Skin cancers are prevalent in Australia and plastic surgeons perform a service to the local community by using their expertise in excision to minimise scarring, and reconstruction with skin grafts and skin flaps.
Skin cancers can be divided into 2 groups, non melanoma skin cancers (NMSC) and Melanoma. The most common, about 75% of NMSC would be the Basal Cell Carcinoma (BCC). It grows slowly over months and occurs most often on sun exposed skin - although it may appear in other parts of the body. If the BCC is on the nose or near the eye, excision is recommended before it invades and causes damage to surrounding structures and deep structures. It can be a lump or an ulcer and be pearly or red.
Squamous cell carcinoma (SCC) grows over weeks, and is also caused by sun exposure. SCC look red and scaly and can be tender to touch. Untreated, these can spread to other parts of the body. Sometimes SCC can arise from sunspots or solar keratoses, so sun damaged skin needs to be watched carefully. There is another lesion that mimics SCC, called keratoacanthoma (KA) which grows rapidly but does not spread. KA can sometimes heal without treatment.
If BCC or SCC is suspected, Dr Tew would do a biopsy to confirm. Then Dr Tew would proceed to remove the whole lesion and send it to pathology to confirm completeness of excision.
Melanoma occurs in about 5% of patients with skin cancer, but is highly malignant. For diagnosis, it is important for Doctor to cut around it and not cut into it. It can occur anywhere on the body and about half of melanoma originate from moles. The signs that a mole may be transforming to a melanoma often referred to the A, B, C and D of melanoma. A is for asymmetry, B for irregular Borders, C for Colour, D is for diameter - 6 mm or greater.
About 99% of patients with NMSC and about 85% of patients with melanoma are curable with surgery.
The operation is done in your doctor’s rooms under local anaesthetic or in hospital either under twilight sedation or general anaesthetic. The anaesthesia used will depend on the size of the skin cancer, its location on the body and the patient’s preference.
Once the skin cancer is removed, the remaining skin can be gently pulled together for stitching. For elliptical excision, the oval shape cut is made to run in a skin wrinkle line, so the scar blends in better. It is longer than the original lesion as the ends of the cut needs to be trimmed to avoid the skin “bunching up”. If the skin cancer is on the lip, nostril, eyelid or ear, a wedge section may be necessary. A variety of suturing techniques and materials, absorbable and non-absorbable, are used to assist healing and achieve wound strength.
If a lot of skin is removed, reconstructive surgery is required to repair the defect. Plastic and reconstructive surgery uses skin grafts and skin flaps to fill defects.
A skin graft involves removing a thin layer of normal skin from another part of the body, devoid of its blood supply, and placing it in the defect and securing it with dressings. A skin flap is a technique that transfers the surrounding tissue, still attached to its blood supply, to fill the defect.
Incisions heal in a week, but the wound is not strong for about 3 weeks. To minimise the chance of infection, patients are encouraged to keep the wound dry in the first week. Patients are discouraged from stressing the wound so strenuous activity may need to be avoided until the wound is strong.
Skin grafts can take about 3 weeks to heal, and skin grafts on legs can require dressings for several weeks afterwards, especially if the blood supply to the leg is not good. The appearance of grafts can take months to improve.
Most surgery is done as Day surgery and is only mildly uncomfortable. Bruising and swelling settle in about 1 to 2 weeks.
Infection, bleeding, wound breakdown are possible complications. If the excision is incomplete, further surgery may be required.
The diagnosis of skin cancer can be a stressful event. Understanding the condition, and its treatment can reduce this stress as the vast majority are curable. Most patients seek support from family and friends, as it is a common condition, and most patients would know someone who has had surgery for similar condition. Additional support is available from the anti-cancer council and the melanoma foundation.