clinical Nurse Specialist. She is part of
the multi-disciplinary team working towards improving the quality of care
for people with skin cancer.
As a Nurse Specialist, she is available to
• help co-ordinate your care from diagnosis to treatment and through
to follow up care
• be a familiar face who can provide support for you and your family
• provide information on tests, investigations and treatment options
• offer support and advice on symptom control
• provide a link to other professionals and support services
Ruth can be contacted
Monday – Friday
9am – 5pm
01752 439800
e-mail: ruth.devlin@phnt.swest.nhs.uk
Your Treatment Plan
If you would like written details of your management plan please contact
Ruth Devlin, Skin Cancer Nurse Specialist/Key worker on 01752 439800.
Your Key Worker
You will be offered a named Key Worker who will be responsible for
co-ordinating your care. The whole team can be contacted via your key
worker. To find out who your key worker is or for any other information
about your care, please contact Ruth Devlin on 01752 439800.
Skin Cancer Nursing Service
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Your Treatment Plan
Your Hospital Team
Your suggested treatment plan is
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Test results
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Your Treatment Plan
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Malignant Melanoma
Your Hospital Team
What is a Malignant Melanoma?
Malignant melanoma is the rarest, but the most serious of all
skin cancers. There has been a sharp rise in numbers over the
last decade and it accounts for around 7,000 new cases each
year.
It is a cancer of the melanocyte cells, which produce the brown
pigmentation in your skin that forms freckles, moles, and your
suntan. They are found at the base of the epidermis (the top
layer of your skin).
Malignant Melanomas appear in normal skin or in changing
moles. Suspicious changes include an increase in size or
change in shape, deepening in colour, itching, bleeding and
surrounding inflammation. They can spread along the skin’s
surface but they can also penetrate inwards into the deeper
layers of the skin. This is when, if left untreated, they may
spread to other areas of your body.
If any of the melanoma cells have broken away they can spread
to your lymph glands (also called nodes). You have lymph
glands all over your body. There are large groups of them in
your neck, jaw, axilla (armpit), elbow creases, groin and behind
your knees. If the melanoma has spread it will generally travel
to the nearest group of nodes from the original site and if this
happens you will need to have all the glands in that area
removed. This is known as a “block dissection”.
Malignant Melanoma
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Malignant Melanoma
What are the causes?
The cause of melanoma is not entirely understood but there is
strong evidence to suggest that ultraviolet radiation caused by
exposure to high intensity sunshine (causing the skin to burn) is
a major factor. People with fair or red complexions are
particularly at risk especially if they have been sunburnt during
childhood and early adulthood. A small group of people may
have a genetic predisposition to the development of melanoma
and the use of sun beds is also thought to increase the risk of
developing skin cancer.
How are they treated?
Treatment of malignant melanoma depends largely on the result
of your biopsy, which usually involves close but complete
surgical excision of the mole, and will tell us how thick your
melanoma is (the Breslow thickness). You will be given the
results of your tests approximately 4 weeks afterwards in the
outpatients department.
Following your biopsy you may need to have another operation
called a “wide local excision” this is where a margin of healthy
tissue is removed from around your biopsy scar. See additional
leaflet on “wide local excision”.
In some cases you will be asked to have other investigations to
find out if there has already been any spread of your melanoma.
Lentigo maligna (a form of malignant melanoma in situ) is not
always treated with surgery because it has not penetrated into
the deeper layer of skin it can sometimes be treated with
radiotherapy or chemotherapy creams.
Malignant Melanoma
Skin Cancer Service
Plymouth Hospital NHS Trust
Malignant Melanoma
Your Hospital Team
Skin Cancer Service
-
Follow-Up Care
You will initially need to be seen as an outpatient every 3 months
for 3 years, this may then be continued on a 6 monthly basis for
a further 2 years.
At your follow-up appointments your melanoma site will be
examined for signs of recurrence and your lymph glands will be
examined for signs of enlargement. You will be shown what to
look for in your melanoma site and how to examine your own
lymph glands by your Consultant and the Clinical Nurse
Specialist. See additional leaflet on “how to check your lymph
nodes”.
Telephone numbers for follow-up appointments:
Dermatology 01752 439936
Plastic Surgery 01752 439937/431184
Oncology 01752 763994
Malignant Melanoma
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Wide Local Excision
The aim of this surgery is to remove an area of healthy tissue
from around the site of the melanoma and therefore minimise
the risk of the cancer returning to that area. You will already
have a scar from where you had your mole/lesion removed, and
as we need to take away more skin you will end up with a
slightly longer scar. The wound itself will be closed with stitches
and tape over the top to reinforce the wound. The stitches (if
they are not dissolvable) will need to be removed 7–14 days
post surgery.
In some cases there will not be enough skin to close the wound
directly, in which case you may need to have a skin graft, but
your doctor will discuss this with you beforehand.
Following your procedure your doctor will advise you on care of
the wound.
Possible post operative problems
Pain – You may experience some mild discomfort following
surgery. This can easily be controlled with mild pain killers.
You will be given a supply before you leave hospital.
Bruising and haematoma – You may experience some
bruising. This will gradually disappear, but occasionally blood
collects within the tissues surrounding the wound causing
swelling, discomfort and hardness. This is called a haematoma.
Although the blood will eventually be reabsorbed by the body,
this can take a few weeks. If the haematoma causes you a lot of
discomfort, you should contact:
• Your GP
• Dermatology Department on 763053
• Plastic Surgery Dressing Clinic on 01752 431024
Wide Local Excision
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Infection – If your wound becomes red, inflamed, more painful
or begins to ooze you may need a course of antibiotics, so you
will need to contact:
• Your GP
• Dermatology Department on 01752 763053
• Plastic Surgery Dressing Clinic on 01752 431024
Movement – Depending on where your wound is you may need
to be careful when moving/lifting but you will be told this before
you leave hospital.
Follow-Up Appointment
You will need to have a wound check following surgery. This is
to check that there are no problems and that your wound is
healing well. This may be done at your G.P.’s surgery by the
practice nurse (you will need to make an appointment).
Following this you may need to come back to the hospital
outpatient department for follow-up. (See previous paragraph on
follow-up care).
Wide Local Excision
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
How to Check Your Lymph Nodes
Your Hospital Team
Introduction
You have been diagnosed with a skin cancer that on occasions
can spread into the lymphatic system. That is why, as part of
your examination, your nodes are examined by your doctor or
specialist nurse at your follow-up appointments. The lymph
nodes examined depend on the location of your skin cancer,
eg: if your skin cancer was on your leg then the lymph nodes in
your inguinal area (groin) will be felt or if on your face then the
nodes in your head and neck would be examined. The aim is to
detect any enlargement of the lymph nodes and undertake
investigations at an early stage. Some people express a wish to
check their own lymph nodes between clinic appointments. This
is why you have been given this information. Your doctor or
nurse will show you how and which lymph nodes to check.
The Lymphatic System
This system consists of
lymphatic vessels and
tissue. Lymph is a fluid that
contains proteins and waste
materials, which is collected
from around the cells in the
body, eventually draining into
larger vessels.
Position of Lymph Nodes
How to Check Your Lymph Nodes
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Lymphatic vessels.
One way of describing this is to imagine a river that starts as a
small stream, which then weaves its way between the cells and
small blood vessels of the body’s connective tissue. On its
journey more tissue and waste material is collected. The fluid
(lymph) that accumulates firstly drains into larger lymph vessels,
then into ducts in the neck, before emptying into the blood
stream.
Lymphatic tissue.
Lymph nodes are small oval clumps of lymphatic tissue found at
intervals along the vessels. They are grouped like “beads on a
string” both deep in the body and near the surface (see previous
diagram). These lymph nodes filter out harmful organisms and
cells from the lymphatic fluid before it is returned to the blood
stream. Lymph nodes can only be felt in the areas listed:
• head and neck
• arms
• axilla (armpits)
• inguinal area (groin)
• back of knees
Usually lymph nodes are not enlarged and thus not able to be
felt, but if you have previously had an infection (such as
tonsillitis) you may have noticed and felt lymph nodes becoming
enlarged, painful and tender. Lymph nodes can also become
enlarged due to cancer cells lodging in them.
Checking your lymph nodes once a month is sufficient and this
can be done at the same time as you check your skin for any
changing moles. Checking them more often may result
indifficulty noticing any change.
Do not panic if you feel a lymph node as it may well be due to an
infection, but if it has not gone away in a week contact your
doctor or specialist nurse.
How to Check Your Lymph Nodes
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
How to Check Lymph Nodes in the Head
and Neck
Your Hospital Team
• With your fingertips, in a gentle circular motion feel the lymph
nodes shown.
• Start with the nodes in front of the ear (1) then follow in order
finishing just above the collar bone (10)
• Always check your nodes in this order.
• Check both sides for comparison. If you have an enlarged
lymph node it may feel like a swelling the size of a pea,
sometimes they can be larger.
When feeling the nodes in your neck (marked 8):
• Tilt your head towards the side you are examining, this helps
to relax the muscle.
• Now press your fingers under the muscle.
When checking the lymph nodes above the collar bone:
• Hunch your shoulders and bring your elbows forward to relax
the skin.
• Now feel above the collar bone (marked 10).
How to Check Lymph Nodes in the Head and Neck
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
How to Check Lymph Nodes in the Armpit
Your Hospital Team
Remove all clothing down to the waist to get easy access
to the armpits.
• Sit in a comfortable position.
• Check each armpit in turn.
To check the left side, lift your arm slightly then place the fingers
of your right hand high into the armpit and then lower your arm.
• Feel in the central area of the armpit.
Now move your fingers firmly against the chest wall as
follows:
• Along the front border of the armpit.
• Along the back border of the armpit.
• Feel along the inner border of the arm.
Now check the other armpit.
How to Check Lymph Nodes in The Armpit
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
How to Check Lymph Nodes in the Groin
Your Hospital Team
There are two areas to look for inguinal (groin) nodes:
• Feel the horizontal chain of nodes in the right groin just
below the ligament (see above diagram).
• Feel the vertical chain along the upper thigh (see above
diagram).
• Check the lymph nodes in the other groin.
Conclusion
The purpose of this information is to help you understand why
you have your nodes checked at your follow-up appointments.
It explains which lymph nodes you need to check and how to
undertake this procedure yourself. The aim is to ensure that if in
the unlikely case there is spread of your skin cancer to the
lymph nodes, it is detected and reported to your doctor or nurse
straight away rather than waiting until your next clinic
appointment.
How to Check Lymph Nodes in the Groin
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Pre-operative Assessment
What is pre-operative assessment and why do I
have to have it?
Pre-operative assessment is an outpatient clinic you will be
asked to attend prior to your surgery. It will be on Marlborough
Ward, Level 10 at Derriford Hospital.
Assessing you before your operation allows us to:
• determine your fitness for the forthcoming anaesthetic
• give you information about your operation and answer any
questions you may have
• prepare you for your operation and plan your discharge
You will be seen one to two weeks before your operation
How long will it take?
Assessment itself usually takes about 45 minutes, but you will
need to allow time for any tests to be carried out. Please allow
two hours in total.
How will I be assessed?
Pre-assessment is a very individual process where a specially
trained nurse will assess you. It may also be necessary for you
to see
• A consultant or doctor
• An anaesthetist
What does the assessment involve?
The assessment will involve checking:
• any previous medical / surgical history
• whether you have any current medical problems
• any medications you take
• how you will manage at home with personal hygiene and
domestic chores
Pre-operative Assesment
Skin Cancer Service
Plymouth Hospital NHS Trust
• what help and support you have, e.g. with cooking,
shopping, care of young children
Skin Cancer Service
We will give you information about:
• the operation itself
• how long you can expect to be in hospital
• what to expect after the operation and your discharge
from hospital
• some of the risks involved
• we will want to weigh you, record your blood pressure and
pulse
We may also want to carry out other investigations, including:
• blood tests
• ECG (tracing of heart activity)
• MRSA screening
What do I need to bring?
You need to bring any medication you are taking
What happens if you feel unwell or we find
something wrong?
Simple problems can often be treated by your GP before you are
due to come into hospital, this will allow the operation to go
ahead as planned. However, complicated problems are
sometimes more difficult to solve; your consultant or anaesthetist
may postpone your operation temporarily to allow time for further
tests or treatment. This is to ensure you are as fit as possible for
your operation. If this happens you will be given a new
admission date as soon as possible.
If you have any problems / queries please
do not hesitate to contact Marlborough Ward
Tel: 0845 155 8133
Pre-operative Assesment
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Grafts for Skin Cancer
Skin Cancer Service
Your Hospital Team
Surgery for skin cancer involves removing the affected area and
some of the surrounding, healthy-looking skin. If the area is
fairly small, it will be possible to close the wound by bringing the
edges of the skin together. Larger wounds may need a skin graft
to cover the area.
Skin grafts are layers of skin taken from another part of the body
(see the ‘donor site’ leaflet) and placed over the area where the
cancer has been removed. A partial thickness (or split thickness)
skin graft is where the epidermis and a part of the dermis layer is
used. The skin is usually taken from the thigh, buttock or upper
arm. Skin will grow back in this area.
A full thickness skin graft is where the epidermis and the full
dermis layers are used. In this case, only a small area is taken
from the donor site and the skin edges of the donor site are then
stitched together to heal. Skin may be taken from the neck, the
area behind the ears and the inner side of the upper arm.
How is a skin graft applied?
You may have either a general or a local anaesthetic depending
on the area being grafted. Your doctor will advise you which is
best for you. Once the skin layer has been taken from the donor
site, it is placed over the wound where the cancer has been
removed. The graft may be stapled, stitched or glued in place,
or simply laid onto the area. These techniques depend on the
patient, the size of the skin graft and the area where it is applied,
or on the Consultant’s instructions.
What happens after the surgery?
You will need to take things gently for the first two weeks to allow
the graft to heal properly. The grafted area is quite fragile, so it
is important not to rub or brush against the graft or the dressing,
Skin Grafts for Skin Cancer
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
or put any pressure on the area. If it is anywhere other than on
your leg(s), you can start walking as soon as you feel up to it.
If it is on one or both of your legs, then we encourage limited
mobility for usually for 2 days, or until the skin graft is secure
enough for walking. This means you can transfer from bed to
chair only and avoiding putting any weight through the grafted
leg. The nursing staff will advise you when you can start to walk.
If the grafted area is on your hand you may have a sling to keep
your arm raised as much as possible.
What dressing will be used?
Both the graft and donor site will be covered by a dressing. The
dressing applied to the graft is important as it helps to immobilise
the grafted area, which will encourage the graft to take.
Will I need to keep it dressed when I go home?
Yes, in the early days a protective dressing will be necessary.
This will be changed by either the plastic surgery dressing clinic
at the hospital, the district nurse or by your GP practice nurse if
you can attend there.
How can I help my skin graft to take?
By eating a healthy balanced diet with plenty of protein such as
milk, meat, cheese, yoghurt, eggs and fish. Avoiding smoking
also helps as smoking slows down the healing process by
reducing the oxygen and blood supply to the grafted area.
What will my skin graft look like?
With any skin graft, scar formation is inevitable. The appearance
of your skin graft will change considerably over the weeks and
months to follow, so its initial appearance should not cause
alarm. It can take up to 18 months for a scar to “mature”, usually
leaving a pale, soft, flat and supple surface.
Skin Grafts for Skin Cancer
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
How do I care for the skin graft once it has healed?
Skin grafts have fewer oil and sweat glands so tend to become
dry. When the graft is completely healed, it should be kept clean
by gentle washing. Avoid very hot water and never use highly
perfumed soaps, creams or bubble baths until it is well healed.
You need to gently massage oily cream in once or twice a day to
moisturise the graft and keep the skin supple. E45, aqueous
cream or unperfumed Nivea can be used. This is usually kept
up for 6 months.
Will I need to wear any support when I go home?
If your skin graft is on your leg, yes you will. Tubigrip (an elastic
stocking) is required for walking for several months after and
should not be discontinued without medical advice. Tubigrip
should be applied in the morning and removed when you go to
bed. Your leg(s) should be elevated on a stool when you are
resting to prevent any unnecessary swelling.
Is there any other advice I should know about
caring for my skin graft?
Yes, the skin graft will be very sensitive to the sun. The graft
may sunburn more readily or develop blotchy pigmentation. For
the first year during strong sunshine, your graft should be
protected. Keep it covered up or use total block cream that you
can buy from your local chemist.
If you experience any problems immediately after your
discharge from hospital, you can telephone Lynher Ward
anytime on 01752 7922744 for advice. If you experience any
problems once you are under the care of the dressing clinic,
please contact them on 01752 431024 (Monday-Friday, 0830-
1630).
Skin Grafts for Skin Cancer
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Donor Sites
What is a donor site?
A donor site is the area left where a piece of skin has been taken
to cover a wound on another part of the body. There are various
areas from which skin can be taken, such as the thigh, the upper
arm, or even the buttocks.
How long will it take for the donor site to heal?
It usually takes around 10-14 days. The dressing applied in
theatre at the time of your operation will stay in place for that
period and should be kept clean and dry. A donor site is like a
bad graze, so the dressing protects the raw surface and allows it
to heal, and also soaks up any fluid that naturally seeps from the
wound. This can sometimes cause a strange odour, but this is
normal.
Will the dressing need to be changed before the
10-14 day period?
There are times when a donor area does need to be changed,
such as if the dressing becomes loose, if there is an excessive
loss of fluid through the dressing or if it becomes infected. This
can be done by the hospital nurse if you are still in hospital, by
the plastic surgery dressing clinic nurses or by your local
practice nurse once you have been discharged.
Will I get any pain from my donor site?
Some people experience more pain than others, usually within
the first 48 hours. Regular painkillers, such as paracetamol, can
be taken.
Donor Sites
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Who will remove the dressing when it is due to
come off?
This will be done by the plastic surgery dressing clinic at the
hospital, the district nurse or by your GP practice nurse if you
can attend there. This will be arranged by the ward staff when
you are discharged. The dressing usually loosens itself as the
wound heals, otherwise it can be soaked off in the bath. If the
area is fully healed and dry, then it can be left exposed and you
can massage in cream, such as E45 or Nivea, twice a day.
Do not apply it to raw areas.
Do I have to be careful about what clothing I wear?
Try not to wear articles of clothing that might make you itch or
may be too tight. But if you find that some clothes do rub, a
protective dry dressing should be worn.
Will my donor site look like normal skin when it is
healed?
You can expect your donor site to change colour. At first it can
look bright red, but over several months will become paler.
Eventually it will blend in, but it may end up slightly paler than
your surrounding skin. Be aware that, as with your skin graft,
you should avoid strong sunlight, so you need to cover up or use
total sun block. Advice should be taken from your doctor about
lifting, stretching and returning to work.
If you experience any problems immediately after your discharge
from hospital, you can telephone Lynher Ward anytime on
01752 7922744 for advice. If you experience any problems
once you are under the care of the dressing clinic, please
contact them on 01752 431024 (Monday-Friday, 0830-1630).
Donor Sites
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Squamous Cell Carcinoma (SCC)
What is a squamous cell carcinoma?
Squamous cell carcinoma is the second most common form of
skin cancer. They are slow growing, red, scaly, irregular lesions
that can bleed easily and fail to heal within 4-6 weeks. If left
untreated they can spread to other parts of the body.
What are the causes?
Prolonged exposure to sunlight is the cause of almost all
squamous cell carcinomas. They occur most frequently on
exposed parts of the body such as the face, ears, neck, scalp,
shoulders and back. Rarely, SCCs can develop on non-exposed
areas of the body. Anyone with a history of frequent sun
exposure and repeated sunburn are high risk and also people
who have fair skin, light hair, and blue, green, or grey eyes.
How are they treated?
Squamous cell carcinoma can be treated by minor surgery under
a local or general anaesthetic. Treatment depends on the size
and position of the SCC and can involve:-
Currettage:
For very small SCCs this is a very effective treatment. Under a
local anaesthetic your doctor can simply scrape the lesion away
from your skin. This might leave a small scar.
Surgery:
Most SCCs can be cut out and this is often the best treatment.
This allows the tissue to be tested by a pathologist to confirm the
diagnosis and check that it has been completely removed.
Occasionally excision is not complete or the margin is narrow
necessitating further treatment. Cutting the SCC out means that
Sqaumous Cell Carcinoma
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
the hole left behind may require a skin graft (see leaflet on “skin
grafts”).
SCCs that are large (greater than 2cm in diameter) or thick,
have a higher risk of spreading to other parts of the body. If the
SCC spreads to the local lymph glands (there may be a lump in
the groin, armpit or neck) then surgical removal of all the glands
in that area will be required. See leaflet “how to check your
lymph nodes”.
Radiotherapy:
Treating SCCs with a very short and localised course of
radiotherapy has been shown to be as effective in curing SCCs.
In some patients this may be the best option.
Follow up
Patients with small, low risk SCCs may be discharged back to
their GP after removal.
Patients with more aggressive tumours are followed up regularly
every 3-6 months in out patients for up to five years. Your doctor
will decide how often your follow up will be.
Telephone numbers for follow-up appointments:
Dermatology 01752 439936
Plastic Surgery 01752 439937/431184
Oncology 01752 763994
Sqaumous Cell Carcinoma
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Contact Details
Some contacts that you may find useful:
• Macmillan Cancer Support – contact cancer nurses for
support and information, produce an extensive range of
booklets and fact sheets on all aspects of cancer, available
free to patients.
Telephone 0808 808 0000 or www.macmillan.org.uk
• Macmillan Cancer Support Fund – is a UK-wide charity
which supports people living with cancer. Macmillan
cancer relief will provide grants for people with cancer in
financial need. Your skin cancer specialist nurse can apply for
grants to the fund on your behalf.
• Marcs Line – a resource centre for melanoma and related
conditions and has a help line.
Telephone 01722 415071 or marcsline@wessexcancer.org or
www.wessexcancer.org
• Cancer Research UK – a national information service for
all types of cancer.
Telephone 0808 800 4040 or www.cancerhelp.org.uk and
www.sunsmart.org.uk
• Winston’s Wish – guidance and information for families of
bereaved children, supporting bereaved children and young
people.
Telephone 0845 203 0405 or www.winstonswish.org.uk
• Benefit Enquiry Line – for help and advice on claiming
benefit entitlements.
Telephone 0800 882200
Contact Details
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Contact Details
• Citizens Advice Bureau –Your phone book will have the
number for your local office.
• Southwest Public Health Observatory
www.swpho.nhs.uk
• The Mustard Tree Macmillan Centre
Offer people affected by cancer access to good quality,
comprehensive and appropriate information and support.
The Centre is based on Level 3, Derriford Hospital.
Opening times are Monday to Friday (except Bank Holidays).
Drop in or telephone on 01752 763672.
• The Triangle Centres
For cancer support and information for patients, their families
and carers. The Centres, staffed by professionals and trained
volunteers, provide a friendly and welcoming environment
where you can share your concerns, ask questions and
receive support and information.
Devonport, Cumberland Centre
Mondays 1.45pm - 5.50pm
Telephone 08451558002
Kingsbridge, South Hams Hospital
Tuesday 9.30am - 4.40pm
Telephone 01548 852349
Liskeard, Liskeard Community Hospital
Thursday 9.30am - 4.30pm
Telephone 01579 335600 Ext. 5628
Tavistock, Tavistock Clinic
Fridays 9.15am - 4.15pm
Telephone 01822 615935
Contact Details
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Help with Finance
Your Hospital Team
Help with travel costs for patients
Patients in receipt of the following can claim for help with travel
expenses:
• Pension credit (guaranteed credit)
• Income support
• Income based job seekers allowance
• Working tax credit in certain cases
• Child tax credit in certain cases
• Patients on a low income who have been issued with a
HC2 or HC3 form
• Patients who are on a low income but are unable to
produce the above should complete a HC1 or HC5 form
and send it to the health benefits division in the envelope
provided with the form
• War pensions (claim direct from War Office)
• Asylum Seekers
Help with travel costs for carers
Carers can claim back travel cost from the DWP social fund if
the patient is in receipt of:
• Pension credit
• Income support
• Income based job seeker allowance
Other Funding for travel costs
You may be eligible for assistance via other charitable funding
such as Macmillan grants or local cancer charities. You can
speak to our benefits advisor to check your entitlement.
Help with Finance
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Help with Finance
Your Hospital Team
Full time benefits advisor
We appreciate that during times of prolonged treatment a
person’s financial position can alter radically. If you are not sure
whether you are entitled to a benefit, or need help and advice,
why not make a confidential appointment with our benefits
advisor who is now full time within the Mustard Tree Cancer
Support Centre. She can help with:
• Prescription charges
• Work and cancer
• General benefits for those who are sick or are caring
• Travel costs for patients and their carers
• Macmillan Grants
• Plymouth and Cornwall Cancer Fund
• Patient Voluntary Welfare Fund
Please ring the Mustard Tree Macmillan Centre (01752) 763672
to arrange an appointment.
How do I find out more information?
Advice and useful links can also be obtained from
www.be.macmillan.org.uk or from the Macmillan helpline on
freefone 0808 808 0000
Help with Finance
Skin Cancer Service
Plymouth Hospital NHS Trust
Car Parking and Transport
Skin Cancer Service
Public Transport
Derriford Hospital is well served by buses from Plymouth and
the surrounding area. For information on timetables and fares
contact:
http://www.traveline.org.uk
Park and Ride
Derriford is served well by public transport, hosting the second
busiest bus terminal in Plymouth with 44 buses per hour calling
at peak times.
In addition, there is a public park and ride site located north of
the hospital at the George junction (opposite the George
Pub/Hotel). This is ideal for patients and visitors travelling from
the north of the city to Derriford Hospital. It is open from 6.30am
to 6.30pm and parking is free, although you will need to buy a
ticket to travel on the bus (currently £1.50).
Catch the First Bus no.7 service from the park and ride, which
stops directly outside the main entrance to the hospital.
The no.7 service leaves the park and ride every 30 minutes at
24 minutes and 44 minutes past the hour.
Car Parking and Transport
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Walking and Cycling
Walking or cycling to the hospital may be an option for you or
visitors. Cycle parking is located by the main entrance. For a
Plymouth cycle map contact Plymouth City Council on 304316 or
pick one up from the hospital foyer.
Taxis
You can phone Taxifast free from the Derriford Hospital foyer on
01752 222222. There are several other taxi providers, some of
which are wheelchair accessible meaning patients can remain in
their wheelchairs without transferring and drivers will convey
patients direct to their appointments
Drop-off bays
Drop-off and collection bays are available around the hospital
entrances.
Transport Access for Patients (TAP)
Priority is given to vulnerable people in isolated and rural areas.
You may qualify for TAP if you:
• Do not have or are unable for medical reasons to travel in
your own transport
• Cannot be driven to your healthcare appointment with friends,
neighbours or relatives
• Are medically unable to use public transport, or this is not
practical due to your isolated/rural address AND without
transport you will be unable to keep your hospital
appointment.
Please telephone TAP (Transport Access for Patients)
On: 08450 539100
Car Parking and Transport
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
Car parking charges
There are several short-stay pay and display car parks for
patients and visitors. Parking charges apply between 8am and
9pm.
Time
Cost
0-45 min Free (must obtain free ticket from pay and display
45m-2hr £2.20
2-3 hrs £3.30
3-4 hrs £4.40
4-6 hrs £6.60
6-8 hrs £8.00
No Charge between 21.00hrs – 07.00hrs
There is a change machine at the main entrance on level 6.
Concessions
A range of concessionary tickets are available:
• Patients attending clinics for Oncology, Chemotherapy or
Radiotherapy.
• Discounts are available for stays of a week or longer:
£24 for a 5 day ticket (2 days free parking)
£32 or a 7 day ticket (3 days free parking)
£96 for a 1 month ticket (7 days free parking)
All concessionary tickets can be shared between different
vehicles
Car Parking and Transport
Skin Cancer Service
Plymouth Hospital NHS Trust
Skin Cancer Service
For more information on these concessions please
• ring 01752 763949
• or go to the parking office in car park A. The parking office is
open Monday – Friday 9am – 4pm; Saturday & Sunday
3pm – 3.30pm and closed on Bank Holidays
Free Parking
The following groups are entitled to free parking:
• All registered disabled patients who hold a disabled badge or
drivers who are transporting a patient who holds a disabled
badge
• Relatives of those patients who are being cared for on the
Liverpool End of Life Care Pathway (wards must ring to
notify the parking office)
Unexpected Stays
If a patient’s stay is unexpectedly extended either due to clinics
running late or unexpected admission to hospital, then please
ask the ward/department to contact the parking office on 53949
giving the patients car details and which car park they are parked
in.
Travel Expenses
Some patients in receipt of certain state benefits may be entitled
to a refund of their parking costs and travel expenses. Patients
who are entitled to claim back their parking costs must collect a
receipt from the parking office in car park A and take this receipt
to the cashier’s office on level 7, Derriford Hospital or telephone
0845 155 8170.
Car Parking and Transport
Skin Cancer Service
Plymouth Hospital NHS Trust
Your Questions
Skin Cancer Service
Your Questions
Skin Cancer Service
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