Skin Cancer Removal & Reconstruction

Skin cancer is the commonest form of cancer in Australia.  Almost half of the adult population will have at least one form of skin cancer during their life, and is due to the combination of our sunny climate and the largely fair-skinned nature of our population.

There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.  All three types generally require some form of surgical intervention and ongoing surveillance. 

More than ninety-five percent of skin cancers can be cured if treated early.

Basal cell carcinomas are the commonest and least aggressive form of skin cancer.  They continue to grow only in their original location and do not tend to spread to elsewhere in the body.  Therefore, once the cancer has been completely removed surgically, no further treatment is required.

Squamous cell carcinomas are slightly more aggressive, and may occur for reasons other than excessive sun exposure, including chronic exposure to certain chemicals and in the presence of a chronic wound or scar.  Some SCC’s have the ability to spread elsewhere in the body, including the lymph glands and other body organs, but this tends to occur more frequently in larger cancers, and those that have been present for a longer period of time.  Treatment of these cancers involves complete surgical removal of the cancer, as well as close monitoring of the lymph glands in the area.

Melanoma is the most aggressive form of skin cancer, but also the least common.  Melanoma will spread to the surrounding lymph glands and other body organs if not detected early.  Treatment requires complete surgical removal of the cancer, along with a rim of normal skin from around the melanoma.  The amount of normal skin that needs to be removed is determined by how thick the melanoma has become, and this is sometimes only known after the first operation to remove the melanoma.  Therefore, it is sometimes necessary to have a second operation. 

Other tests may be arranged to investigate whether the cancer has spread elsewhere.  These can include sampling of the lymph glands, a chest X-ray, blood tests, and CT scans.  If the melanoma is already advanced, or has spread to other areas, further treatment may be considered.  This can include removal of the affected lymph glands, radiotherapy, or chemotherapy.  Close follow-up of all patients with a melanoma is essential for the first few years in order to detect recurrence or spread of the cancer.

Treatment

Removal of most skin cancers can be performed under local anaesthetic in the office.  Most often after skin cancer removal the wound can be closed with sutures, leaving a straight-line scar.  However, in certain areas of the body, and in the case of large skin cancers, this is not possible and a skin graft or local skin flap may be required.  If this is the case, then the procedure may be performed in a hospital setting, and may require an overnight admission.

A skin graft is a piece of skin that is removed from one part of the body and moved to another to allow closure of a wound.  The site that the skin was taken from is usually one with spare skin and can be closed directly with sutures.  Sometimes a skin graft will not give a very good cosmetic result, and so a local skin flap may be chosen as a better option by your surgeon.  This involves moving skin around from an area adjacent to the skin cancer to allow closure of the wound.  The advantage of this technique is that it uses skin that is most similar to that removed with the skin cancer, and so provides a very good colour, contour and texture match.  The disadvantage is that you will end up with more scarring.  Mr Morgan will outline the particular requirements in your situation and will discuss his surgical plan with you prior to proceeding.