Skin cancer is the most commonly diagnosed cancer in Australia. Australia and New Zealand has the highest incidence of melanoma in the world. Skin cancers are broadly divided into 2 groups:
- non-melanoma skin cancer (NMSC)
- Basal cell carcinoma (BCC)
- Squamous cell carcinoma (SCC)
Symptoms of skin cancer include:
- crusty lesion
- non healing ulcer
- bleeding lesion
- change in colour of the lesion
- new skin lumps or moles
Biopsies may be performed by removing part of or the entire lesion. This can then be examined by a specialist pathologist. Adjacent lymph nodes may also need to be examined and a needle biopsy taken if enlarged.
Most NMSC are managed by your GP or dermatologist but some skin cancers may require surgical treatment because of its size, location or involvement of lymph nodes.
BCC rarely spread and complete local excision is often sufficient. Occasionally the lesion is too large to be repaired by simple closure. A skin graft or local skin flap may be required.
SCC is often treated by complete local excision but it also has a tendency to spread to the nearest lymph gland. If the lymph node has confirmed spread of cancer or the skin cancer is sufficiently large, the local lymph node group may need to be removed during the same operation. It is called a lymph node dissection. This is performed under general anaesthesia. Further investigations such as a CT scan may be requested by your specialists before the planned operation to exclude the spread of disease to other parts of your body.
Surgery can be curative for thin melanomas and requires that the lesion be removed with 1cm of normal skin around it. It can be done under local anaesthesia.
If the melanoma is >1mm thick or has other unfavourable features in the biopsy, examination of the first draining lymph node (sentinel node biopsy) is performed together with removal of the melanoma. This is performed under general anaesthesia. A nuclear medicine scan will need to be organised 24 hours prior to the operation to identify the first draining lymph node. A special blue dye will need to be injected around the melanoma whilst the patient is under general anaesthesia to stain the lymph node blue. These will aid in the identification and removal of the lymph node. The excised melanoma and the lymph node will then be sent for microscopic examination and the results be available when you return to see your specialists in 1-2 weeks. Most patients can go home on the same day of the operation.
Your surgeon will discuss the results of the lymph node biopsy with you at the follow up visit. If there is no disease, you will require no further surgery. However, you will need to be seen by your GP or dermatologist for regular skin checks. If the lymph node does show spread of melanoma, further investigations such as CT scans will be organised to look for spread of disease elsewhere in the body. One will then require ongoing outpatient review in a specialised cancer care centre. These cases will also require discussion in a multidisciplinary meeting where a group of melanoma specialists will formulate a treatment plan for you. Your surgeon will discuss the plan with you in the clinic. Treatment option may include further surgery, targeted therapy, chemotherapy, radiotherapy or a combination of the above. You may also be invited to take part in a clinical trial following discussions with the appropriate specialists.