Skin cancer is extremely common in the Australian community. The reasons for this are a combination of factors. Firstly, many of us, or our parents, come from countries where exposure to the intense radiation of the sun was rare.
For this reason our skin has less natural resilience to sun damage compared to the peoples who have lived close to the equator for thousands of years.
Secondly, due to changes in lifestyle and social behaviours largely since World War II people have increasingly exposed themselves to increasing amounts of solar radiation. This has increased with fashions over recent years.
More recently still some of the protection afforded to us by the earth's atmosphere (i.e. the so called ozone layer) has shown signs of decreasing.
Thirdly, we are all living much longer than previous generations.
The cumulative effects of these changes are the epidemic of skin cancers (BCC, SCC) and non-cancerous sun related skin lesions seen today.
BCC is an abnormality of one of the cell types of the deep layer of the epidermis of the skin. It results directly as a result of the accumulated damage to the skin by the sun's radiation. [In rare cases it may be caused by exposure to arsenic, or be part of an inherited problem (Gorlin's syndrome)]. These specific cells of the base layer of the epidermis grow and multiply abnormally forming a visible change in the skin's appearance in a given area.
Depending on the appearance your doctor may refer to it as nodular (a little lump in the skin), ulcerating (a non-healing ulcer), superficial (pink scaly patches), infiltrating (a grey, flat plaque), or morpheic (very difficult to identify but extending deep into surrounding tissues). These descriptions give us some guidance as to the behaviour of the lesion and as such help our decision making about treatment.
If left untreated a BCC is usually very slow growing but will not go away. A BCC causes local problems as it slowly gets bigger and can ultimately destroy surrounding structures if not attended to. For all practical purposes a BCC has no potential to spread to lymph glands, the bloodstream or distant sites. It is a local problem.
BCC's are most commonly seen on the face, back and exposed areas of the limbs.
Treatment: There are many appropriate treatments depending on the appearance of the BCC, the site, previous treatment and general health of the person involved. Freezing (cryotherapy) of superficial lesions is often performed successfully, curettage (scraping) and a minor excision are also very efficient forms of treatment. In some cases of superficial BCC a cream(imiquimod) may be appropriate under strict supervision and follow up.
In most instances, if you are referred to a plastic surgeon for advice your local doctor or dermatologist feels the lesion requires extra consideration because of where it is (i.e. on your eyelid, nose, ear or other complex structure) or because it is of sufficient size to require consideration of a more complex repair after removal.
SCC is an abnormality of another cell type within the epidermis of the skin. Squamous cell carcinoma rarely arise from unaltered, normal skin. Usually there is some sun damage or keratoses (irritated scaly areas). These tumours usually begin as nodules, often grow more quickly than a BCC and are more likely to be tender or sore than a BCC. They commonly are seen on the face, lower lip, ears, scalp and backs of hands.
SCC does have the potential to spread to lymph glands but the overall risk of this is only 1 to 2%. SCC in certain parts of the body do have a higher risk of spread. For example SCC of the lower lip or ear may have a 9% risk of spreading to the local lymph glands. SCC of the scalp is also often and aggressive form of skin cancer and requires aggressive treatment.
Treatment : Treatment of SCC is surgical removal. This is because without adequate removal documented by a pathologist the risk of spread remains.
When you attend for the consultation I will discuss with you your general health, any medications you may be taking, any allergies to medications you may have experienced. If you are taking a medication called Warfarin or Plavix it is very important that you inform me of this.
We will discuss the area of concern, the diagnosis, and if necessary what is involved in removing the lesion and reconstructing the defect which is created. Commonly the affected area can be dealt with under local anaesthesia in our office facilities if this meets your wishes. In some instances it will be best dealt with in hospital, as a day procedure with an anaesthetist present to care for you. Wherever the procedure is performed all instruments are sterilized to the Australian legislated standards. Only single use local anaesthetic vials are used.
Sometimes after the lesion has been excised the defect created is of such a size that the skin cannot be repaired directly. Where this is the case I will suggest to you that we reconstruct the defect using the adjoining tissue (i.e we often use the term " flap" to describe this procedure) or a skin graft. The donor site for a skin graft is from an area usually hidden from view (like in front or behind your ear or from the collar bone region.) Thin skin grafts called split thickness skin grafts commonly used on the scalp are taken from the thigh. Flaps or skin grafts replace the tissue removed and simultaneously add complexity to the procedure.
In all cases every specimen removed will be sent for examination by a pathologist. This is in your best interests in order that you can be reassured the entire lesion has been removed and that there is no doubt as to the correct diagnosis. I endeavour to inform you promptly of the pathology results.
Most often you will have sutures which will require removal after approximately seven days. This is not usually painful. This visit allows us to discuss any questions about the pathology results and for me to educate you about caring for the wound, massage and other treatments to achieve the optimal appearance. You will receive written advice about these important issues.
Having a surgical procedure however minor can be stressful. I am mindful of this and will endeavour to make you as comfortable and at ease as possible.
To make an appointment to get the best treatment for your skin cancer contact Dr James Burt's rooms now.