Australia has one of the highest incidences of skin cancer in the world. The fair-skinned descendents of Northern European migrants were not designed for the harsh Australian sun.
The most common type of skin cancer is the Basal Cell Carcinoma (BCC). These frequently appear on the face and, if left untreated, may grow wider and deeper into adjacent structures, hence the alternative term, "rodent ulcer". They may be a nodule with small blood vessels on the surface or an ulcer / scab that doesn't heal. Some superficial BCCs may be effectively treated with topical ointments or currettage / laser. Alternatively surgical excision may be recommended.
Squamous Cell Carcinoma (SCC) are another type of skin cancer. This type have the potential to spread to other parts of the body if left untreated. Surgical excision is usually recommended to ensure the lesion is adequately removed.
Melanoma is a more aggressive skin cancer, characterised by a dark brown / black spot. They may arise from an existing mole that has changed colour of shape, or may appear spontaneously. Treatment is with surgical excision with a wide margin of normal skin (1 to 2cm)
Surgery is usually performed under local anaesthetic, but for lesions in sensitive areas or for multiple excisions sedation or general anaesthetic may be recommended. After excision of a skin cancer the wound is closed with stitches. This usually leaves a fine linear scar. In some circumstances the skin cannot be closed directly due to excessive tension or at the risk of distorting surrounding structures (eg pulls down the eyelid or lifts the nostril). In these cases a local flap of skin is brought from an area of relative laxity or a skin graft from a distant site may be used.
The excised specimen will be sent to histopathology for testing. This will confirm the diagnosis and check whether the lesion has been adequately excised.
The wounds are usually dressed with surgical tape that can be safely wet in the shower immediately. Occasionally (eg if a skin graft is used) you will asked to keep the dressings dry for 5 days. Most patients return for a review at 1-2 weeks. The results of the pathology will be available and sutures can be removed if necessary.
Complications
Bleeding from the wound is common after the adrenaline in the anaesthetic wears off. This is usually easily controlled with gentle pressure on the wound with gauze or clean tissue. Very occasionally a return to the operating theatre is necessary
Wound infection may occur after a few days. This is characterised by redness in the surrounding skin, swelling and increasing pain. If you suspect this, please contact the practice rather than waiting for your next appointment. Wound infections nearly always respond to a 5 day course of oral antibiotics.
Delayed healing. Sometimes the wound may take longer to heal than expected or the suture line may gape. This usually settles with an extra period of dressings but occasionally may require placement of more sutures to achieve a better scar.
Incomplete excision. If the skin cancer has "roots" of tumour that extend below the skin, it may not be possible to see these from the outside. Skin cancers are usually excised with a small margin of normal skin to keep the scars to a minimum. When the lesion is examined by the pathologist it may be felt that the lesion extends to the edge of the specimen, implying there may be some tumour left behind. In these circumstances further surgery may be recommended. Overall there is a greater than 95% chance of complete excision following the primary surgery for BCC and SCC (ie less than 1 in 20 patients will need a re-excision following the histology result).
Further information about this procedure can be found here
http://www.plasticsurgeryfoundation.org.au/patient-information/procedures/reconstructive-surgery/skin-cancer/
