Skin Cancer Service - Plymouth Hospitals

plymouthhospitals.nhs.uk

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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Consultant’s name ………………………………………………….................

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Your hospital number ……………………………………...……….................

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Plymouth Hospital NHS Trust

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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

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Plymouth Hospital NHS Trust

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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

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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

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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

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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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