Australia has one of the highest rates of skin cancer globally, with two in three Australians diagnosed before age 70. Skin cancer develops when UV radiation damages the DNA in skin cells and triggers uncontrolled cell growth that forms a tumour. The type and location of skin cancer lesions will influence which surgical or nonsurgical treatment your doctor recommends.
At AF Aesthetics, our patients have access to Specialist Plastic Surgeons and a Dermatopathologist with published research in skin cancer and photobiology.
Types of Skin Cancer
Non-Melanoma Skin Cancers
- Basal Cell Carcinoma (BCC): The most common skin cancer, BCC, grows from cells in the deepest layer of the outer skin. It tends to grow slowly and rarely spreads, but can cause local tissue damage if untreated.
- Squamous Cell Carcinoma (SCC): SCC originates in the outer skin layers and is more aggressive than BCC. It carries a higher risk of spreading, particularly when it develops on the lip or ear, and occurs more in patients with weakened immune systems.
Melanoma
Melanoma develops in the pigment-producing cells in the skin, called melanocytes. This type is less common than BCC and SCC, but it is the most dangerous form because it spreads more readily to distant organs. Melanoma can appear as a new spot on the skin or as a change to an existing mole. Early diagnosis is an important factor in the successful treatment of this type of skin cancer.
Rarer Skin Cancer Types
There are also less common types of skin cancers, including Merkel cell carcinoma, microcystic adnexal carcinoma, dermatofibrosarcoma protuberans and cutaneous lymphoma. These types require highly individualised types of management and close monitoring by a multidisciplinary team.
Non-Surgical Treatment Options for Skin Cancer
Topical Medications
- Imiquimod (Aldara): This cream is often used for superficial BCC and lentigo maligna on the face or other cosmetically sensitive areas.
- 5-Fluorouracil (Efudix): This is a topical chemotherapy cream that is applied directly to the lesion and is used for actinic keratosis, solar keratosis and SCC-in-situ (Bowen’s disease).
Procedural Treatments
- Cryotherapy: During this treatment, liquid nitrogen freezes and destroys abnormal cells.
- Serial Curettage: The cancerous tissue is scraped away during this treatment layer by layer using a curette, sometimes combined with cautery to destroy remaining cells.
- CO2 Laser: This laser technology vaporises superficial lesions.
- Photodynamic Therapy (PDT): During PDT, a light-sensitive medication is applied to the skin and then activated by a specific light wavelength to destroy abnormal cells. It can be painful, so it is reserved for certain BCCs and performed with local anaesthetic.
- Intralesional Interleukin: This treatment is an immunotherapy agent injected into the tumour to stimulate a localised immune response.
Oral Medications
- Vismodegib: This medication is reserved for patients who have widespread BCC lesions over their whole body. It comes with the risk of serious side effects, so it should only be prescribed by a medical oncologist who can manage these risks.
- Nicotinamide: This medication is used as a preventative method to reduce the risk of skin cancer in high-risk patients such as those with Fitzpatrick skin types 1 and 2, and those of Northern European heritage.
Radiation Therapy
If a patient is not a good candidate for other types of surgical and nonsurgical treatments, we may recommend radiation. Radiation uses targeted beams to destroy cancer cells.
Surgical Treatment for Non-Melanoma Skin Cancer
Excision and Wound Closure
Surgery is the primary treatment for most skin cancers. Excision means cutting out the tumour along with a margin of healthy skin. The removed tissue is sent to pathology to make sure it was all removed.
A small wound may be closed directly. For larger or more complex wounds, your surgeon may use a flap repair, where the incision is extended and nearby tissues are rearranged. Sometimes, a skin graft is needed, where skin is taken from another part of the body and transferred to cover the wound.
Anaesthesia Options
Non-melanoma skin cancer surgery can often be performed under a local anaesthetic, which numbs the treatment area while you stay fully awake. This type can also be done in our rooms at AF Aesthetics without having to fast beforehand.
Local anaesthesia with sedation is performed either in a hospital or a day surgery centre, where the anaesthetist provides medication to make you drowsy so you do not feel the numbing injection. You stay awake for the rest of the surgery, but you will need someone to take you home afterwards.
General anaesthesia, where you are fully asleep, is reserved for complex cases and is only performed in a hospital or day surgery centre.
Surgical Treatment for Melanoma
Excision Biopsy
When we suspect that a lesion is melanoma, the entire spot is removed with a narrow margin and examined under a microscope. This confirms the diagnosis and measures the melanoma’s depth, also known as the Breslow thickness. The findings will guide the next stage of treatment. An excision biopsy can often be performed under a local anaesthetic only.
Wide Local Excision
If melanoma is confirmed, a second surgery will be used to remove a wider margin of skin around the original biopsy site to reduce the likelihood of the melanoma returning. The margin size will be determined by the melanoma’s thickness and will also follow national clinical guidelines.
Sentinel Node Biopsy
For certain melanoma types, we may also need to take a sample from a nearby lymph node to determine the next step of management. The adjacent lymph node is removed and then tested. This is often performed at the same time as the wide local excision, and the result will help us make recommendations for additional treatments.
FREQUENTLY ASKED QUESTIONS
Can skin cancer come back after treatment?
Skin cancer can recur at the original site or develop in other regions. Those who have a history of skin cancer have an increased risk of developing additional lesions. It is important for everyone who has had lesions removed to schedule regular follow-up skin checks.
Does skin type affect my risk of skin cancer?
Skin cancer can develop in all skin types and tones. Certain people are more at risk, such as people with fair skin and light eyes who have a tendency to burn. UV exposure is the primary risk factor, regardless of complexion, for developing skin cancer.
When should I see a doctor about a spot on my skin?
If you notice a new spot that looks different from your other moles, it can be a good idea to have it checked. You should also watch for moles that have changed in size, shape or colour and take note of any sores that do not heal within a few weeks or any spot that repeatedly bleeds, itches or crusts over.
Take the Next Step in Your Skin Cancer Care
If you have concerns about a spot on your skin or are due for a skin check, the AF Aesthetics team can help. Call (02) 8004 3323 or enquire online to book a consultation at our Chatswood clinic.
