Skin cancer

1) SKIN CANCER WHAT IS IT? WHAT TO LOOK FOR

Australia has the highest incidence of skin cancer in the western world. This is probably due to a combination of great weather, ozone depletion in our skies and an active Australian lifestyle. As a result of this, unfortunately more than two thirds of the population will develop a skin cancer at some stage in their lives. In the past a lack of education about sun protection and the use of solariums have also contributed to this.

It is important to detect skin cancers early as they can be treated adequately and fully cured before they spread to other tissues.

Skin cancers can affect any person regardless of their skin type and skin colour. The majority of skin cancers tend to affect the head and neck, cosmetically sensitive areas.
Plastic Reconstructive Surgeons play a vital role in early detection and especially excision and reconstruction.

If you have very fair skin or a tendency to develop moles, it is important that you examine your skin regularly. Hence you can perform your own mole scan, from the top of your head to the soles of your feet including back.

If you notice any unusual changes come and see Dr Rajapakse or ask your GP for a tissue sample “punch biopsy” to diagnose what it could be.

Dr Rajapakse works closely with a dermatologists and skin cancer general practitioners, to remove and reconstruct lesions to provide the best cosmetic outcome.

2) TYPES OF SKIN CANCERS

A) ACTINIC KERATOSIS

This is a pre cancerous (pre malignant) lesion, which can be a precursor to develop an invasive squamous cell cancer. These lesions are very prevalent amongst individuals who have had sun exposure, especially the elderly. They are usually rough and scaly.

Often they can be treated by non surgical treatments such as liquid nitrogen or topical Efudix cream.

B) BASAL CELL CARCINOMA (BCC)

Basal cell carcinomas are the most common skin cancer (approximately 75 %).It is caused by frequent and long term sun exposure and has a high incidence on the face and nose. Fortunately this is a slow growing tumour and if detected early can be fully eradicated. Some lesions look ulcerated and nodular thought some can be difficult to differentiate from eczema or psoriasis.

However even small lesions can present on cosmetically sensitive areas like the face and nose. A plastic and reconstructive and cosmetic surgeon can present all options to the patient and provide an adequate reconstruction utilizing skin flaps or graft to provide not only the best therapeutic but also cosmetic result.

C) SQUAMOUS CELL CARCINOMA (SCC)
This type of cancer can be a faster growing tumour and depending on the type can spread to adjacent tissue or the lymph nodes. There may be associated ulceration and bleeding with lesions.

SCC’s frequently appear on the head, neck and forearms, areas that typically are exposed to lots of sun. Actinic keratosis can be precursor lesions.

As they can be aggressive and fast growing it is essential to detect and treat as early as possible, especially in cosmetic sensitive areas such as the face. Using reconstructive techniques, Dr Rajapakse can treat this to give the best cosmetic outcome as well.

D) MELANOMA

Melanoma is one of the most harmful of all skin cancers and one the leading causes of mortality in people under 50. This is as it is highly malignant and can spread to other tissues and organs if not treated early.

However if it is diagnosed and treated early, the outcomes can be curative. It most commonly occurs on the arms and legs in women and in men, on the face back and chest.. Malignant melanoma can occur even on areas of non sun exposed skin, such as the soles of the feet. Approximately 50% of melanomas occur from pre existing moles.

If a mole looks suspicious of melanoma, all or part of the lesion is removed and sent for microscopic analysis. Depending on the pathologist report a wider excision may be recommended. This will usually need skin cancer reconstruction with a skin graft or local skin flap. Dr Rajapakse is a specialist plastic surgeon who has had years of training at major teaching hospital plastic surgery units across the globe and is highly skilled in this form of surgery.

Occasionally if the lymph nodes are involved a multidisciplinary treatment plan is needed. Sometimes depending on the initial depth of the melanoma, a SLNB (sentinel lymph node biopsy is needed to determine if the lymph nodes are involved.

Look out for the ABCDE – warning signs of melanoma

  • Asymmetry – uneven halves
  • Border irregularity – ragged or uneven edges
  • Colour – mottled irregular appearance, mixed shades of tan, brown, black and even blue
  • Diameter – any lesion greater than 6 mm
  • Elevation – any raised lesion

3) TREATMENT OPTIONS

SURGICAL RECONSTRUCTION

Dr Rajapakse uses a variety of reconstructive surgical options to deliver the best therapeutic and cosmetic results. The plastic surgeon’s skill is to combine knowledge of “hiding scars” utilizing natural tension lines of the skin together with employing techniques of flap and skin graft reconstruction to achieve superior results.

NON SURGICAL TREATMENT

For the majority of skin cancer, a surgical option is the definitive treatment. There maybe some non-surgical treatments but the majority of these have a limited application and should be approached with caution. Dr Rajapakse will discuss and advise if any of these treatments maybe suitable for your situation.

There are some topical medications that can be used in certain types of skin cancer, though they usually need several week of treatment.

Liquid nitrogen or cryotherapy, freezing can be useful in pre malignant conditions, thought there is limited benfit in actual cancer removal.

Skin Cancer Prevention

To minimize skin cancer risk you should avoid:

  • excessive sun exporsure especially between 10am and 3pm- when the UV intensisty is greatest
  • wear sun protection- Sun Protection Factor (SPF) 30+ and apply before swimming and afterwards too
  • appropriate sun screen and clothing including
  • avoid tanning booths

Skin cancer FAQs

Do I need a GP Referral?

A GP referral is needed for a medicare rebate. Also it is preferred that the GP has taken small tissue biopsy of the area (punch biopsy) prior to coming in for your appointment.

This will enable a more accurate treatment plan and speed up the process for surgical removal.

Will there be scarring?

Unfortunately any cut on the skin will leave a scar. However plastic surgeons such as Dr Rajapakse are skilled in using the natural tissue tension lines to “hide scars” in cosmetic sensitive places and make them as inconspicuous as possible.

Dr Rajapakse will also provide you with a scar management protocol, and discuss the best options for you.

Scar Revision

Occasionally scars can appear thickened and red, sometimes causing itch and irritation. Everybody heals and forms scars differently and occasionally these scars can be large and unattractive. Dr Rajapakse uses cutting edge surgical and non-surgical techniques to minimise and improve the appearance of scars.

Will there be a need for revision surgery?

It is sometimes necessary for further surgery when removing a large skin cancer. Very occasionally if the cancer has spread to the lymph glands or other areas further surgery may be needed. If this is the case Dr Rajapakse will carefully explain a treatment plan with realistic expectations of functional and cosmetic outcomes of the surgery.

Will I need anaesthesia?

Depending on the size and location of the skin lesion Dr Rajapakse performs surgery either under local anaesthesia with or without sedation or under general anaesthesia. Some procedures may be suitable for local anaesthetic and can be performed in the rooms.

If general anaesthesia or sedation is required Dr Rajapakse will engage the services of a qualified anaesthetist who is a fellow of the Royal Australian and NZ College of Anaesthetists (FRANZCA).

Your anaesthetist will ask you about all the medications that you are taking or have taken and any allergies that you may have.

What are the costs?

You have the right to be informed about the costs associated with you surgery.

There will usually be an out of pocket expense depending on the treatment required.

Dr Rajapakse does offer a “no gap” and bulk billing service in certain circumstances.

Costs associated with the procedure may include:

  • Dr Rajapakse’s surgical fee
  • Accredited hospital / day surgery facility cost
  • Anaesthesia fee if required
  • Pathology tests

Send an enquiry or call (02) 8964 8090

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