What are skin cancer and melanoma?
Skin cancer is the most common form of cancer, with more than 13,000 Australians diagnosed with melanoma yearly. It is a disease caused by excessive sun exposure to ultraviolet (UV) radiation, which can cause your skin cells to grow abnormally and form a tumour in the skin. This can occur from tanning, sunburns, and prolonged skin damage over time, a common cause of skin cancer when living in Australia. Tumours can be benign and non-cancerous or malignant, meaning they contain cancer cells which can spread through the body. Still, if caught early enough, 90% of melanomas can be treated with surgery alone.
Skin cancer can appear as a dark spot, mole, sunspot, lump, or scaly skin area and can change colour, size, or shape over several weeks or months. These changes can help you or your doctor identify whether a mole or spot needs checking. Known as the ‘ABCDE’, characteristics to look for include:
- Asymmetry– is there a difference in the spot or mole on either side?
- Border– is the border jagged or expanding?
- Colours– is there more than one colour, or is the colour uneven and blotchy?
- Diameter– has the spot or mole grown larger?
- Evolution– how much has the mole or spot changed over time?
What treatment options are available for skin cancer and melanoma?
Treatment options for skin cancer and melanoma will depend on the stage of the tumour, which must be determined before creating a treatment plan. Most stages of melanomas require surgical removal. In some cases, sentinel lymph node biopsy may be considered if the melanoma is at a more advanced stage to check and prevent the spread of melanoma. More advanced stages of melanoma require surgical removal and lymph node dissection to remove all nearby lymph nodes or tissues, along with drug or radiation therapy, depending on how advanced the cancer is.
How are skin cancer and melanomas diagnosed?
If you find any new or changing spots on your skin or experience a sore, itchy, bleeding mole, it is essential to see your doctor immediately, who will conduct a physical examination of your skin. The ‘ABCDE’ characteristics are important in determining if a spot or mole is problematic, but this is not a definitive indication that there are cancerous cells in or around the skin lesion. Therefore, your doctor may suggest doing a skin biopsy, where part or all of your spot is removed and tested. Patients may be at higher risk of skin cancer if they have:
- A history of working, playing sports, or spending significant time in the sun
- Previously had skin cancer or have a family history of skin cancer
- Fair or freckled skin that burns easily
- A weakened immune system
- Sunspots or irregular moles on the body
- Actively tan or use solariums
Consultation with Dr Matt Starr
Before you consult with Plastic Surgeon Dr Matt Starr, you will need to have undergone biopsy testing of the concerning mole or spot and have the results of this testing. You will discuss your lifestyle and disclose your medical and family history so that Dr Starr may be able to decide on the appropriate course of action. Before examining the area of concern, he will ask you about any current medications you may be on and previous surgeries you may have undergone. All this information, including what stage of melanoma you have, is vital in determining the right treatment plan for you to excise the cancerous cells and prevent reformation safely. It is also an opportunity to discuss any concerns or questions with Dr Starr, who will give you detailed information on what should be expected before, during, and after your surgery.
The procedure
Several types of surgery can be performed on patients with skin cancer and melanomas, which, as mentioned, will depend on the stage of the melanoma.
Wide local incision
Although a skin biopsy is used to diagnose melanoma, more surgery may likely be needed to ensure the cancer is excised completely where the margins of the removal are more expansive due to the diagnosis. It is a minor operation requiring local anaesthesia injected into the area to numb it before removal. The tumour site is cut out, including a more comprehensive skin margin, determined by the tumour’s thickness and location. Thicker tumours will need larger margins both at the edges and in the depth of the excision.
Mohs surgery
Mohs surgery is a precise procedure for removing skin cancer where the skin and melanoma are removed in very thin layers. After removing each tissue layer, it is examined under a microscope. If any cancer cells remain, the exact area is known, and another layer of tissue is removed precisely from that location. This process is repeated until no cancer cells remain, sparing as much healthy tissue as possible.
Lymph node dissection
This surgery removes all lymph nodes around the primary melanoma tumour, which may occur after a diagnosis of melanoma and an examination of the lymph nodes near the concerned area. This is to prevent the spread of the cancerous cells to surrounding lymph nodes, and if the lymph nodes are abnormally hard or large, a lymph node dissection is done.
Recovery & aftercare
Aftercare is crucial in monitoring your healing and cancer recurrence after surgery. Your recovery and aftercare plan may require regular physical skin examinations and testing to ensure cancer has not recurred or spread to new areas. This is a highly customised part of the treatment based on your history of melanomas and the risk of recurrence. Patients who are treated for melanomas should take steps to protect themselves from further skin damage by doing the following:
- Wearing long sleeves and pants when outside for long periods
- Use a broad-spectrum sunscreen with an SPF of at least 30, making sure to reapply every two hours.
- Wear UV-protective sunglasses
- Wear a hat
- Avoid the use of solariums and other tanning devices.
What risks or complications are associated with the treatment?
Risks and complications can be associated with any medical or cosmetic surgery patients may undergo. The associated side effects or risks are highly individualised to each patient with excision for cancer and melanomas. Thicker melanomas requiring wider excisions may need a skin graft and rehabilitation depending on where the melanoma was located. Patients who require lymph node dissection are at risk of lymphedema, where abnormal fluid build-up in the soft tissue can cause a blockage in the lymphatic system, which is responsible for fighting off disease and infection in the body. There is also the risk that cancer may return later in life, but ensuring you have regular check-ups and follow a comprehensive sun-safe plan can help prevent cancer recurrence.
