Dr Mark Edinburg :: December 2006

The incidence of skin cancer in Australia is rising and part of the reason for this, is the association with our life style and increase in general prosperity. This results in increased exposure to the sun as a result of changing fashion, increased leisure time with sport, barbeques and an increased attendance at the seaside. The incidence of skin cancer increases the nearer we are to the equator and 90% of skin cancers occur in the sun exposed areas of the body.

We know that the presence of skin cancer is increased in people who spend time outdoors and people who have less pigmentation. There are, however, also other causes of skin cancer. Some of these include trauma, burn scars, chronic leg ulcers, previous exposure to radiotherapy, patients who are immuno-suppressed and, rarely, exposure to various types of chemicals.

Skin cancers can be a serious problem and, therefore, should be dealt with by doctors who have been trained adequately to deal with this problem. This means that the treating doctor should have a good clinical ability to pick up the various types of skin cancers and make a correct diagnosis before proceeding on to treatment. The doctor should have an understanding of the pathology and how the tumour behaves and, therefore, knowledge on how to treat these tumours.

(Skin Cancer A Real, Raw Issue...con't)

It is very important that these tumours be treated in the correct manner. It is not appropriate to have tumours treated in a "willy nilly" fashion as this would have far reaching ramifications for the patient. My suggestion to you, the public, is to seek guidance from your local medical officer and, if necessary, proceed on to further management with either your Dermatologist or Plastic Surgeon.

Understanding Your Skin
The history of the lesion is important, to identify how the lesion started, length of time it has been present and behaviour of the lesion. Rapid growth of a lesion would suggest malignancy, as would features of ulceration and bleeding. A family history is also important and, if necessary, a history concerning work environment, drug intake and any other factors will be taken into consideration. It is important for patients to understand that most skin cancers do not produce symptoms and, therefore, it is imperative for patients to be vigilant and aware of any new lumps or bumps of the skin. These should be reported to your local medical officer as soon as possible.

The Consultation & Appropriate Treatment Protocol
At the time of examination, the site of the skin cancer is noted and measured for its size and its shape, surface character and edge of the lesion, whether there is any ulceration, pigmentation and variation in colour of the lesion would all be important. This would then be followed by palpation of the skin cancer and the lymph nodes in the area adjacent to the skin cancer should always be examined.

At this stage we can discuss the diagnosis of the lesion. If this is not possible at the time, a biopsy would be advised. It is important to accurately diagnose the type of skin cancer that is present as there are various treatments available for different types of skin cancers. Specifically, in terms of surgical removal, some skin cancers will require a wider margin of excision than other types of skin cancers and this has particular relevance in certain areas of the body, such as the face.

If surgery is appropriate to treat this lesion, most can be managed in my surgery under local anaesthesia or sedation if required. Other forms of treatment may include liquid nitrogen, creams such as aldara, chemicals such as effudix, laser, and radiotherapy. Often the surgical excision of the tumour will require reconstruction either with flaps or skin grafts. There are many types of flaps and different types of skin grafts and if you require any one of these, the procedure will be explained to you. I believe that these surgical techniques are best carried out by plastic and reconstructive surgeons.

Cosmetic Applications
At the Eden Institute, we remove many benign lesions as well, such as moles, for cosmetic or other reasons. Sometimes it may be inappropriate to excise these lesions because of the risks of poor scarring. At the Eden Institute of Plastic and Cosmetic Surgery, we advise you to not underestimate the importance of seeing a Specialist Skin Cancer Surgeon - prevention and early detection is crucial when dealing with Skin Cancers.