Adelaide Plastic Surgery

Skin Cancer

Skin Cancer

Whilst the ‘C’ word is serious and understandably scary, it should be reassuring to know that many skin moles and growths fortunately turn out to be harmless and more of a cosmetic concern (benign). By the same token, the skin-cancer awareness campaign has motivated many people to have moles removed for their peace of mind.

Skin Cancer

How we operate

To remove thin or early benign growths, along with selected superficial skin cancers, we use the Sciton (Erbium YAG) laser. This device is an extremely accurate ablative laser that produces very little collateral tissue injury resulting in minimal scarring and hyper- or hypo-pigmentation.

Larger, more advanced benign growths may still need to be surgically excised and leave a fine scar.

At Adelaide Plastic Surgery, we do not use chemical or electrical cautery, as these procedures give the operator less control, with a higher risk of complication.

What causes malignant tumours?

Australians have one of the highest rates of skin cancer in the world. And no wonder: many of us have fair skin that’s just not suited to our warm climate, yet we have a cultural obsession with sport and the great outdoors. Maybe Australia is more the ironic country than the lucky one.

Ultraviolet radiation causes skin cancer in two viciously complementary ways: first, it damages the cells in the skin directly; then, the UV also depresses our immune system so that it’s less able to destroy the cancerous cells. Throughout our lifetime, we accumulate this damage. So it is never too late to start protecting your skin with a 30+ broad-spectrum sunscreen, protective clothing and hats. The good news is most skin cancers are curable. However, early detection is important.

Types of skin cancer

Basal cell carcinomas (BCCs) are the most common. They usually occur on areas exposed to the sun and grow slowly over time. They almost never spread elsewhere. If left untreated, however, they will continue to grow, potentially making treatment more difficult.

Squamous cell carcinomas (SCCs) are also very common in Australia. As they can grow quickly, they need to be detected early. If treated too late, they can – occasionally – spread.

Melanomas are another form of skin cancer that arise from our pigment-producing cells (melanocytes). Whilst not as common as BCCs or SCCs, they are potentially fatal and early detection is crucial. They can arise from moles, but often develop on normal skin.

Melanomas, unlike BCCs and SCCs, can often occur in younger people. The risk factors for developing melanomas include:

  • a family history of melanoma;
  • excessive sun exposure;
  • sunburn (particularly when young); and
  • having many moles (a change in a mole is an important clue as is an irregular outline or colour).

When should I get my skin checked?

Given Australia’s statistics (and particularly the climatic conditions of our own state, South Australia), regular skin checks will improve your chances of having a skin cancer detected early. At Adelaide Plastic Surgery, we have doctors who offer full skin examinations and are experienced in treating skin cancers. Depending on the type detected, we can offer topical creams, laser or photodynamic therapy (described below), or surgery.

Of course, we also have treatments for other sun-induced skin problems, such as sunspots, increased pigmentation, prominent capillaries and wrinkles.

Non-surgical alternatives for skin cancer

You’d no doubt agree that finding a cure for a life-threatening ailment will always take precedence over concerns about vanity. That’s why surgery continues to be the principal practice for treating skin cancer and pre-malignant skin lesions: not only does it ensure the lesion is completely excised, but there is histological confirmation of that fact (we study the removed tissue for evidence).

That said, there are obvious benefits to non-invasive treatments, including the elimination of scarring and possible disfigurement. Today, we can offer a number of these options to treat selected skin cancers and pre-malignant skin lesions. These include:

  • cryotherapy
  • laser ablation
  • topical 5-fluorouracil
  • imiquimod creams
  • intralesional interferon.

How photodynamic therapy works

One non-surgical treatment we offer at Adelaide Plastic Surgery that has a number of advantages for selected skin cancers and pre-malignant skin lesions is photodynamic therapy. This single-stage treatment may be used on a large area in a single setting with proven efficacy. Here’s what happens.

  1. First, we apply a cream containing aminolevulinic acid to the lesion, so it can be absorbed by the neoplastic (cancerous) cells.
  2. The cream is covered and left in contact with the lesion for four hours.
  3. After this time, the lesion is uncovered and excess cream is simply wiped away.
  4. We then direct red light to the lesion for 20 minutes.
  5. The cream and the red light work together to damage the neoplastic cells exclusively, leaving the normal, healthy cells unharmed.

You may experience some discomfort in the 20 minutes while the light is being applied. For one to two weeks afterwards, the area will be red, inflamed and crusted over.

We must warn you in advance, however, that photodynamic therapy is only appropriate for selected skin cancers and pre-malignant skin lesions. However, your surgeon will advise you whether photodynamic therapy (or any other non-surgical option) will work for you, along with their degree of confidence in the outcome.

Minor Procedure Discharge Information

Simple Excisions and Hand Surgery

Bleeding
It is normal for the suture lines to ooze blood for 24–48 hours.

If the area bleeds:

  • Sit or lie down and elevate the area.
  • Apply firm pressure over the area for 20–25 minutes.
  • Ice packs can be applied to assist in controlling the bleeding.
  • If bleeding does not stop please call and speak to one of the nursing staff on 8213 1800 Monday to Friday 9.00am to 5.00pm.
  • Outside of these hours please call 8213 1800 and listen to the message. You will be provided with contact details for our on call surgeon or nurse.

Pain or discomfort
If you are experiencing pain or discomfort take Panadol or Panadeine 4 hourly (as long as you are not allergic to these) with a maximum of 8 tablets in 24 hours.

Aspirin based analgesia should not be taken before or immediately after surgery as this can increase the tendency for you to bleed.

If the pain worsens over the first few days please phone and speak to one of our nursing staff. Hand and finger injuries should be kept elevated above the level of the heart.

General wound care
You will often have steri strips or hypafix applied. Please leave these in place until they fall off. You can shower with the tapes on and pat them dry with a towel. If the tapes fall off, leave the wound open, wash daily and pat dry.

If you are unsure as to what type of dressing you have, please call and speak to one of our nursing staff.

Do not use a sling for hand and finger injuries unless instructed by your surgeon.

If you have more than a simple tape dressing this needs to be kept clean and dry until your post op appointment

Wound care—grafts

Graft Site
Grafts will either have a dressing on top of them or left open. If there is a dressing, it must remain clean and dry. The dressing will be removed at 7 to 10 days. If it is left open then the area can get wet in the shower (after the first 24 hours) and you will be given ointment to gently and sparingly apply 4 times a day.

Donor Site
The donor site will have a dressing, and unless you are told otherwise this must remain clean and dry. It is common for these sites to bleed or ooze for a number of days. These dressings must remain in place for up to 14 days. You may add additional tape to the dressing if it becomes loose.

Scar management
All surgeries result in scarring. To help you to achieve the best results, a number of options suitable to your particular circumstance will be discussed at the appropriate time once healing has occurred.

Wound care—lasering

Lasering on the body
Often the area is covered with a dressing. You may shower as normal. After 2–3 days the dressing can be removed, and the area left open.

Lasering on the face
Often the area is left open and will ooze a little. You will need to keep the area clean by removing as much ooze as possible. This needs to be done every 4–5 hours for the first few days until the area is no longer oozing.

After cleaning apply a thin coat of Vaseline to prevent the area drying out, cracking and bleeding.

You may wash and shower as normal. As the area heals the ooze will lessen and cleaning is reduced.

After 4–7 days the area should have healed and will be pink. You will no longer require Vaseline—instead use a moisturising cream twice a day.

The redness will fade over time and must be protected from the sun. We recommend you use a good sunscreen.

General Information

Any Concerns
Please phone 8213 1800 and ask to speak to our nursing staff Monday to Friday 9.00am to 5.00pm.

In case of an emergency
Your surgeon or the on call surgeon can be contacted on 8213 1800 at any time.