Skin Cancer Surgery: Comprehensive Treatment and Management

Understanding Skin Cancer 

Skin cancer, one of the most common types of cancer, develops from abnormal skin cells. The primary cause of basal cell skin cancer is often exposure to UV radiation from the sun and tanning beds, leading to damaged skin cells. In Australia, particularly in coastal areas like Port Macquarie, the incidence of skin cancer is notably high due to the prevalent sun and surf lifestyle. There are three types of sun radiation – UVA, UVB, and UVC, with UVA and UVB being responsible for skin cell damage, while UVC is generally blocked by the atmosphere. 

Australia leads the world in the skin cancer rates.  

Skin cancer represents a significant health concern, accounting for 80% of all newly diagnosed cancers, a statistic that underscores its prevalence compared to other cancer types. The primary cause of skin cancer is exposure to the sun, contributing to 95-99% of cases. This link highlights the critical importance of sun protection and awareness. Furthermore, when compared to other Western countries, the incidence of skin cancer in Australia is notably higher, being 2-3 times more prevalent than in countries like the UK and North America. This elevated rate can be attributed to factors such as Australia’s geographical location, climate, and outdoor lifestyle, emphasising the need for increased vigilance and preventive measures in these regions. 

Skin cancer is primarily categorised into three types, each with unique characteristics and treatment approaches: 

  1. Melanoma: Known for its potential to be lethal if not treated early, melanoma is a type of skin cancer that can rapidly spread to other parts of the body, including lymph nodes and internal organs. It’s characterised by the uncontrolled growth of pigment-producing cells. Melanomas can appear as new dark spots or existing moles that change in color, shape, or size. The key to treating melanoma effectively is early detection, often through regular skin checks. 
  2. Basal Cell Carcinoma (BCC): BCC is the most common and usually the least aggressive form of skin cancer. It arises from the basal cells in the skin and often appears as a painless raised area of skin that may be shiny or pearly in appearance. While BCCs rarely spread to other parts of the body, they can cause significant damage by growing and invading surrounding tissue. 
  3. Squamous Cell Carcinoma (SCC): SCCs are potentially more aggressive and can spread to other parts of the body. They originate from squamous cells, which are found in the middle and outer layers of the skin. SCCs often appear as scaly, crusty, or bleeding patches of skin that persist and can become painful. Early treatment is crucial to prevent the spread of SCCs. 

Incidence and mortality of Skin Cancers in Australia 

  • 2 out 3 Australians diagnosed with skin cancer by 70 years of age 
  • Between 1982 to 2007 Melanoma diagnosis increased by 50% 
  • BCC’s and SCC’s are the most common type of skin cancer 
  • More than 400,000 people are treated for one or more Non-melanoma skin cancer 
  • 543 people died of non-melanoma skin cancers in 2011 
  • Melanoma is the 3rd most common cancer in both males and females, and the most common cancer in people aged 15-44 years old 
  • In 2009 approximately 11,500 people were diagnosed with melanoma 
  • In 2011 there were 1544 deaths due to melanoma 
  • The 5 year survival rate for melanoma is 90% for men and 94% for women 
  • More than 2000 people died from all types of skin cancer in 2011 

Diagnosis and Symptoms 

The diagnosis of skin cancer involves a thorough examination of the skin. Dermatologists or skin cancer specialists look for any unusual growths or changes in the skin. Symptoms that may indicate skin cancer include: 

  • New growths or sores that do not heal. 
  • Changes in the size, shape, color, or texture of existing moles or skin lesions. 
  • The appearance of new moles or skin lesions, especially if they look different from other moles on your body. 
  • Itching, tenderness, or pain in an area of the skin. 

A biopsy, where a small sample of the suspicious skin area is taken and examined under a microscope, is often required to confirm a diagnosis of skin cancer. Early detection through regular self-examinations and professional skin checks is key to successful treatment against developing skin cancer. 

Treatment Options 

Treatment for skin cancer varies based on the type and stage of the cancer. Options to treat skin cancer include: 

  1. Surgical Excision: This involves removing the cancerous lesion along with some healthy tissue to ensure all cancer cells are eliminated from the affected area.
  2. Mohs Surgery: Particularly effective for complex skin cancers, Mohs micrographic surgery involves removing the cancer layer by layer, examining each layer under a microscope until only healthy tissue remains.
  3. Radiation Therapy: Used for certain types of skin cancers, especially when surgery isn’t an option.
  4. Cryotherapy: This method involves freezing superficial skin cancers.
  5. Topical Treatments: Creams and ointments are used for treating certain small, superficial skin cancers.

For larger skin cancers, treatment may involve more complex surgical procedures, possibly requiring skin grafts or skin flaps to repair the area where cancer was removed. The goal of further surgery is always to remove all the cancer cells while preserving as much healthy skin as possible. 

Prevention and Protection 

Preventing skin cancer is crucial and involves several key steps: 

  • Sun Protection: Regular use of sunscreen with an SPF of 30-50, wearing protective clothing, wide-brimmed hats, and sunglasses, and seeking shade during peak sun hours can significantly reduce the risk of skin cancer. 
  • Avoiding Tanning Beds: Tanning beds emit harmful UV radiation and are strongly linked to an increased risk of skin cancer, including melanoma. 
  • Regular Skin Checks: Both self-examinations and professional skin checks are important for early detection of skin cancer. The earlier skin cancer is detected, the easier it is to treat. 
  • Understanding UV Index: Being aware of the UV index, which measures the level of UV radiation, can help people understand when they need to be most cautious about sun exposure. 

In summary, understanding the types of skin cancer, their symptoms, and the various treatment options is crucial. With the high incidence of skin cancer in Australia, awareness, and proactive measures for prevention and early detection are key. For those diagnosed with skin cancer, a comprehensive approach to treatment, considering all available options, is essential for effective management and recovery. 


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