Skin Cancer Treatment

What is a Skin Cancer and what types are there?

Skin cancer is very very common in Australia. It is largely combination of the your skin type (more lighter skinned you are the more you are likely to develop skin cancer) and the environment (Australia and New Zealand has strong sun predisposing us to developing skin cancers).

In general, there are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Melanoma. There are other types of course, but let’s concentrate on the commonest in Australia.

BCC

SCC

Melanoma

What is a Basal Cell Carcinoma (BCC)?

  • Mostly it is a slower growing skin cancer variety that rarely goes anywhere else- it slowly grows where it is over many years and if caught early before it grows large you can safely and effective treat it and no longer becomes a problem.
  • Biopsy (taking a sample of tissue and having it looked at by pathologist) is important because it tells us what subtype it is- there are slower growing subtypes (for example “nodular” type) that do not spread to other parts of the body but there are aggressive subtypes too (such as “infiltrative”). This biology of BCC is important and your treatment changes where more aggressive forms needs more aggressive treatment.
  • Cutting it out with surgery is a good treatment but there are others depending in the subtype- some can be treated with cream alone or other non surgical methods. Consult your skin specialist dermatologist and specialist plastic surgeon.

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If the tumour is small enough it can often be treated under local anaesthetic in an office setting. For those that are not fond of needles, facilities for “twilight sedation” can be arranged- such sedation arrangement means no general anaesthetics but no pain of the needle when the local anaesthetic is going in. For more complex cases general anaesthetic may be considered and discussed with you.

What is a Squamous Cell Carcinoma (SCC)?

  • It originates in the spinosum or melphighian part of the top layer of the skin.
  • Majority of the SCC arises from the previous “sun spots”- these red and scaly spots on the sun exposed part of the skin if left can progress into a SCC. It is common to have those “frozen off” at your doctor but those that persist need a closer attention.
  • Much like BCCs, SCCs can be divided into a low risk form (well differentiated) and aggressive forms (poorly differentiated) with grades of aggressiveness in between. The poorer the biology of the disease the more aggressive the treatment must be, because it can often travel in lymph channels into nearby lymph glands and it can also travel to nearby nerves.
  • Regular Skin Checks are a must to prevent these skin cancers from getting bigger and more difficult to treat.

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Does Local Anaesthetic Hurt?

In a word, yes, because there is no local anaesthetic for local anaesthetics. But there are a number of things one can do to make it less unpleasant- we warm up the local anaesthetic agent, we use very very fine needle and inject very very slowly. When the initial dose is given, we wait, and come back again. Just part of us making your experience a little better. It is not uncommon we treat even kids under local anaesthetic to save them from having a general anaesthetic. And if you really don’t like it, we ask for a help from Specialist Anaethetists in accredited hospitals. We’re here to look after you. 🙂

What is a Melanoma?

  • Melanocytes are cells in your skin that act to protect your skin from harmful effects of the sun by providing “window shading” of sorts. Sometimes these melanocytes turn into cancer and these are called Melanoma.
  • Melanoma if left untreated can be dangerous and even fatal. This is because when melanocyte turn into cancer in the top layer of skin it begins to burrow downwards into deeper tissues.
  • Once it starts to invade into deeper tissues it can travel to local lymph glands and even distant organs such as brain and liver.
  • It is crucial to have a regular skin check especially if you have had melanoma in the past or you have a family history of melanoma.
  • If caught early it can be treated safely and effectively with surgery.
  • Remember ABCDE of melanoma. One feature from below doesn’t necessarily mean it is melanoma, but you need to watch out for signs of change.
    • A- Asymmetry. If you can’t divide the dark spot into 2 equal halves it’s a warning sign. For example a perfect circle is better than a map of Australia.
    • B- Border. A clear border, where you can easily tell “this is where the dark spot stops and this is where the normal skin begins” is a good thing. If the edges or the border looks like someone had spilt ink it is a warning sign.
    • C- Colour. One uniform colour of say light brown is okay. Multiple colours of red, blue and black is not.
    • D- Diameter greater than 6mm. Bigger than 6mm of greatest dimension needs a closer look.
    • E- Elevation (it’s raised) or Evolution- IT IS CHANGING. If you’ve had a dark spot that is changing, see us IMMEDIATELY, we will fit you in.

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What are some treatment options for Skin Cancers?

Treatment needs to be tailored to each person, the biology of the skin cancer itself, the location of such tumour and the circumstance of each person. Ask Us for the first step.

  • Once a diagnosis is made, a tailored planned will be made for you. Note these are some examples only and you must consult a specialist prior to embarking upon a treatment.
  • Treatment may consist of
    • Non surgical options- include topical creams, light therapy, radiotherapy
    • Surgery- Excision and reconstruction but also curette and electrocautery.

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So if I need surgery, what reconstruction do I need?

Each skin cancer, its treatment and reconstruction will be tailored to you. Largely though, there are 4 surgical options.

  • Direct closure (also known as Primary Closure)- The direction of the resulting scar is crucial in achieving the optimal cosmesis. The resulting defect after the skin cancer has been removed are brought together in a single line.
  • Local flap closure– by “borrowing” local tissue and rearranging the tissue we are able to reconstruct the defect from the skin cancer surgery. There are many different types of local flaps and needs to be carefully chosen for the given location on the body.
  • Skin graft– In essence it is a skin transplant where we “harvest” skin from one site and put it on another. It may be a thin skin in case of “split skin graft” or the full depth of skin called “full thickness” skin graft. These different types of skin grafts need to be carefully selected for that location on that particular patient.
  • Distant flap closure- in some cases, usually large cancers there may not be enough local tissue to be able to reconstruct the defect. In this case we borrow from a distant site for reconstruction. This is common place in case of large head and neck cancers as well as breast reconstructions.

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What happens after Surgery?

Feel free to read our Patient Resources Section, it outlines what happens when you have surgery with us.

You will receive a phone call to make sure you’re doing okay and make sure you are well on your way to recovering quickly.

You will receive a postoperative instruction sheet right after your surgery. Then when your wound has healed and cancer long gone you will receive another Scar instruction sheet designed to maximise the cosmetic appearance of the scar. Of course, you will be seen again down the line by Dr Kim to see whether we can do anything else to optimise your scar. We are here to look after you. 🙂

What can I do about scars from the surgery?

Following surgery we embark upon a rigorous scar management strategy to optimise the resulting scars. Feel free to read our scar management advice under Patient Resources Section.

We continue to see you, guide your resultant scar and monitor to see if further interventions are needed. Contact Us for more information

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900000

Number of Skin Cancers treated in Australia each year

90%

5 year percentage survival rate of newly diagnosed Melanoma in Australia

13134

New melanoma cases per year in Australia

It is extremely important to become more familiar with skin cancers especially in Australia. 2 out 3 Australians will have a skin cancer by the age of 70 but if diagnosed early and treated early it has excellent outcomes. Regular skin checks with a specialist dermatologist, specialist plastic surgeon or qualified general practitioners are crucial.

Feel free to click on the links below to learn more. If in doubt, Ask Us

Cancer Council Information

Australian Government on Skin Cancers

Australian Government on Melanoma

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Contact us for a thorough discussion about your needs and your situation. Make sure you get a referral from your local GP as you may be eligible for a rebate from Medicare for the consultation. Send us a message here and we will contact you at a time that is convenient for you. 🙂

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