Types of skin cancers | Risks | Recovery | Aim of skin cancer and melanoma management |
Skin cancers affect two thirds of Australians during their lifetime and the risk is higher in Queensland due to year long sun exposure. The UV damage to skin cells can result in melanoma or non melanoma cancers, typically basal or squamous cell cancers.
The specialist plastic and reconstructive surgeons at NorthEast Plastic Surgery have performed thousands of skin cancer and melanoma excisions and have undertaken reconstructions which aim to restore function and achieve optimal aesthetic outcomes.
The specialist plastic and reconstructive surgeons at NorthEast Plastic Surgery have performed thousands of skin cancer and melanoma excisions and have undertaken reconstructions which aim to restore function and achieve optimal aesthetic outcomes.
Skin cancers treated at NorthEast Plastic surgery include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.
Other less common skin cancers are also treated and include Atypical Fibrous Xanthoma (AFX), Malignant Fibrous Histiocytoma (MFH), Merkel Cell Carcinoma and Microcystic Adenxal Carcinoma (MAC).
Other skin lumps removed at NorthEast Plastic Surgery includes lipoma and cysts in addition to benign moles or naevi.
BCC is the most common type of skin cancer and typically occur on sun affected areas of the body including the face, neck, scalp, legs and back.
Whilst they rarely spread to other areas of the body, they may invade deep structures so early intervention results in better outcomes. Types of BCC include superficial, nodular, morphoeic and other less common varieties.
Some early BCC’s can be treated without surgery including topical treatment but most are best treated with surgical excision and appropriate reconstruction.
Guidelines on BCC management is resection with 3mm to 5 mm margins with repair or reconstruction of the resulting defect.
Squamous cell carcinoma (SCC’s) is the second commonest skin cancer and are typically more aggressive than BCC’s. Early or in situ SCC’s can be treated without surgery but invasive SCC’s require surgical excision as they can spread to lymph glands, via nerves or the blood stream to other organs.
Guidelines on the management of SCC’s is surgical excision with 5mm to 10 mm margin and appropriate reconstruction of the defect.
Melanoma is the most serious skin cancer type and whilst it can be cured if identified early, late presentation can impact longevity.
It which typically presents as a dark lesion but can be in some cases be non-pigmented.
Features of skin lesions which are a useful guide identifying melanoma include :
Asymmetry
Border notching
Colour change
Diameter greater than 6mm (the size of an eraser on the end of a pencil)
Elevation
The aim of melanoma treatment is early detection and surgery comprising wide local excision of 10mm to 20 mm margin with appropriate reconstruction. In situ melanoma is resected with a 5 mm margin.
The greatest risk to patients is incomplete resection margins which can impact cancer spread to local structures or distant organs. The primary focus of the specialist plastic surgeons at NorthEast Plastic surgery is, therefore is to achieve clear excisional margins confident in their skills to reconstruct the defect, once defined.
The skin cancer and melanoma surgery risks will be discussed at your consultation with the specialist plastic surgeon. The risks include scarring which may be wide, thick or discoloured. Wound healing risks include infection, bleeding, seroma formation, wound breakdown, graft or flap necrosis.
These risks will be minimised by the surgeons who will undertake patient optimisation before surgery. Risk minimisation strategies include cessation of smoking, management of blood thinning medication in consultation with the general practitioner or physician and optimisation of diabetes mellitus or other medical conditions.
In some cases, skin cancer or melanoma resection can result in deformity due to the need to remove tissue to treat the cancer.
A variety of medical practitioners including general practitioners, dermatologists, surgeons and plastic surgeons may all remove skin cancers.
Where complex reconstructive techniques are required, the skill set of specialist plastic surgeons may be necessary to provide optimal outcomes.
The specialist plastic surgeons at NorthEast Plastic Surgery work closely with all medical practitioners to collaboratively manage patients. They regularly undertake educational events to train medical practitioners on skin cancer removal and reconstructive techniques.
Skin cancer removal requires an ‘excisional margin’ to achieve clearance of the tumour based on scientific guidelines. This is the reason that the tissue removed is larger than the cancerous lesion. The result is referred as the ‘defect’ and requires reconstruction by wound closure directly or advanced surgical techniques.
The specialist plastic and reconstructive surgeons at NorthEast plastic surgery have over 20 years’ experience at skin cancer plastic surgery and reconstructive techniques including reconstructive microsurgeons.
As skin cancer surgeons, they have expertise in excision and reconstruction of skin cancers involving functional or aesthetically sensitive areas such as eyelids, nose, lip, ear or fingers. They are also experienced in treating cancers requiring more technically complex reconstructions due to aesthetic considerations such as the face, neck or chest or where wound healing can be challenging such as lower legs, feet and genitalia.
They have performed thousands of reconstructive operations ranging from skin cancer removal and direct closure of the wounds to more complex reconstructive techniques including skin graft, local flap and microsurgical reconstructions.
Given their expertise, the surgeons are able to undertake the required resection margins with the technical ability and confidence to reconstruct the defect based on the reconstructive armamentarium.
All skin cancer specimens are examined by a specialist histopathologist to confirm adequacy of ‘excision margins.
NorthEast Plastic Surgery aims to achieve the benchmark resection statistic of less than 3% incomplete or re-excision rates.
NorthEast Plastic Surgery has dedicated nursing and dermal therapy staff who focus on scar management. The same scar management advice provided to aesthetic plastic surgery patients such as face and neck lift, breast or abdominal surgery is also available to skin cancer patients.
Our aim is for both aesthetic and reconstructive patients to achieve optimal functional and aesthetic outcomes.
The dressings used by the specialist plastic surgeons at NorthEast Plastic Surgery are generally waterproof so you can shower after surgery.
Recovery is usually complete over 2 to 3 weeks and during this time, you will receive after care instructions specific to your circumstances.
The instructions may include the requirement to elevate the area, avoid certain activities such as swimming, driving or exercise depending on the operative site and will have antibiotic therapy prescribed.
Contact NorthEast Plastic Surgery for further information or to book an appointment to consult with Dr Sugitha Seneviratne or Dr Patrick Tansley.
Mr Patrick Tansley MD FRCS (Plast) and Dr Sugitha Seneviratne FRACS (Plast) provide second opinion to patients seeking to address problems following plastic surgery performed elsewhere and revisional or corrective surgery. If you would like a second opinion on previously undertaken surgery, book a consultation to discuss this with one or both of our surgeons.
As the privacy of our patients is of the utmost importance to us, we do not provide before and after photos on our website. You will be shown a number of before and after images during your private consultation to illustrate the potential outcomes of surgery. These images have been provided by previous patients who have consented to their private use.
E: brisbane@northeastplasticsurgery.com.au
T (07) 3180 3400
F (07) 3180 3401
P 0411865055
(paging service for after hours emergencies only)
NorthEast Plastic Surgery
Wickham House
Level 1 155 Wickham Terrace
Spring Hill
Brisbane
Queensland 4000