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Treatments for Skin Cancer Spacer   Spacer

Excision

For certain skin cancers simple excision is all that is required. When a dermatologist performs an excision the lesion as well as a margin of normal skin is marked with a pen. The width of this margin depends upon what is being treated, certain skin cancers such as melanomas may require a 1 or even 2 cm margin of skin to be taken around the cancer whereas for non-melanoma skin cancer a few millimetres will suffice. A circular defect is difficult to close satisfactorily so circular defects are usually converted to an elliptical shape. Usually a 3 to 1 ratio (wound length to wound width) is employed to give the best appearance of the scar. It is quite common to be surprised by the length of the scar for what was initially a ‘small’ lesion. Remember that the lesion plus the width of the margin must be multiplied by 3 to get the ideal length of the final scar. All excision specimens are sent to a specialist pathologist. On rare occasions the excision is deemed by the pathologist to be incomplete and a ‘re-excision’ is recommended so that complete clearance of the lesion can be assured.

 

Cryotherapy

Cryotherapy is the use of extreme cold to treat skin lesions. It is used for the treatment of benign (non cancerous), pre-cancerous and certain cancerous lesions. In the past ‘dry ice’ was used but today liquid nitrogen is the preferred cryogen. Usually the liquid nitrogen is sprayed onto the treatment area until the desired degree of freezing has occurred. This results in a ‘frost bite’ type injury to the lesion and allows for new skin to heal from the sides and underneath. Healing is usually rapid and for lesions that are treated on the face, make-up can usually be worn within a week. Initially in the first hours after treatment the treated spots will look red and then they may crust up or even blister. Blistering is common in certain areas like the backs of the hands. If this occurs the blister is best left intact as it will act like a natural dressing. When the blister breaks, a dressing or bandaid may be applied together with a little Vaseline® or an antiseptic cream such as Savlon®.

 

Mohs surgery

Mohs surgery was developed by an American surgeon Dr Frederick Mohs in the 1930s. In essence it involves the removal of a skin cancer, processing of the tissue in a laboratory and the careful microscopic examination of 100% of the excision margin to confirm that all the skin cancer has been removed. One tissue removal and examination is called a ‘stage’. If skin cancer is seen remaining in the tissue then it is carefully mapped and more tissue is then taken from the patient so that it too can be checked. This is a second (or subsequent) stage. Most skin cancers (about 70%) are cured in one stage but sometimes many stages are needed to remove a large or complex tumour.

Mohs surgery has the highest cure rate of any treatment for skin cancer and is especially useful in those areas of the body where the conservation of normal skin (unaffected by cancer) is desirable such as on the nose or eyelid. Once a tumour has been removed by Mohs surgery then a definitive repair can be undertaken in the knowledge that repeat surgery will not be needed at a later date. Mohs surgery differs from traditional ‘frozen section’ surgery which you may have heard about elsewhere in several important ways. In Mohs surgery 100% of the margin is examined and it is the surgeon who also performs the microscopic examination of the tissue so that the exact location of any residual skin cancer can be carefully located. Because of these advantages, Mohs surgery offers the highest cure rate for the treatment of skin cancers and is increasing in popularity and usage worldwide. More Information.

Creams for skin cancer

Certain pre- skin cancers and skin cancers may be suitable for non-surgical treatments. In recent years a number of options have been developed. Common cream treatments include imiquimod cream (Aldara®) and 5-flurouracil (Efudix®). These creams work by targeting the abnormal skin cells but in different ways. Imiquimod works  by stimulating the immune system to recognize the abnormal skin cancer cells and destroy them. Because it is triggering the immune system, sometimes a response occurs well away from where the cream is being applied. For example a skin cancer on the chest may be treated with imiquimod cream and areas of pre skin cancer on the face may become inflamed as part of the immune response.

5-flurouracil cream is a chemotherapy drug in cream form which is taken up by pre skin cancer and skin cancer cells and then kills those cells. It works only on the areas to which it is applied. Both of these creams may generate significant skin reactions. It is wise to budget on some ‘down time’ if these creams have been prescribed for you. It is important to note that not all skin cancers are suitable for cream treatment, your dermatologist will be able to advise you on which ones can and can’t be treated with a cream.

 

Radiotherapy

Radiotherapy is the use of X-rays to treat skin cancers. It has been used for over 100 years and is very effective with cure rates approaching that of surgical excision for certain skin cancers. It can be an excellent option and a first line treatment for frail patients who may be unable to tolerate surgical excision. It is usually not a first line treatment for younger patients. It is available only in specialized clinics and hospitals and is usually given over several treatment sessions. Inflammation and sometimes ulceration of the treatment site occurs a few weeks into treatment and is part of the normal healing response and usually settles in a few weeks. Sometimes, for particularly aggressive skin cancers, radiotherapy is used as an ‘adjuvant’ treatment, that is an additional treatment after surgery in order to improve the cure rate.

 

Curettage and Cautery

Curettage and cautery is a technique for the removal skin cancers whereby a sharp blade (the curette) is used to scrape away the skin cancer. The base of the wound is then cauterized to seal any blood vessels. The wound is then left to heal in by itself (like a bad graze) and no stitches are required. It is a treatment used mainly for skin cancers found on the back and other areas of thick skin. Over time the wound contracts to be about 70% of its original size although it may remain paler and shinier than the surrounding skin.

 

Photodynamic therapy (PDT)

Is a newer form of therapy for skin cancers and pre-skin cancers. The area to be treated is gently scraped and a photosensitizing cream is rubbed on the lesion. The cream must be allowed to soak into the skin over about 3 hours. A light-proof dressing is placed over the lesion so that the cream does not react with the sunlight. After 3 hours the dressing is removed and a bright red light is shone on the lesion for about 7-9 minutes. Over the 3 hours the active ingredient in the cream (called ALA) has been taken up by the cancerous cells. The ALA absorbs the energy in the light and this energy then destroys the cancerous cells. Because the ALA is not taken up by the normal skin cells these are protected from damage and this mean that healing can be more rapid and often without scarring following PDT  when compared to other treatment options. For these reasons PDT is the treatment of choice for certain skin cancers on the legs such as squamous cell carcinoma in situ (also known as Bowen’s disease).

 

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Detection of Skin Cancer Spacer Spacer

Early detection of skin cancer is of particular importance for Australians whose risk is higher than in any other country in the world. Skin cancers, if recognised and treated at an early stage can be safely treated with minimal scarring and a lower risk of more serious complications.

Detection of skin cancer begins with you. Skin self examination is the most important technique to identify skin cancers and pre-skin cancers. You will know your skin better than anyone and a simple 3 monthly SSE, especially if using clinical photographs of your skin as a point of comparison will help identify at-risk lesions.

 

Skin self examination should be supplemented by examination by your GP if you identify any new or changing lesions. Similarly, other risk factors such as a history of having had a skin cancer excised, a family history of skin cancer or previous excessive sun exposure should prompt a visit to your GP for a check. We would also recommend that fair skinned Australians aged over 50 have their skin examined by a doctor who can diagnose any suspicious lesions and determine whether ongoing checks are required. Your GP will also determine whether you need to be referred to a dermatologist for further assessment. Dermatologists are skilled in early detection of skin cancers and the full range of surgical and non-surgical treatments that allow customisation of therapy to suit each individual patient.

 

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Laser, Light and Cosmetic treatments Spacer  

Dr Adam Sheridan offers various laser and light treatments to address common skin concerns including photodamage and age related textural, pigment, vascular changes; acne scarring; acne rosacea (flushing, redness and broken capillaries of the face). Botulinum toxin (Botox and Dysport) injections are provided to reduce unwantred wrinkles and excessive sweating. Soft Tissue Fillers are employed to refine facial contours, reduce deep lines and furrows, and to firm areas of skin laxity and collagen loss.

 
 

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Moles and Blemishes Spacer   Spacer

These are the harmless brown spots and lumps that are present to some extent on most of us. Moles are in part determined by a family history and also by sun exposure, particularly in childhood. Some types are present from birth (congenital melanocytic naevi) but most come on in childhood and early adulthood. Any new mole that develops in someone over the age of 30 and continues to grow should be assessed by a medical practitioner. Harmless moles are most commonly found on the torso and arms/legs, but they can be found on virtually any body surface including the palms, soles, genital area and in the scalp. Moles in these sites do not necessarily have a higher risk of skin cancer but can be more difficult to assess and monitor.

Blemishes refers to the harmless brown ‘age spots’ (aka ‘liver spots’ or correctly called lentigines) that are found on chronically sun exposed skin such as the face and backs of the hands. With time, some of these can become ‘warty’ on the surface but are not considered to be pre-cancerous. Nonetheless, they can mimic a very slow growing melanoma that is also found on chronically sun exposed skin. Any skin lesion that is progressively enlarging should be assessed by your doctor.

Treatments for these harmless spots can be performed by gentle cryotherapy (freezing), laser therapy, shave excision or excision with suturing (stitches). Importantly, strict sun avoidance will minimise the development of more spots. The best treatment for moles and blemishes depends on many factors and should be discussed with your doctor.

 

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