Dr Moss manages the full range of skin cancers. Surgical treatment is usually performed under local anaesthetic, however some lesions or reconstructions may require local anaesthetic with sedation.
If you feel you have a suspicious lesion this should be assessed initially without delay by your local medical officer who will arrange a referral as appropriate for your management.
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Skin Cancer - What is it?What is Cancer?
Cancer is a disease caused by uncontrolled multiplication of the body's cells. Our bodies are constantly making new cells to enable us to grow, to replace worn out cells or to heal damaged cells after an injury. Normally cells grow and multiply in an orderly way. Occasionally, however, some cells behave abnormally. They multiply in an uncontrolled way and these cells may then grow into a lump that is called a tumour.
Tumours can be benign (not cancerous) or malignant (cancerous). Benign tumours do not spread outside their normal boundary to other parts of the body. A malignant tumour is made of cancer cells. If these malignant cells are not treated they may spread into surrounding tissues and sometimes spread (metastasise) to distant sites.
Skin cancer is caused by uncontrolled replication of the surface cells of the skin. This is usually due to prolonged or excessive ultraviolet (UV) light exposure from the sun. Skin cancer is the commonest of all cancers and Australia has the highest incidence of skin cancer worldwide. Unfortunately, two thirds of Australians will develop at least one skin cancer in their lifetime. People over 40 are at highest risk.
If you check your skin regularly, you should be able to identify suspicious skin lumps early and get any checked by a doctor without delay. Skin cancer is diagnosed by physical examination and sometimes biopsy. Other parts of your skin also need to be checked for suspicious lesions. Skin cancers take a variety of forms:
Melanoma is highly malignant and is therefore the most dangerous skin cancer. Melanomas grow over weeks to months and can be anywhere on the body. It appears as a new spot, or an existing spot, freckle or mole that changes colour, size or shape. Usually it has an irregular or smudgy outline and is more than one colour. If any of these suspicious signs develop they should be assessed at the earliest possible time. It is best treated within 2 weeks of diagnosis. If untreated, cancer cells spread to other parts of the body. If treated early, 95% are cured.
2. Squamous Cell Carcinoma (SCC)
SCCs are not as dangerous as melanoma but may spread to other parts of the body if not treated. May first appear as a thickened red, scaly spot and later may bleed easily or ulcerate. Usually they appear on sites most often exposed to the sun such as the head, neck, hands and forearms. They grow over some months or in as little as a fortnight.
3. Basal Cell Carcinoma (BCC)
Most common and the least dangerous of the skin cancers. BCCs typically appear as a slow growing, lump or scaling area, are red, pale or pearly in colour. As they grow they may become ulcerated like an unhealing sore or one that heals then breaks down again. These skin cancers do not spread (metastasise) to distant sites but spread locally. They are usually on the head, neck and upper torso and not necessarily on areas exposed to the sun.
Surgery to remove skin cancer
If a skin cancer is at an early stage and the Pathologist reports that it has been successfully removed by an excisional biopsy, sometimes no further treatment is deemed necessary. However, if only a sample of the tumour was taken for testing at the biopsy, or if Dr Moss feels that not enough tissue was removed during the biopsy, a further operation will be necessary.
After the diagnosis has been made Dr Moss will remove the skin cancer by cutting around it with a scalpel. A margin of healthy skin is removed as this improves the likelihood that all of the cancer is removed. The amount of surrounding healthy skin removed will depend on the type and extent of the skin cancer.
Once the cancer is removed, the remaining skin can sometimes simply be gently pulled together for stitching.
If a skin cancer is larger, Dr Moss may need to make a bigger excision to improve the chances of removing all malignant cells. This treatment is usually performed in hospital as a day procedure. The anaesthesia will depend on the size and extent of the skin cancer, the patient’s preference and upon any discomfort levels likely to be experienced. While many skin cancers can be removed under local anaesthesia, some may require sedation or general anaesthesia. In Dr Moss' practice this treatment is performed at hospital, usually as a day surgery. The anaesthesia will depend on the size and extent of the skin cancer, the patient’s preference and upon any discomfort levels likely to be experienced. While many skin cancers can be removed under local anaesthesia, some may require further sedation or general anaesthesia for a larger operation.
If a lot of skin must be removed, Dr Moss may not be able to pull the edges of the healthy skin back together and may use one of the following reconstructions:
- Skin graft, which involves removing a thin layer of normal skin from a healthy part of the body, such as the thigh or area behind the ears. This piece of skin, called a "split skin graft" or a “full thickness skin graft”, is placed over the gap created by the removal of the skin cancer and sutured or stapled into position.
- Skin flap repair, which is the transferring of adjacent local tissue of the same texture and thickness into the defect. This method is often used for the face.
Follow-up and Prevention
Follow-up after diagnosis of skin cancer
Regular and long term examination by Dr Moss is essential after treatment of skin cancer. This is to make sure the cancer has not recurred. This may include examination of the lymph glands, as they are usually the first place a tumour reappears. The frequency of visits will depend on the stage and type of the skin cancer.
Regular check-ups of the skin on the rest of the body are also important, as anyone who has ever had a skin cancer has an increased risk of developing another one.
Prevention of Skin Cancer
It is not too late to save your skin and help prevent skin cancers, skin damage and premature aging. It is up to you to reduce future risk by changing old habits and developing new ones. These preventive measures also apply to people who have not had skin cancer.
How? It is easy. Reduce your sunlight exposure - cover up, regardless of the temperature. More people get sunburnt on cooler or overcast days than when it is hot. Find some shade or create your own. Here are some simple rules to remember:
- Slip on a closely woven, long sleeved collared shirt (natural fibres are coolest).
- Slop on SPF 30+ sunscreen before you go out for the day AND reapply regularly (every two hours).
- Slap on a hat with a broad brim.
- Take particular care between the high risk times of 10 am and 3 pm.
- Don't forget your eyes. Wear sunglasses when you go outside. 90% of reflected UV light comes directly from the horizon.
The different techniques used in treating skin cancers can be life saving, but they may leave a patient with less than pleasing cosmetic or functional results. Depending on the location and severity of the cancer, the consequences may range from a small but unsightly scar to permanent changes in facial structures such as your eyelids, nose, ear or lip.
In such cases, no matter who performs the initial treatment, Dr Moss can be an important part of the treatment team by performing further corrective (secondary) surgery even after the initial skin cancer removal. Secondary reconstructive techniques – ranging from a simple scar revision to a complex transfer of tissue flaps from elsewhere on the body – can often repair damaged tissue, rebuild body parts, and restore most patients to acceptable appearance and function.