Australia has one of the highest rates of skin cancer in the world and we are four times more likely to develop a skin cancer than any other type of cancer. It occurs when skin cells are damaged, most commonly by exposure to UV rays from the sun or sunbeds. Approximately 2 out of 3 Australians will be diagnosed with skin cancer before the age of 70 and over 2000 Australians died from skin cancer in 2011.
The three main types of skin cancer are named after the type of skin cell from which they arise.
Basal Cell Carcinoma (BCC) probably originates from the basal cells, the lowest layer of the epidermis (though the exact cell of origin remains unclear). It is the most common skin cancer accounting for 75% of skin cancers detected, but thankfully is the least dangerous. BCCs usually present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. However, because they can cause significant destruction and disfigurement by invading surrounding tissues, it is still considered to be a malignant disease. BCCs are easily treated with surgery, but can also be treated with radiation. Very superficial BCCs can be treated with creams such as Aldara or Efudix or in some cases 35% TCA chemical peels.
Squamous Cell Carcinoma (SCC) originates from epithelial cells- the middle layer, and is less common (20% of skin cancers) but more likely to spread and, if untreated, can be fatal. SCC is considered common, but much less so than BCCs. The rate of metastasis is quite low in most cases, however thick tumours and those with certain adverse microscopic features are more likely to spread. Metastasis is also more common in immunosuppressed patients.
Melanoma, which originates in the pigment-producing cells (melanocytes), is the least common (5%) but most aggressive skin cancer. It is the most likely to spread and, if untreated, has the greatest potential to be fatal.
Evidence suggests that the effects of UV exposure are cumulative, meaning that the risk of developing skin cancers increases with age. Having said that, melanomas and BCCs can be seen in people under 20 years of age.
Any new or changing lesion, lump or sore which has not gone away after a few weeks should be examined by an experienced doctor and a sample (biopsy) taken, if necessary, to confirm the diagnosis. Your general practitioner can do this for you and they should be your first point of contact.
How can they be treated?
Very superficial (thin) BCCs and SCCs can sometimes be treated non-surgically. Creams such as Aldara and Efudix, which are chemotherapy agents, can be effective. Other methods include freezing with liquid nitrogen (cryotherapy) or burning the lesions off with a chemical peel such as 35% TCA.
Surgery can be simple or more complicated. The simplest surgical method is called a curette excision- this involves scraping the cancer off and letting the wound heal. Alternatively the cancer can be excised (cut out) and the defect closed with stitches, or where the lesion is large, by using techniques such as skin grafting or skin flaps. Occasionally for very large cancers of the head and neck Dr Rahdon performs complex reconstructive techniques such as free tissue transfer.
Melanomas require a larger margin of normal tissue to be removed from around them compared to SCCs and BCCs. Therefore in most cases the surgery is more complex for melanomas and more likely to involve skin flaps or grafts for closure.
Advanced cancers may require radiotherapy and/ or chemotherapy in addition to surgery. Where appropriate Dr Rahdon will refer patients needing these additional treatments on to appropriate specialists. There may also be a need for body imaging to be performed, such as a CT or PET scan, which are available in Geelong.
How do I know if I have skin cancer?
There are several ways in which a doctor can diagnose skin cancer- although a biopsy may be required for confirm the diagnosis. These cells will be sent to a pathologist for analysis.
When Dr Rahdon examines a lesion he will note variances in:
B- Border irregularities
Why should I have skin cancer treated by Dr Rahdon rather than a GP?
Dr Rahdon is a trained Plastic and Reconstructive surgeon specialising in skin cancer removal. He cares about the aesthetic appearance of your scars post excision and is highly skilled in their surgical removal. As Dr Rahdon has techniques to close any wound, no matter the size, he can focus on adequate removal of the lesion. He is also very aware of the appearance of the dressings and will ensure that they are easy to look after.
Is skin cancer hereditary?
Fairer skin types are more at risk and if your parents have multiple skin cancers from UV exposure it may follow that you will too. There are also a number of rare genetic disorders (eg Gorlin’s syndrome) that have high rates of skin cancer.
Does treatment require hospital admission?
It depends on the severity of the lesion and where on the body it is. Sometimes Dr Rahdon will operate to remove lesions at Body Recon Plastic Surgery on Level 5 at St John of God Hospital. This is often done if the patient does not have private health insurance and if the procedure is likely to be straightforward. More complex procedures may be best done in a hospital setting though in most cases can be performed as day surgery. This can be discussed during a consultation with Dr Rahdon.
Do I require private health insurance?
It depends on the type of lesion and the proposed treatment. We always recommend that our patients consider private health insurance.
What surveillance is required post treatment?
Dr Rahdon will usually review patients following surgical removal to check wound healing. Ongoing review will usually be carried out by the GP over a 12 month period. Melanomas usually require surveillance every four months for three years.