Australians have the highest rate of skin cancer in the world. With an incidence that is continuing to rise faster than any other form of cancer, with skin cancer accounting for 80% of all newly diagnosed cancers. Most Australians will develop a skin cancer during their lives.
While some skin lesions are benign eg. moles and may be required to be removed for cosmetic concerns. Cancerous lesions need definitive treatment, with surgery the most common and reliable method. People often request plastic surgical removal of these lesions to attain best cosmetic outcomes.
Who Gets Skin Cancer… and Why?
The primary cause of skin cancer is ultraviolet radiation – mostly from the sun (which we have with abundance in Australia), but also from artificial sources like tanning booths. Unfortunately our culture and desire for the perfect tan, increase in outdoors activities, and thinning of the ozone layer are behind the alarming rise in skin cancers.
Anyone can get skin cancer – no matter what your skin type, race or age. But your risk is greater if…
• Your skin is fair and freckles easily.
• You have light-coloured hair and eyes.
• You have a large number of moles, or unusual size or shaped moles.
• You have a family history of skin cancer.
• You spend a lot of time outdoors.
• You received therapeutic radiation treatments for adolescent acne
Get to know your skin and examine it regularly, if you notice an unusual growth or change on any part of your body, consult a plastic surgeon or a dermatologist.
These are benign and have no danger of developing into cancer. They may include simple moles, skin tags or lumps. They may be treated because of cosmetic concerns.
These lesions exhibit early changes of malignancy and if not treated appropriately possess the potential to develop into malignant skin cancers. Examples include SCC-in-situ (Bowen’s disease) and solar keratosis.
There are three main types of skin cancer:
Basal Cell Carcinoma (BCC)
By far the most common type of skin cancer is basal cell carcinoma, which fortuitously has the best cure rate with surgery. They are slow growing lesions, and rarely spreads to other areas of the body. If left untreated however it can grow beneath the skin and erode underlying tissues, including bone causing serious damage and requirement for extensive surgery to both treat the cancer and reconstruct the defect.
Squamous Cell Carcinoma (SCC)
Squamous cell cancers are more aggressive than BCC; they grow faster and occur in older people. It present as a scaly, quickly growing pink lump, which may also bleed and ulcerate. They occur mostly in sun-exposed areas, such as the face and backs of the hands. It sometimes spreads to distant sites, including lymph nodes and internal organs. Surgical treatment will usually be curative if diagnosed in its early stages, if left untreated can be life threatening.
Malignant Melanoma (MM)
Australia has the highest rate of melanoma in the world. Although it is the least common skin cancer, it is the most deadly. Melanoma mostly occurs on sun exposed skin, but can occur anywhere. It may develop from an existing mole or appear as a new brown, red or black spot which changes and grows in size. Fortunately, if diagnosed early, most melanomas can be cured with surgical treatment alone. Once diagnosis is made, one is usually required to undergo wider excision of the lesion and possibly have lymph glands sampled as well. If however, malignant melanoma may spread throughout the body and is often deadly.
Treatment & Reconstruction
Skin cancers can be treated by a number of methods, depending on the type of cancer and its location on your body. These range from simple creams through to surgical excision and reconstructive procedures. However most skin cancers are best removed surgically, as the cancer will be sent to the pathologist to ensure it has been completely removed.
Treatments of complex skin cancers, or those that occur in cosmetically sensitive areas, such as the face require considerable expertise to ensure the best outcome is achieved. Specialist Plastic Surgeons are highly regarded as the best at performing these procedures as they have been trained to analyse these problems and provide the best functional and cosmetic outcome.
After removal of a skin cancer a ‘defect’ may be left, as it may not be possible to simply stitch the wound closed. This requires reconstruction by employing many different plastic surgery techniques, the most common techniques including:
- Skin flaps
This involves moving some skin around to either fill a defect that is either too large or to achieve a better cosmetic outcome. Because the skin flap is usually moved from an adjacent area, the characteristics of the skin are closely matched and hence give a superior cosmetic outcome.
- Skin grafts
This involves taking some skin from another location to fill the defect. It relies on new blood vessels to grow into it the graft for it to ‘take’ and needs to be protected during this phase. The final cosmetic result takes much longer than with a skin flap.
No matter what type of skin cancer you had it is important to have a plan for follow up of both of the cancer you had treated and detection of new lesions. This involves regular skin surveillance by yourself in conjunction with your doctors. If you notice any changes in your skin, or lumps appearing in your lymph nodes (glands), such as in your neck, armpits or groin, please let your doctors know.