Skin Cancers
The unfortunate combination of New Zealand's genetic heritage, lifestyle and the harsh level of ultra violet light in our environment means that New Zealanders have one of the highest rates of skin cancer in the world. The two most prevalent forms of skin cancer are the basal cell carcinoma (BCC) and the squamous cell carcinoma (SCC). Both of these tumours are related primarily to the cumulative dose of ultra violet radiation the skin has been exposed to during the patient’s lifetime. In addition to these factors, there are also several familial and environmental promoters of each form of cancer. Melanoma is a less common but potentially more troublesome form of skin cancer.
Basal Cell Carcinoma (BCC)
BCCs are the most common form of skin cancer in the world. Thankfully, they are also one of the safest forms of malignancies to have. They tend to be very prevalent on the face but can occur on any skin surface. Diagnosis is usually by clinical examination alone. It is very rare for a BCC to spread to other parts of the body and, for this reason, they are rarely investigated any further than clinical examination.
Treatment is by surgical excision of the lesion with narrow margins. Unless the legion has been neglected or is in an anatomically difficult location, the post-excisional wound can usually be directly closed with stitches. Once the laboratory has confirmed complete excision, there is no need for any further follow up for that particular lesion. People who have had one basal cell carcinoma, are more likely to develop a second.
Squamous Cell Carcinoma (SCC)
SCCs are the next most frequent form of skin malignancy in New Zealand. Like BCCs, SCCs can be thought of as an indicator of cumulative ultra violet light exposure in the patient, they also have a number of familial and environmental promoters. There are various body tissues which can develop BCCs. When they affect the skin, they are relatively easy to diagnose on a clinical basis. Although more aggressive than BCCs, skin SCCs are also unlikely to have spread to different parts of the body unless the original lesion has been neglected and allowed to develop to a large size.
Treatment is usually by way of surgical excision with relatively narrow margins and direct closure of the wound. As these lesions do have a tendency to occur on the extremities where it is more difficult to close the wounds directly, flaps and grafts are slightly more frequently employed. If the lesion is large and/or appears to have invaded the deeper structures, further investigations (eg CT Scans, etc) will frequently be used to ascertain the true degree of tumour involvement.
Melanoma
Melanoma is a serious form of skin cancer. As a nation, New Zealand has the highest rate of melanoma per capita in the world. Like other skin cancers, it can present in a variety of patterns, although most commonly it has a dark pigment associated with it, it can also be a pale lesion without any pigmentation. Melanoma is a cancer derived from the out-of-control replication of melanocytes, the cells in the skin which produce melanin – our natural defence against ultra violet radiation.
Although vast amounts of research, time and resources are being devoted to the diagnosis and treatment of melanoma, the condition still remains primarily a surgical disease at this point in time. The fundamental principles of melanoma surgery are the complete excision of the lesion and an area of normal surrounding skin, which varies in size according to the thickness of the actual melanoma lesion. Where appropriate, the treating surgeon may also initiate investigations of the surrounding lymph nodes.
Complications (general)
Before deciding to proceed with surgery, every patient needs to thoroughly consider the risks, as well as the benefits, of surgery. During your pre-operative consultation(s), Mr Masters will openly discuss the risks with you so that you can consider them. A full listing of all the potential complications and risks of this procedure is beyond the scope of this website. There are two broad groupings of surgical risks: those that pertain to surgery in general; and those specific to the procedure being performed.
Generalised surgical risks include:-
Bleeding – usually occurs within the first 24-48 hours of the procedure and may require a return to the operating room. A quiet, restful post-operative period will help to avoid this problem.
- Bruising – whenever possible, Mr Masters uses medications and techniques that help to avoid post-operative bruising. The appropriate use of Arnica may help to speed the resolution of bruising.
- Infection – surgical incisions, even though created in ideal circumstances, can become infected.
- When appropriate, antibiotics will be prescribed to lower this risk.
- Unfavourable scarring – every surgical incision results in a scar. It is Mr Masters’ role to maximise the quality of your scars and, whenever possible, to hide them in natural skin creases.
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