Plastic and Reconstructive Surgeon
Plastic and Reconstructive Surgeon
Skin cancers initially cause little in the way of symptoms but as they grow they may bleed, ulcerate or crust. Skin cancer in Australia is very common with 2 in every 3 adults under 70 years of age developing a skin cancer. Many patients are unaware of their cancers so a regular check of all your skin is essential.
What to look for:
(1) A new spot
(2) A spot that is changing in size, shape or colour
(3) A sore that does not heal, scabs or bleeds
(4) A spot that is sore or tender
(5) Odd looking moles (Melanoma’s)–
A Asymmetry - One half unlike the other
B Border -Irregular, ragged, hazy or notched edges
C Colour - Many Shades of tan and brown, black or white
D Diameter - Larger than 6mm as a rule
There are 3 main types of skin cancers;
Basal Cell Carcinoma’s (BCC’s) and Squamous Cell Carcinoma’s (SCC’s) are usually pink-red and either scaly, scar-like or pearly nodules. As they develop and enlarge they may ulcerate or bleed.
Melanoma's are usually multicoloured (black-brown-white). large (1-2cm's) and irregular in shape.
Anyone in Australia can develop skin cancer but risk is increased for people who:
Most skin cancers are related to both age and sun exposure. Here in Australia we have the highest rate in the world of all types of skin cancer. Most skin cancers do not cause symptoms such as bleeding or itching until they are larger and well developed.
A research study1 published by Ms Terrill showed that over 70% of patients presenting with a skin cancer detected by themselves or their doctor had further skin lesions that required treatment. Therefore a full skin examination will be offered at the initial consultati
Are known as a Non-Melanoma Skin Cancer (NMSC)
There are several types;
BCC’s are extremely common. According to the Australian Institute of Health and Welfare and Australasian Association of Cancer Registries in 2008, 296,000 new cases of BCC were diagnosed in Australia. The majority of these are in people over 40 years of age
Most skin cancers require surgery. BCC’s and SCC’s require excision with a 3-5mm cuff of normal tissue surrounding the lesion. When small they can be cut out and sewn up directly to provide a straight line scar but if larger usually require reconstruction with specialized techniques such as a skin graft or flap. The cure rate for these type of skin cancers is excellent with surgery (greater than 98%cure rates).
Some superficial BCC’s can be treated with cream when biopsy proven. The success rate is not as good as surgery (approximally 70%) but the advantage is that no surgery is required and scaring is usually minimal. It can be also used to treat lesions that are large or in difficult areas that would be difficult to treat with surgery. The success rate is 70-80%.
Radiotherapy can be used to treat BCC’s and SCC’s in certain areas of the body. This is useful when surgery would create a significant defect that would be hard to reconstruct or in the frail, medically unwell patient. It may also be used as an adjunct to surgery if the tumour is very large or showing signs of spread in the blood vessels or lymphatic’s
A biopsy involves the removal of a mole or suspected melanoma and is usually done under a local anaesthetic in the surgery. The excised lesion is then sent to a pathologist who confirms the diagnosis and then we are able to assess the likely tumour progression, it’s depth and risk of spreading.
Even though an initial biopsy often removes all the recognisable melanoma, wide local re-excision is usually recommended to further reduce the risk of the melanoma recurring , removing any stray cells that may still be there.
A wide local excision usually removes a 1-2cm of skin and fat around the site of the original melanoma, however this amount varies depending on the depth of the tumour and how far it has spread into the lower layers of the skin. Most Wide Local Excisions are closed with stitches, however larger excisions may require skin grafts or skin flaps. This surgery is occasionally done in the surgery but frequently may involve admission to hospital.
This type of surgery is performed when a higher risk melanoma's (e.g >1mm thick) has been diagnosed. It determines whether the melanoma has spread to the surrounding lymph nodes. Knowing whether the melanoma has spread to lymph nodes also provides a estimate of the risk of potential spread to other parts of the body.
When the wider excision of the melanoma is performed we sample the closest lymph node to the tumour to see if there are any melanoma cells in it. Before the surgery a Lymphoscintigram is performed (a nuclear medicine test) where an in injection of radioactive tracer is injected to identify the closest lymph node. At surgery, dye is injected into the skin around a melanoma where it passes into the lymphatic system. Lymphatic mapping identifies the closest lymph node to the mole - the sentinel node.
The sentinel node is removed and sent to a pathologist who assesses whether melanoma cells are present. If present, they are an indicator of the risk that melanoma may have spread to other parts of the body. CT and/or MRI scans may be appropriate.
An Atypical Fibroxanthoma (AFX) is an uncommon type of skin cancer, accounting for less than 0.2% of all skin cancers. It occurs mainly on the head or neck of older people, usually after the skin has been damaged by prolonged exposure to sunlight.
There is a strong link between AFX development and damage to the skin from ultraviolet (UV) light, either from the sun or sun beds, especially to the face, head, neck and ears. An AFX may also develop where previous radiotherapy treatment has damaged the skin. AFXs are more common in men that women and usually only develop in individuals with fair skin. They grow more frequently on people in their 70s and 80s.
Symptoms of Atypical Fibroxanthoma
A lump develops that may be pink or red in colour. As it enlarges it may bleed, scab or weep. Multiple lumps may also occur over a few months on the head or neck area. It is not usually painful, sore or itchy. Some patients, especially younger patients without the typically history of sun damage, may develop a form of AFX on areas other than the head and neck.
Diagnosis of Atypical Fibroxanthoma
Often the exact diagnosis is not clear from the appearance as they may look like other types of skin cancer, such as squamous cell carcinoma. Usually the diagnosis is made by taking a small piece of the lump under local anaesthesia, i.e. a biopsy, and examining the skin under the microscope.
Treatment of Atypical Fibroxanthoma
Treatment for AFX is surgery. Usually this involves cutting away the AFX, along with some normal skin around it, usually around about 1cm to 2cm as it has a tendency to recur locally. There is approximately a 5-10% chance that the tumour may recur locally over the first few years especially, so regular follow-up afterwards will be required, looking for any new lumps occurring in the area especially.