New Zealand has the highest incidence of skin cancer in the world. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.
Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.
There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
Basal Cell Carcinoma (BCC)
This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not spread to other areas of the body. Sometimes BCCs can ulcerate and scab so it is important not to mistake it for a sore.
They appear usually as small, pearly red lumps that don’t heal and sometimes bleed. They have the increase in size over time, some are superficial and can be treated topically with creams or cryotherapy.
Treatment
Often a BCC can be diagnosed just by its appearance, both clinically and dermoscopically. In other cases it will be removed totally and sent for pathological examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.
Removal of a BCC will require an appointment with a surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and some stitches. Some complex or large BCCs will require a general anaesthetic (you will sleep through the operation) for removal or reconstruction. A new treatment called Imiquimod is now available for topical treatment of superficial BCCs, please make an appointment to discuss.
Squamous Cell Carcinoma (SCC)
This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the head and neck, but an SCC can also affect other parts of the body and can spread to lymph nodes or to distant sites (very rare). The spreading (metastasising) can potentially be fatal if not successfully treated.
A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like. They can appear like an ulcer that does not heal.
All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC. SCC's are a spectrum of disease with well differentiated ones easily curable through to high risk SCC's (greater than 6mm thick, perineural invasion, lympho-vascular invasion, poorly differentiated etc). High risk SCC's may require sentinel node staging or radiological imaging.
Melanoma
This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from melanoma.
A melanoma usually starts as a pigmented lesion on normal skin or a changing mole. They often, but not always, occur on areas that have high sun exposure. Some melanomas are not pigmented or amelanotic.
What to look for:
• an existing mole that changes colour (it may be black, dark blue or even red)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle
Click here to see what to look for
Treatment
It is important that any suspect moles or freckles are checked by a skin specialist. The sooner a melanoma is treated, there is less chance of it spreading.
A biopsy or removal will be carried for diagnosis and staging. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. More surgery may be required to take a wider area around the scar. A Sentinel Node Biopsy maybe recommended depending on the thickness of the melanoma.
A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread. However there has been enormous advances in melanoma management in the past few years with immunotherapy and targeted therapy drugs.
Growths, lumps, tumours or masses in the head and neck can be benign (noncancerous) or cancerous and can form in the larynx, pharynx, thyroid gland, salivary glands (parotid, submandibular), mouth, neck, or face.
Tests to diagnose a mass may include:
• Examination – Clinical palpation of lump and lymph nodes, neurological testing etc
• Ultrasound assessment
• MRI – magnetic resonance imaging uses magnetic fields and radio waves to give images of internal organs and body structures
• CT Scan – computer tomography combines x-rays with computer technology to give cross-sectional images of the body
• Biopsy – a sample of tissue is taken for pathological assessment.
Enlarged Lymph Nodes
Lymph nodes in the neck often become swollen when the body is fighting an infection.
Benign Lesions
Noncancerous masses such as cysts and lipomas are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck.
Cancer
Cancerous masses spread to surrounding tissues and may be:
• Primary – they arise in the head or neck. Mostly caused by UV radiation and tobacco or alcohol use
• Secondary – they have spread from a primary tumour in another part of the body (most common is skin cancer).
Cancers may be treated by a combination of surgery, radiotherapy, and systemic drug therapy.
LUMPS AND BUMPS
Lumps and bumps can occur anywhere on the body. Most are diagnosed clinically although ultrasound or MRI can be used if large or suspicious. Most can be excised under local anaesthetic unless large or in complex sites.
INGROWN TOE NAILS
Ingrown toe nails can been painful and get infected. They are easily fixed under local anaesthetic or day stay surgery for more comfort.
HERNIAS
Hernias are a bulging of tissue through a weakness in the body wall (inguinal, femoral, umbilical or incisional (from prior surgery). Most can be fixed under day stay general anaesthetic with mesh (not the bad stuff!).
GALLSTONES
Gallstones can be very painful or become infected. Mostly this is fixed by removing the gall bladder under a general anaesthetic called a laparoscopic cholecystectomy
Abnormalities of the endocrine system treated by general surgery include disorders of the thyroid and parathyroid glands in the neck. These are often complex conditions requiring multiple investigations.
Thyroidectomy
An incision (cut) is made in the front of and at the base of the neck and part or all of the thyroid gland is removed.
Parathyroidectomy
An incision (cut) is made in the front of and at the base of the neck and one or more of the parathyroid glands are removed.
General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.
A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.
Ingrown toe nails can been painful and get infected. They are easily fixed under local anaesthetic or day stay surgery for more comfort.
Lipomas are fatty lumps that can occur anywhere on the body. Most are single although some people have multiple lipomas. If small they can be removed under local anaesthetic but if large or multiple they should be done under day stay general anaesthetic.
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