Skin cancer is the most common form of cancer in Australia. Two out of three Australians will be diagnosed with some form of skin cancer before the age of 70. As an Australian plastic surgeon, I place enormous importance on providing a high level of care to skin cancer patients. This forms a significant part of my day-to-day services.
Fortunately, not all skin cancers are equal. The most common varieties, such as basal cell carcinomas (BCCs), rarely spread through the body. In the vast majority of cases these are curable by a single excision procedure. More aggressive cancers such as squamous cell carcinomas (SCCs) or melanomas may be cured by early removal, though advanced forms may require more invasive surgery, removal of associated lymph nodes, chemotherapy or radiotherapy.
Irrespective of the kind of skin cancer you have, there are two key priorities when removing them: complete removal and treatment of the cancer, and leaving as little evidence as possible that surgery has occurred.
Even the smallest skin cancers must be removed with a small border of normal tissue, therefore creating surprisingly large skin defects. Many of these are located on the lips, nose, mouth, ears and eyelids and cheeks, leaving little margin for error when planning a cosmetically acceptable reconstruction. Treating more hidden areas, while easier, is no excuse to perform anything but the most meticulous surgery. The techniques used for such reconstructions include grafting skin from elsewhere on the body or rotating flaps of skin and other tissue into the site. Detailed planning and careful execution is key in achieving the best possible result.
In the unfortunate event that you do have a more aggressive or advanced form of skin cancer I will arrange all necessary tests and liaise with trusted medical oncologists and radiation oncologists when required. I am experienced in performing lymph node surgery and will discuss the risks and benefits of this should it become necessary.
In some instances no procedure will be required. Depending on your type of cancer, circumstances and preferences, I may prescribe a cream, or refer you for light therapy.
In the majority of cases, excision of the cancer is the best option. This may result in a wound able to be sutured closed, or one requires a more complex reconstruction for the best result. Most of these procedures can be offered in the office under local anaesthetic. If your procedure is more extensive, or you do not wish to have local anaesthetic injections alone, your procedure will be performed in a fully accredited private hospital as day surgery, with a specialist anaesthetist providing sedation.
In most instances you are able to return to work the next day. If a large cancer has been removed from the lower leg you may need a few days of bed rest. Showering is usually permitted after 24 hours. On the body and limbs I recommend scar taping for six weeks, on the face ointment is applied. Scars may remain slightly pink for the first few months, before fading.
Whenever a skin mole is removed it is exchanged for a scar. That scar must therefore be as inconspicuous as possible.
There are many reasons people seek to have benign moles removed. These include concerns they will turn into skin cancer, a dislike of their appearance that may distract from other features, or the way they cast shadows and alter photographs. Irrespective of the motivation, removal of these lesions is cosmetic surgery and must be performed with the greatest attention to detail.
Removal of such lesions is deceptively complex. If they are simply cut out and sutured, the resulting scar may be more apparent than the mole itself. However careful planning and meticulous technique can create a short fine-line scar hidden in natural skin creases, which is all but invisible.
Mole excision is usually offered in the office under local anaesthetic. If you are having multiple moles removed or do not wish to have local anaesthetic injections alone you may choose to have your procedure in a fully accredited private hospital with a specialist anaesthetist providing sedation.
You can usually return to work immediately. Showering is permitted the next day. If you experience any mild swelling this resolves within a few days. Scars may be pink for a few weeks to months, before fading.
Poor scarring can be an unpleasant reminder of a traumatic event. Fortunately, bad scars can usually be improved. Once formed, it is impossible to completely eliminate a scar. However scars that are raised, lumpy, indented, stretched or pigmented may be altered to become less conspicuous.
There are many factors that influence scar formation – the type of injury, the anatomical location, your genetics and the conditions under which the wound healed. Some of these factors can be controlled and others cannot. Some scars are stretched because they were closed incorrectly. Some become raised because they were slow to heal or may have had an infection during the healing process. Keloid scarring is a genetic condition in which scars grow beyond the original wound. These may be unsightly, itchy or painful.
By first assessing all the factors that contributed to your poor scar I will be able to provide a treatment plan addressing the relevant problems. This will lead to the best improvement possible. Treatments may include topical therapies, injections or revision surgery, and will be tailored to your needs.
This will vary, depending on what you don’t like about your scar and how and when it formed. Treatment may include ointments, pads or injections in the office. Depending on the extent of the scar, revision surgery may be available in the office under local anaesthetic, or may require a day procedure in a fully accredited private hospital.
Recovery from scar revision surgery is generally very comfortable, depending on the extent. In most cases you will be able to return to work the next day and shower within 24 hours. Full treatment courses often last several months, requiring ointments, taping or massage to continue as the scar matures.