BASAL CELL CARCINOMA
Basal Cell carcinoma (BCC) is the commonest type of skin cancer. It is five times more common than the next commonest type (squamous cell carcinoma) and is the least dangerous type of skin cancer. Its main cause is cumulative sun exposure and sun induced skin damage.
BCC hence tends to occur most commonly on sun exposed areas of the body in older age groups. They are common on the face including nose, ears and around the eyes. They also occur commonly on the top surface of the arms and hands and on the back of individuals who have led a life outdoors of sun exposure. Racial background can play an important role as those of celtic or other fair skinned backgrounds are more severely affected, particularly if having spent their lives in high sun exposed areas such as Australia.
BCC is slow growing and does not spread to other parts of the body and therefore has is very treatable and relatively non dangerous. It does, however, continue to grow both in its size and its depth and left untreated or neglected for many years and may cause considerable damage and even death. Its term “rodent” or eating ulcer is well deserved.
Many BCC’s are very typical and easily defined by clinical examination. Many others, however, may look atypical or are not clearly defined. In such cases, formal biopsy to accurately define diagnosis is important before planning treatment and in such cases, Dr Drielsma always insists on such formal biopsy and pathological diagnosis before embarking on treatment.
The most effective treatment of choice for BCC is surgery. In some early or thin cases, non-surgical treatments such as creams and photo-dynamic therapy may be used, surgery is still the most effective treatment of choice with a 90% or so cure rate.
As a large proportion of BCC’s occur on the face, surgical treatment with plastic, cosmetically optimised treatment is very important to minimise scarring and give the best aesthetic outcome. Plastic surgeons have pioneered techniques to remove BCC’s and cosmetically reconstruct the resultant defects in the best possible way along well established aesthetic principles.
Reconstructive options may be simple such as direct closure but often more complex approaches such as local or distant flaps, skin grafts and even microsurgery may be involved. Only a well trained, experienced plastic and reconstructive surgeon can offer all these possible options.
Dr Drielsma has over 20 years experience treating thousands of skin cancers of the face and body generally and offers the highest level of plastic surgical expertise to deliver reliable surgical eradication and cure of these tumours and the best possible aesthetic or cosmetic outcome.
SQUAMO-PROLIFERATIVE TUMOURS OF SKIN.
1. Actinic Keratosis
Actinic keratoses (AK’S) are very common “barnacles” of skin. They are caused by prolonged sun damage to the skin and tend to occur in older age groups. The skin cells found in AK’s are cancer like but are confined to the skin surface and so are not considered invasive skin cancers. They may however progress to skin cancer (squamous cell carcinoma) over time.
AK’s in themselves are not dangerous but given their potential to progress to SCC, are best treated.
These lesions are commonly effectively treated by surgery but can also be treated in some instances effectively by creams (Effudix, Solaraze and Aldara) and by photodynamic therapy (PDT).
Keratoacanthoma (KA) is a fascinating condition also known as self limiting squamous cell carcinoma. KA can be a rather alarming rapidly growing nodular growth of the skin that looks identical to more malignant tumours. Typically KA’s appear suddenly and grow rapidly over a two month period. The tumours then typically form a cratered appearance and stop growing for around two months. These often mysterious tumours then regress and all but disappear.
KA’s are impossible to distinguish form aggressive squamous cell carcinomas’s and therefore surgical excision is recommended. Such excision is not generally done on an urgent basis but more appropriately on a semi elective basis within 4 to 6 weeks. Surgery is planned as for SCC and complex reconstructive surgery may be required.
SQUAMOUS CELL CARCINOMA.
Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer. It is one fifth as common as BCC. SCC is more aggressive than BCC being faster growing and having a small propensity to spread to other parts of the body (lymph nodes or other) of 3 %. SCC’s are also mainly related to sun exposure and damage.
As with basal cell carcinoma, SCC tends to occur most commonly on sun exposed areas of the body in older age groups. They are common on the face including nose, ears and around the eyes. They also occur commonly on the top surface of the arms and hands and on the back of individuals who have led a life outdoors of sun exposure. Racial background can play an important role as those of celtic or other fair skinned backgrounds are more severely affected, particularly if having spent their lives in high sun exposed areas such as Australia.
The most effective, recommended treatment of SCC is surgery which needs to be somewhat more aggressive than with BCC. Biopsy is very important to accurately establish diagnosis prior to surgical treatment. Reconstructive methods following adequate removal of SCC’s will usually be more complex than with BCC and may involve complex flaps or skin grafts to give best possible cosmetic outcomes, particularly on the face, nose, ears and eyelids. A well trained, experienced plastic and reconstructive surgeon such as Dr Drielsma can offer all these possible options.
Melanoma is the most serious form of skin cancer you will hear a lot about. It is quite uncommon compared to BCC and SCC but because of its serious nature and propensity to spread, most people hear more about it than other skin cancers. Melanoma is also related to sun damage and occur more commonly in individuals who have led a life outdoors of sun exposure. Racial background again plays an important role as those of celtic or other fair skinned backgrounds are more severely affected, particularly if having spent their lives in high sun exposed areas such as Australia.
Melanoma may develop from existing moles, particularly dark flat moles (junctional or compound naevi) but this is very uncommon. For this reason, dark moles should be kept under observation by yourself and your doctor and in some cases, removal will be recommended.
It is important that melanoma be diagnosed and treated by surgical excision or removal in its very early stages when cure by adequate excision is usually possible. The larger a melanoma becomes, the lower the cure rate possible. Because operations to adequately remove melanomas need to be bigger, removing more tissue around it, more complex reconstructions such as skin grafts and flaps are usually necessary and hence the importance of treatment by a qualified surgeon.
OTHER SKIN CANCERS
Many other, rarer skin cancers occur but are too uncommon to describe here. Suffice to stress again the importance of accurate diagnosis to appropriately plan effective treatment. This highlights the importance of seeing a well trained and experienced practitioner with higher surgical or dermatological qualification. Biopsy of suspicious lesions is also of paramount importance.
HAVE YOU NOTICED A LUMP OR TUMOUR OF THE SKIN?
The best next step is to see your GP who can advise you of the likely diagnosis or do a biopsy of the lesion for you. Dr Drielsma can also see you to accurately diagnose the lesion ( with biopsy if required) and treat the problem appropriately.
I HAVE BEEN TOLD YOU HAVE A SKIN CANCER – WHAT SHOULD I DO?
Your GP can advise you. Many GP’s are happy to remove lesions of the body, arms legs etc if small. Larger lesions may need reconstruction and in such cases seeing a plastic surgeon such as Dr Drielsma is advised.
Many skin cancers involve the face, nose, eyelids, ears and lips. In such cases, cosmetic outcome following excision and reconstruction is extremely important and having a Plastic Surgeon with vast experience in skin cancer excision and reconstruction such as Dr Drielsma is even more important.
WHAT ABOUT SKIN CANCER CLINICS?
Skin cancer clinics have become very common over recent years. What may not be realised however is that these clinics are generally general practitioner based and practitioners practising within them generally have no higher dermatological or surgical training. As such, the treatment these clinics offer is similar to that which can be offered by your family GP.
The diagnosis and treatment of many skin cancers is often simple and your GP and skin cancer clinics may be suitably equipped to diagnose and manage them. However, many more complex skin cancers may be confused with simple ones to the non qualified practitioner. Having an appropriately trained and qualified surgeon or dermatologist mange your skin cancer will ensure you are appropriately diagnosed and treated. When lesions or more complex diagnoses and treatment plans are required, there is no substitute for adequate higher surgical and dermatological training and experience. Surgical treatment of lesions on aesthetically sensitive areas such as the face, nose, lips, ears and eyelids requires a higher level of reconstructive surgical expertise offered by plastic surgeons.
Dr Drielsma is a fully qualified plastic and reconstructive surgeon with a vast experience of diagnosis and surgical treatment of skin cancers along with the highest standard of reconstruction following excision. If you have a skin cancer or growth in a sensitive area, Dr Drielsma will optimise adequate excision along with the best possible reconstructive outcome.