Understanding and Managing Skin Lesions and Cancers in the Elderly

Skin cancer is one of the most common types of cancer in the UK, with a sharp rise among older adults. Here, we discuss some of the most common types of skin cancers seen in the elderly population.

Basal Cell Carcinoma (BCC)

Basal cell carcinoma, also known as “rodent ulcers”, is the most common type of skin cancer, particularly among white and fair-skinned individuals. It’s rare in dark-skinned people. The incidence of BCC increases with age, with those aged over 75 years being about five times more likely to have a BCC than those aged between 50-55 years.

BCC typically develops on sun-exposed areas of the skin such as the face, head, neck, and ears. The most common cause is exposure to ultraviolet (UV) light from the sun or from sunbeds. They appear as slightly elevated waxy brown, black or tan growths on the skin surface.

While BCCs can occur anywhere on the body, they are most common on areas exposed to the sun. In rare cases, they can develop in a longstanding scar or be a part of rare genetic syndromes. Although BCCs mainly affect fair-skinned adults, other skin types are also at risk.

Most basal cell carcinomas (BCCs) can be effectively treated and eliminated if identified in the early stages. It’s crucial to seek immediate treatment as the tumor can become increasingly hazardous and potentially disfiguring as it expands, necessitating more comprehensive treatment. If not addressed immediately, certain uncommon, aggressive types can be life-threatening.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the second most common skin cancer, particularly among white and fair-skinned people. It’s rare in dark-skinned individuals. The incidence of SCC increases with age, with those aged over 75 years being about thirty-five times more likely to have an SCC than those aged between 50-55 years.

SCCs can vary greatly in their appearance. They often appear as firm pink lumps with a rough or crusted surface, and there can be a lot of surface scale. Sometimes, a spiky horn may stick up from the surface. The lump often feels tender when touched, bleeds easily, and may develop into an ulcer.

People often first become aware of SCCs as a scab that bleeds and does not heal completely or a new red or pearly lump on the skin. Some SCCs are superficial and look like a scaly red flat mark on the skin. Others form a lump and have a pearl-like rim surrounding a central crater, and there may be small red blood vessels present across the surface.

It’s important to consult with a healthcare professional for personalized advice and treatment options. These conditions can vary greatly among individuals and timely detection and treatment can significantly improve outcomes.

Melanoma

Melanoma is less common than Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC), but it is more dangerous because it’s more likely to spread to other parts of the body. Melanoma cases across all age groups have reached 17,500 a year in the UK, the highest since records began, according to Cancer Research UK. There has been a particular rise in cases among adults aged 55 and over.

Melanoma is not just a skin cancer. It can develop anywhere on the body – eyes, scalp, nails, feet, mouth, etc. Melanoma does not discriminate by age, race, or gender. Everyone is at risk. In the UK, 49% of melanoma skin cancer cases are in females, and 51% are in males. In women, the most common place for melanoma to develop is on the legs. In men, melanoma is most commonly found on the chest and back.

Healthcare professionals should advise patients to monitor their skin for any changes and seek medical attention if they notice new or changing moles or skin lesions.

Actinic Keratosis

Actinic keratosis is a rough, scaly patch on the skin that develops from years of exposure to the sun. It’s most often found on sun-exposed areas such as the face, lips, ears, back of the hands, forearms, scalp or neck. Actinic keratoses feel rough and dry and are slightly raised from the surface of the skin. Often it is easier to feel rather than see them. They can also be hard and warty. Sometimes hard skin grows out of an actinic keratosis like a horn, a condition known as a cutaneous horn. Several actinic keratoses may develop at about the same time, often in the same area of skin.

While actinic keratosis itself is not cancerous, if left untreated, it can develop into squamous cell carcinoma. Typical treatments for actinic keratosis encompass: 1) elimination through freezing, also known as cryotherapy; 2) photodynamic therapy, which is a form of light therapy; 3) application of medicated creams or ointments; and 4) a blend of these therapies. Cryosurgery is often the chosen approach for addressing a solitary lesion.

Merkel Cell Carcinoma

Merkel cell carcinoma is a rare and dangerous type of skin cancer that usually appears as a flesh-coloured or bluish-red nodule, often on your face, head or neck. Also known as neuroendocrine carcinoma of the skin, it grows rapidly and can metastasize at an early stage.

Despite its severity, MCC is treatable, especially when detected early. While MCC is about three to five times more likely to be deadly than melanoma, successful treatment is possible with early detection. Medical advice should be sought if MCC is suspected.  

In conclusion, there are several types of skin cancers that are commonly seen in the elderly population. Regular skin examinations are crucial for early detection and treatment of any potentially harmful lesions. As healthcare providers, it’s important to educate patients about regular self-examinations and when to seek medical attention.

For more information on dermatological lesions, we highly recommend that health care providers attend the Practitioner Development UK course Dermatological Conditions in the Older Adult or Recognising and Managing Acute Skin Conditions in Primary Care. 

References

Cancer Research UK, 2021. Skin cancer incidence statistics. [online] Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/skin-cancer/incidence [Accessed 12 October 2023].

British Association of Dermatologists, 2021. Basal cell carcinoma. [online] Available at: http://www.bad.org.uk/shared/get-file.ashx?id=65&itemtype=document [Accessed 12 October 2023].

British Association of Dermatologists, 2021. Seborrhoeic keratoses. [online] Available at: http://www.bad.org.uk/shared/get-file.ashx?id=219&itemtype=document [Accessed 12 October 2023].

British Association of Dermatologists, 2021. Actinic (solar) keratosis. [online] Available at: http://www.bad.org.uk/shared/get-file.ashx?id=219&itemtype=document [Accessed 12 October 2023].