Northern Plastic Surgery (NT)
Skin cancer treatment
Skin cancer is the most common cancer in Australia. Many affect cosmetically sensitive areas like the face or can be large requiring specialized plastic surgical reconstruction techniques. These cancers fall into 3 broad groups, BCC, SCC and melanoma. There are others but these are rare. Sometimes skin cancers can be treated without surgery but skin cancers are serious and need attention. Skin cancers like BCC tend to only grow in the local area. Others like melanoma are very aggressive and need treatment early.
Some skin cancers can be excised in our office under local anaesthetic, or with an anaesthetic in day surgery. Some skin cancers are excised as an ellipse and the wound closed as a line. Others require techniques known as flaps or grafts to give the best result. Some examples are provided. The surgical excision of any lesion will leave a scar. We attempt to minimize the scars and use methods to create the best aesthetic result while bearing in mind the need to remove the cancer. After a cancer is removed, you will come back for the results and we will manage your post operative care.
However, once you have been diagnosed with skin cancer, you are at a higher risk for developing more skin cancers. You need to check your skin regularly. If there are new lesions or lesions that are changing, you must bring this to your doctors attention. In addition, you should have an annual skin check with your General Practitioner. We would recommend you see your family doctor however should you not have a family doctor, there is a skin check clinic attached to the practice.
Types of Skin Cancer
Basal cell carcinoma (BCC)
This is by far, the most common skin cancer. A slow growing cancer that rarely metastasizes (spreads) to other parts of the body but it continues to grow in the local area. Most are on the face or on sun exposed areas. They appear as a lump or flat growth and several images are shown (reddish patch, open sore, pink growth, scar-like mark or shiny bump). If left untreated these do grow and track along nerves especially in the face so early treatment is ideal. As they grow, they may ulcerate like an unhealing sore or one that heals then breaks down again so they can bleed and heal. Occasionally for flat skin cancers, these can be treated with creams but for the majority surgical excision is necessary.
Squamous cell carcinoma (SCC)
More aggressive than basal cell carcinomas these have the potential to spread to other parts of the body. Like BCC, it is usually sun related. It appears as a thickened red, scaly red spot which may later bleed easily or ulcerate. Usually, they appear on sites most often exposed to the sun such as the head, neck, hands and forearms. There are stages of SCC that can be treated with creams ( see Aktinic keratosis and Bowen's disease) but for most,surgical excision is necessary. Occasionally it may spread to the lymph glands or further but this is not common. and these then need treatment. Squamous cell carcinoma is generally, not as dangerous as melanoma, however a patient who has had a scc needs monitoring post operation either with your GP and/or our practice.
Actinic keratosis or solar keratosis
This is sun damaged skin that looks like a red scaly patch and can feel rough. It means the skin is damaged by the sun and it can rarely turn into an early skin cancer (called Bowens disease) or invasive skin cancer. They are often found in sun-exposed areas of the body. They can be treated with freezing ( cryotherapy) or with creams like Efudix ( topical treatments). If a solar keratosis does not go away with topical treatments, it may be an invasive cancer and so the recalcitrant solar keratosis needs further treatment. Actinic keratosis or solar keratosis may develop into skin cancers.
Melanoma (M.M.)
Melanoma is the most aggressive form of skin cancer and usually appears as a black or brown growning lesion from pigment producing cells (melanocytes) . Any new black or brown spot or ones that are changing needs urgent investigation. Melanoma is aggressive as this spreads, either to the lymph glands or via the blood stream. Early detection is crucial to prevent metastasising. Surgical excision is necessary to remove the affected skin and surveillance is required to ensure that the cancer has not come back or spread; even though the histopathology indicates that the melanoma has been completely excised. Excessive sun exposure, sunburn (particularly when young), moles and family history of melanoma can increase the risk factors. Changes in a mole such as increase in size, shape, bleeding, ulceration and tenderness is an important clue. If untreated, cancer cells spread to other parts of the body and if treated early, 95% are cured.
Check regularly
It is VERY IMPORTANT to have regular skin checks to improve the chances of detecting early skin cancers. We would recommend an annual skin check with your family doctor however you are the best person to monitor changing lesions. A family member should be encouraged to monitor your back and parts of your body you cannot check.
Check for new lesions or lesions that are changing. Monitor these for Asymmetry, Border irregularity, Colour changes, Diametre increases, Elevations of the moles or Symptoms like bleeding, pain or itching. ABCDE'S for short : In short if you notice anything new or anything changing, then see a doctor.
The Surgery
Once the benign lesion has been completely excised and confirmed histologically, there is no further treatment necessary. However, if the pathology indicates that the lesion is incompletely excised, further surgery will be necessary by a wider local excision to ensure that all the skin cancer is removed. Sometimes, if the skin cancer is large, Dr. Mahajani may need to use a skin graft or local flap repair to reconstruct the deficit left from the excision of the skin cancer. Skin cancer surgery is usually a day procedure under sedation (neurolept) or local anaesthetic depending on the size and extent of the skin cancer and discomfort levels.
Once again, it is very important to have regular skin checks to improve the chances of detecting early skin cancers and early treatment. It is never too late to save your skin and prevent skin cancers, skin damage and premature aging by avoiding excessive sunlight exposure by covering up regardless of the temperature. Stay in the shade, wear hat, sunscreen, long sleeves and sunglasses.
Consequences – Plastic and Reconstructive Surgery, Risks and Complications
The aim of skin cancer surgery is to remove the cancer and hence, all surgery leaves scars. Whislst every attempt is made to make the scar thin discrete and cosmetically optimal, it is not possible to know how a scar will behave. Scars may thicken or stretch, even form keloids or wounds may heal poorly or slowly leaving the skin weak or ulcerate. If a scar is thick, it may need special silicone sheeting, scar managment massage or even steroid injections. Weaker scars or may need further revision with scar excisions. Some defects are large requiring skin grafts or flaps to cover the defect. Skin grafts may not heal or heal very slowly, they may leave depressions or indents and the colour of the graft may not match the adjacent skin. Flaps may on the other hand match the colour of the adjacent skin but can leave more regional scarring or a pincushion effect. Dr Mahajani will discuss the various options for your surgery and may suggest the best option in his hands that would give the best outcome.
Infections are also a risk of surgery and may require antibiotics to fix. Rarely a surgical procedure is required for some infections that cause necrosis of skin or deeper tissue ( but these are very rare and can be severe conditions) .
Other skin cancers. Even after successful removal of skin cancers, a patient is prone to skin cancers. This is because the remaining skin has already been affected by the sun. It is important as outlined above to check for new lesions or for anything abnormal in the area operated upon and have regular skin checks.
Realistic expectations from surgery
It is important for your expectations to be realistic. We will try as far as possible , within the constraints of your physical health, the nature of the problem, and your wishes to help you achieve your goals. The surgeon cannot guarantee all expectations and nor can guarantee the longlasting effect as the ageing process continues and there may be other variations. Sometimes other procedures are required, and infrequently sometimes severe complications are encountered. We will endeavour to the best of our ability to help you where possible. Rarely, it may be required to seek the help of other specialists. If you however have any concerns at any time please feel free to contact the practice. You are always entitled to second opinions at any stage and we are happy to help facilitate this for you if you so desired.