Press release posted 12 September 2025
A patient from Sale in Manchester has become the first person in the North West of England to have radiotherapy treatment as part of a major new non-melanoma skin cancer trial at The Christie.
The study, co-led by Professor Agata Rembielak, Consultant Clinical Oncologist at The Christie, and Professor Catherine Harwood, Consultant Dermatologist at Barts Health NHS Trust in London, is recruiting patients with high-risk skin cancer called squamous cell carcinoma (SCC), the second most common form of non-melanoma skin cancer in the UK.
Commenting on the launch of the trial, Professor Agata Rembielak said: “We are delighted to have recruited our first patient, Pauline, to SCC-AFTER here at The Christie. This is an important trial which will provide vital evidence as to whether radiotherapy should be used after surgery to reduce the chances of skin cancer returning.
“Current practice is inconsistent around the world. Some patients are offered radiotherapy, while others are monitored closely. By comparing these two approaches in a structured, randomised study, we can gather the evidence we need to guide treatment in the future. We’re proud to offer this opportunity to patients at The Christie and in other UK centres.”
Non-melanoma skin cancer, which includes skin SCC, is more common but less aggressive than melanoma. There are at least 50,000 new cases of skin SCC diagnosed each year in the UK, and this number is increasing by at least 5% a year.
Skin SCC is driven by increasing ultraviolet (UV) exposure, immunosuppression and an ageing population. Skin SCC is typically treated with surgery alone. However, it can reappear in approximately 1 in 3 patients affected by a high-risk form of skin SCC.
Pauline’s story
Pauline Short, age 76, is taking part in the SCC-AFTER clinical study, which is investigating whether the addition of radiotherapy after surgery can reduce the risk of skin cancer returning in high-risk cases. Pauline, who lives with her husband, has 5 children and 6 grandchildren.
Pauline first noticed a small, regular-shaped growth on her arm. She wasn't worried initially, but it continued to grow and was painful if she pressed on it. Pauline’s husband later encouraged her to see a dermatologist just before Christmas in 2024.
The dermatologist immediately referred Pauline to a surgeon so that the lump could be surgically removed on 15 January 2025. When the sample was analysed, it was confirmed to be skin SCC. The surgeon was confident he had got all the cancer out, but referred Pauline to The Christie to see if she was eligible to join a clinical trial offering the possibility of additional radiotherapy to her treatment.
Pauline feels very grateful that the cancer was found early and removed quickly. “You never think it is going to happen to you, she says. I had never been one to lie out in the sun and didn’t go on hot summer holidays.”
In late March 2025, Pauline came to The Christie and was offered the chance to join the SCC-AFTER clinical trial. “It was a relief when I found out I was eligible to join the trial. I was very pleased to have that opportunity, for myself, my family, and to help others."
As part of the clinical trial, Pauline received ten sessions of radiotherapy in the following months of April and May. She describes the treatment as “straightforward, causing only minor skin irritation.”
Pauline had a positive experience of being on the trial at The Christie. "The staff were very kind, well organised and thorough,” she says. “The trials team talked me through everything and answered all my questions before we started, which put my mind at ease.
"My specialist nurse in particular was very attentive, with regular telephone calls to check how I was, and he helped me get through all the trial questionnaires.”
3 months after the radiotherapy, Pauline says her recovery is going well. "It's also very reassuring that I will be followed up regularly for the next 3 years,” she said.
As well as feeling positive about her recovery, Pauline is aware that taking part in clinical research will potentially help others in the future. "Participating in research feels like the right thing to do,” she says. “Although I was allocated to the radiotherapy part of the trial, I would have been totally comfortable in being allocated to the close clinical follow-up arm of the trial, as studies like this are the best way for researchers to understand the most effective ways to treat cancer.”
The experience has also made her more vigilant about the sun, and she now uses factor 50 sun protection and wears a hat in the garden. Pauline, who enjoys gardening and crossword puzzles in her spare time, is looking forward to getting together with 16 family members at Center Parcs in October.
The SCC-AFTER trial
The SCC-AFTER trial - which stands for “Adjuvant Radiotherapy in Patients with High-risk Primary Cutaneous Squamous Cell Carcinoma AFTER surgery” - is a phase III, randomised, multi-centre national study. It aims to recruit 100 patients by the end of 2025 and is currently available at 17 cancer centres in the UK.
Currently, many hospitals treat high-risk skin SCC with post-surgery radiotherapy to destroy any remaining cancer cells. But it has not been proven that radiotherapy to the cancer site prevents the cancer from returning, and the treatment itself is not without its consequences, causing possible short and long-term side effects in some patients. This includes skin inflammation and discolouration in the areas targeted with the radiotherapy.
The SCC-AFTER trial will look to determine if radiotherapy is helpful or not in reducing the chances of high-risk cutaneous squamous carcinoma returning after surgery at the original site of the disease. If it is shown to be effective, it will be recommended as a routine NHS treatment – if it is not, researchers will recommend it be stopped to prevent unnecessary side effects.
All patients are followed by standard clinical monitoring for 3 years.
Participants in the study are randomly allocated to either the radiotherapy arm or the monitoring-only arm, because there is uncertainty whether radiotherapy definitely helps to prevent the return of high-risk SCCs. Pauline was assigned to the radiotherapy group, meaning she received radiotherapy over two weeks, with follow-ups every 3 to 4 months for the first 2 years and every 6 months in the third year.
The goal of the study is to determine whether adding radiotherapy reduces or does not reduce the likelihood of cancer returning in nearby tissues or lymph nodes, known as loco-regional recurrence.
The trial is not only examining recurrence rates but also overall survival, quality of life, and the cost-effectiveness of adding radiotherapy to the treatment regimen. The results could provide clear evidence to support whether radiotherapy should become standard practice for patients like Pauline.
The SCC-AFTER trial aims to recruit 840 patients across 25 hospitals in the UK over the next four years, making it one of the most extensive clinical trials of its kind in non-melanoma skin cancer treatment. It is the first study of its kind globally, and the results have the potential to significantly reshape UK and international guidelines for high-risk skin SCC treatment.
SCC-AFTER trial is sponsored by Cardiff University and coordinated by its Centre for Trials Research, with funding provided by the National Institute for Health and Care Research Health Technology Assessment Programme (NIHR).
Further information about the trial can be found on the Cardiff University website with a patient-facing poster also available to download.
Promoting inclusion in research
SCC-AFTER is designed to make clinical research more inclusive, especially for groups historically underrepresented in trials, such as older adults, people with long-term conditions, those lacking capacity or those from minority and economically disadvantaged backgrounds.
To achieve this, the study includes targeted outreach and interviews with patients and health care professionals to understand and address barriers to participation. These measures aim to make the trial more accessible and ensure its results reflect the diverse population affected by skin cancer.
2 key initiatives are supporting this approach: the QuinteT Recruitment Intervention (QRI) and the INCLUSION SWAP. The QRI involves researchers listening to and learning from conversations between staff and patients about the trial, helping refine recruitment strategies. The INCLUSION SWAP focuses on understanding how to support older adults and those with multiple health conditions, including dementia, to take part in the trial. Previously, trials have often excluded these groups.
Professor Rembielak said: “We want the SCC-AFTER trial to be as inclusive as possible, so its findings are relevant and useful for everyone affected by high-risk skin cancer.”
The trial has involved patient representation from the start. Patricia Fairbrother, a skin cancer survivor and advocate and SCC-AFTER Research Partner, said: “I’m so pleased the trial is now open. It’s needed to help prove whether certain skin cancer treatments can benefit patients.”
Sun safety
To reduce your risk, use at least SPF30 suncream, cover up with clothes and sunglasses, and stay in the shade as much as possible between 11am and 3pm. Take extra care with children and make sure you and they never burn.
Take extra care in the sun if you have freckles or red or fair hair, many moles, or a personal or family history of skin cancer.
Regularly check your skin for unusual changes. Early detection and prevention are key.
Learn more about sun safety on the Greater Manchester Cancer Alliance website.