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Skin Cancer Surgery Melbourne

Skin Cancer Surgery

Skin cancer refers to the uncontrollable growth of abnormal skin cells. It is the most common form of cancer in Australia, with two out of three Australians being diagnosed with it before the age of 70. Skin cancer should be treated promptly as it can invade and spread; whilst early diagnosis and treatment can result in minor surgery with good outcomes and minimal recovery.

People at higher risk of developing skin cancer and melanoma include those with:

  • Fair skin who have a tendency to develop freckles
  • A large number of moles with unusual shapes or sizes
  • Light eye and fair hair colour
  • Regular or extended episodes of high exposure to ultraviolet (UV) light
  • A history of several episodes of sunburn as a child
  • A history of skin cancer in the family. 

Other less common causes of skin cancer include the use of immunosuppressant medications, solarium or sunbed use, and exposure to certain chemicals.

The most common types of skin cancer include basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM). Both BCC and SCC are known as non-melanoma skin cancer (NMSC).

Basal Cell Carcinoma (BCC) is the most common but least dangerous form of skin cancer. It grows slowly, invades locally, and rarely spreads throughout the body.

Squamous Cell Carcinoma (SCC) occurs in areas of high sun exposure (head, neck, arms and hands) and grows more rapidly than BCCs. Because SCC can spread around the body, it can be life-threatening if not caught and treated early.

Malignant Melanoma (MM) accounts for 5% of all skin cancers and may develop from a mole or as a new skin lesion. Melanoma can occur in any part of the body, even in non-sun-exposed areas. Because it has a tendency to spread through the lymphatics or bloodstream, melanoma can be life-threatening if not caught and treated early.

Skin cancer varies in appearance and may present as a:

  • Small red spot with a scaly, dry, or rough texture
  • Pale scar or pink nodule with a pearly, shiny, or pitted appearance
  • Crusted or ulcerated nodule
  • Pink/red firm or tender lump
  • Sore which bleeds and does not to heal
  • Pink, red, tan, brown or black spot with an irregular or changing colour or edge.

The following characteristics are suspicious of melanoma and, if found, the lesion should be promptly examined:

  • Asymmetry – in size, shape or growth
  • Border irregularity – blurred or uneven edges
  • Colour – a mole with varying shades of brown/black, or even red, white or blue
  • Diameter – any abnormal increase in size, especially if more than 6mm across. 

A biopsy of the lesion may first be taken to confirm the diagnosis. The skin cancer is then excised with a small margin of normal tissue and examined to confirm complete removal. Typically, the area is reconstructed at the same time whilst under local anaesthesia as a day procedure, but more extensive excisions may require sedation or general anaesthesia with a short overnight stay. A further margin of normal tissue around the scar may need to be excised to ensure complete removal and decrease the change of recurrence, or a sample of the draining lymph nodes may be required.

Skin closure techniques with skin cancer surgery include the following:

Simple elliptical excision where the skin is closed directly, leaving a small scar that will fade with time. Ellipse excisions give a smooth contour by preventing the margins of the incision from being raised.

Wedge excision for lesions located at the edge of the eyelid, ear, nostril, or lip.

Skin grafting where a layer of skin is removed from a different part of the body and used to cover the defect. Two common types of grafts include:

  1. Split thickness skin grafts (STSG) where a thin layer of skin is removed from the body (e.g. buttock or thigh) and laid over the defect. This is secured and dressed for 5-7 days before being checked. The donor site – where the skin has been taken – has enough skin for new skin to regrow. A dressing is applied whilst healing.
  2. Full thickness skin grafts (FTSG) are commonly used to on the face, scalp or hands. Here, a full section of skin is removed and stitched into the defect. The donor site – commonly from behind or in front of the ear, neck, or groin – is closed and dressed. 

Skin flaps involve moving tissue from an area of laxity next to the defect into the area of excision. Skin flaps may be used to repair areas of the body from which large amounts of skin have been treated.

Depending on the type of skin cancer, alternative treatments may be available, which include:

Cryotherapy – Freezing with liquid nitrogen to destroy abnormal cells.

Laser – Ablation of small or superficial types of skin cancers.

Topical chemotherapy – Medications applied to certain types of skin cancer (e.g. Aldara for superficial BCCs).

Chemotherapy – Medications that target and destroy rapidly dividing cancer cells.

Immunotherapy – Medications that help the body’s immune system target and destroy rapidly dividing cancer cells.

Radiation – Utilising different forms of targeted X-rays to destroy cancer cells.

Timely surgery removes cancerous tissue, decreases the risk of the skin cancer spread, and minimises damage to normal surrounding tissue. Most skin cancer procedures can be performed as a day case under local anaesthetic or sedation, and skin cancer excisions provide pathological information to confirm that a skin cancer has been removed.

Every surgical procedure has its own benefits and potential limitations. 

In the days following surgery, you will be required to rest and elevate the operated site. This allows you to heal whilst the swelling goes down and any skin flaps or grafts settle. You should make preparations for this period of reduced activity.

If you are having a large or advanced skin cancer removed, further surgery or treatment may be required to ensure complete excision or to minimise the risk of recurrence. Major surgery may be needed if the skin cancer is located in a specialised body region or if it has spread.

Protecting your skin from the harmful effects of the sun is important. The following are recommended to help prevent development of further skin cancers: 

  • Stay out of the sun between 10am–4pm when the sun’s UV rays are most intense
  • Wear a wide-brimmed hat
  • Wear sunglasses with UV protection
  • Avoid sun-baking and using tanning beds
  • Wear long-sleeved shirts and full length pants
  • Apply SPF 50+ sunscreen liberally over sun-exposed areas and reapply every two hours, especially if sweating or swimming.

Following skin cancer surgery, it is important to monitor and maintain the results you have achieved. This will include living a healthy lifestyle and not smoking, as well as regular skin care, sun protection with a high SPF and routine skin checks.

Skin Cancer Surgery Dr Jeremy Richardson

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To schedule a consultation with Dr Jeremy Richardson regarding skin cancer and melanoma procedures, contact us today on (03) 9486 6721

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Dr Jeremy Richardson