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1 in 2 Australians will have a skin cancer in their lifetime.
Anyone can get skin cancer, but it is more common the older you are.

It is important to get your skin checked regularly by a qualified medical professional – at least once a year, or every few months if you are at high-risk of skin cancer or have been diagnosed with skin cancer previously.

Routine self-examinations are also a good way to monitor your own skin in between skin checks, but should not be relied upon to catch every suspicious spot.


Skin Checks & Diagnostics

The Skin Exam


A head-to-toe skin check with a qualified skin cancer doctor is the only way to know if you have a skin cancer.

A comprehensive skin check takes around 15 minutes.

You will be required to undress to your underwear. A gown can be provided for your comfort.

The doctor will examine your head, face, neck, body, legs, feet, toes, arms, hands, and fingers.

Genital areas are not routinely examined; however, skin cancers can develop in any area of the body and you should inform the doctor about any suspicious spots under your underwear. The doctor will only check these areas if you request them to do so.

Your skin will first be examined with a Maggie Lamp (a bright illuminated magnifying glass).

A Dermatoscope (a special skin microscope) will be used to help make a decision regarding a suspicious skin lesion or mole.

If the doctor finds a suspicious spot, a photograph will be taken and filed in your medical record.

Photographs are stored in your medical record for comparison at a later skin check. You will be asked to sign a form regarding any other specific use of your photos. The release of your photos for a second medical opinion, teaching or any internet usage will not be released without your permission.

A suspicious skin lesion may require a biopsy. A biopsy is a sample of the skin taken as a small punch, a shave or an incision or excision.

It is important to get your skin checked regularly by a qualified medical professional – at least once a year, or every few months if you are at high-risk of skin cancer or have been diagnosed with skin cancer previously. Routine self-examinations are also a good way to monitor your own skin in between skin checks, but should not be relied upon to catch every suspicious spot.

Dermatoscopy


Dermatoscopy is now the standard of care in early skin cancer diagnosis. It is a very important examination tool for detecting skin cancer early before it starts to look unusual on the surface. Our doctors are highly trained in dermatoscopy.

Examination of a skin spot with the dermatoscope is performed with a specialised hand device that magnifies and looks through the top layer of skin. This unique view allows the doctor to study a spot in detail to assess if it may be an early skin cancer.

A photograph of a suspicious skin spot is taken and stored in your medical record.  This photograph can be used for comparison in future to identify any changes that may indicate a skin cancer has developed. A biopsy of the suspicious spot may be taken.

Early detection of skin cancer is crucial to prevent disfigurement or even death.

Biopsies


Some skin spots are obviously cancerous, while others are not so obvious and require further analysis. If the doctor finds a suspicious spot that shows signs of being skin cancer, a biopsy may be recommended.

A biopsy involves taking a small sample of skin to be analysed by a qualified dermatopathologist at a pathology laboratory.

This helps confirm the diagnosis, the type and depth of the cancer, and allows your doctor to advise you about the recommended treatment.

A small amount of local anaesthetic si used to numb the skin form where the biopsy is taken. There are 4 ways a biopsy can be performed.

  1. punch biopsy:  For a punch biopsy, the doctor uses a small tool to extract a tube-shaped sample of skin and some underlying tissue.
  2. shave biopsy: A shave biopsy involves using a tool to shave the top layer of tissue from the surface of the skin.
  1. incision biopsy: For an incision biopsy a small section of abnormal next to normal skin is removed with a scalpel.
  2. excision biopsy: Anexcision biopsy refers to the complete removal with a scalpel of the suspicious spot and a margin of surrounding tissue.

Treatment

The doctors strive to deliver prompt and effective treatments that minimise scarring. Most skin cancers can be completely cured if detected early.

Your treatment you receive will depend on multiple factors:

  1. The type of skin cancer. The type of skin cancer varies. BCCs SCCs and melanomas need surgery to remove them.
  2. The size of the skin cancer. Skin cancers can spread out across a larger area of skin and may be grow deep to the skin.
  3. The location. A skin cancer on the body will require different treatment to one on the face scalp or neck that are sensitive aesthetic areas.
  4. Whether it has spread to other parts of the body. Some more advanced skin cancers may have spread to other parts of the body and will need a combination of different treatment methods.

There are also non-surgical treatment options, which the doctor will consider if appropriate. These include:

  • Curettage: The doctor removes the skin cancer by scraping it with a sharp instrument and burning the tissue to eliminate cancer cell remnants. This is often used to treat superficial cancers confined to the top layer of skin.
  • Cryotherapy: The doctor freezes the skin cancer with liquid nitrogen, killing the tumour cells.
  • Topical treatments: This involves the application of creams that stimulate the immune system and promote your own body to destroy the cancer naturally.

If your skin cancer is at an advanced stage or has spread to other organs, we will assist you with onward referral to undergo radiotherapy or chemotherapy. Don’t worry – if detected early, this is a highly unlikely outcome.

Treatment of skin cancer can be surgical or non surgical.


Non-Surgical Treatments

Cryotherapy or Cryosurgery


Cryotherapy refers to a freezing technique to remove sunspots and some superficial BCCs.

The doctor sprays liquid nitrogen onto a sunspot or skin cancer and a small area of skin around it.

The cold of the liquid nitrogen causes stinging sensation, which lasts a few minutes.

The liquid nitrogen freezes and kills the abnormal skin cells and creates an injury to the skin that is red or blisters. There may be some swelling as well. The blister will scab and healing will take 1-4 weeks.

The healed skin may look paler or whiter than the surrounding skin.

Cryotherapy is a procedure that may need to be repeated.

Curettage and Cautery


Curettage and cautery is used to treat some BCCs and squamous cell carcinoma in situ.

You will be given a local anaesthetic and the doctor will scoop out the cancer using an instrument called a curette. Afterwards a low-level heat (cautery) is applied to stop the bleeding and destroy any remaining cancer.  

The wound is covered with a dressing.

Healing occurs within a few weeks, leaving a small, flat, round, white scar.

Topical Therapy


Aldara cream (imiquimod)

Sunspots, superficial BCCs and squamous cell carcinoma in situ (Bowen disease) can be treated using a cream called, Aldara.

Aldara causes the body’s immune system to destroy the cancer cells. You apply the cream directly to the affected area once a day at night, usually five days a week for six weeks.

Aldara causes the skin to become red and inflamed . The treated area may become tender to touch, scabby and crusted.

Some people have a more serious reaction to Aldara but this is uncommon. Symptoms include pain or itching in the affected area, fever, achy joints, headache and a rash. If you experience any of these more serious side effects, stop using the cream and see your doctor immediately.

Efudix(5-fluorouracil)

Efudix cream is used to treat superficial BCCs, sunspots and, sometimes, squamous cell carcinoma in situ (Bowen disease). It works best on the face and scalp.

Efudix is used daily or twice a day for three to four weeks.

While using the cream, you will be more sensitive to the sun and will need to stay out of the sun.

The treated skin may become red, blister, peel and crack, and often feel uncomfortable.

These effects will usually settle within a few weeks after treatment has finished.

Picato gel (ingenol mebutate)

Picato is a new type of topical chemotherapy for sunspots.

It is a gel that you apply to the affected skin once a day for two or three days.

Reaction to the gel is immediate with the skin reddening, flaking or scaling, mild swelling, crusting or scabbing, and blisters. These side effects should disappear within a couple of weeks after treatment has finished.


Surgical Treatments

Many skin cancers will need to be removed surgically.

Excision and closure


Surgical excision involves numbing the area with local anaesthetic and cutting out the skin cancer with a surrounding area of normal looking skin (a margin) to ensure all the skin cancer has been removed.

Following excision the wound will be treated in one of the following ways.

  • Closed with sutures (direct closure)
  • Closure with a flap is where surrounding skin with a blood supply needed to be moved around to close the wound (flap repair)
  • Repair with a skin graft is where a piece of skin is taken form somewhere else on the body and placed on the wound so that it will pick up a blood supply and heal (full thickness or partial thickness skin graft)

Every piece of tissue removed is placed into a specimen container for analysis at a pathology laboratory.

It takes 2 to 3 days for a pathology result to return to the clinic.

Further treatment may not be required and the doctor will discuss scar management at the time of suture removal.

If further treatment is required (further surgery, radiotherapy or investigations) you doctor will discuss options with you.

Excision and delayed primary closure


Sometimes the margins of the skin cancer are microscopic and the first excision margin may not be wide or deep enough. Your doctor will then arrange for a delayed closure of your wound.

The excision of the skin cancer with a margin will be performed and the wound will be dressed.  The specimen is sent to the laboratory for testing and the dressing will stay on for that time.

When the pathology result returns to the doctor after 2 days you will return for a delayed closure of your wound or you may need more tissue to be removed and tested again until all the skin cancer is removed.

Mohs Surgery


In very few cases the edges of a skin cancer cannot be seen.  If removal of the skin cancer is incomplete then wider excision ore radiotherapy will be required.  Occasionally, Mohs surgery is a preferred. It is a procedure of sequential excisions around the skin cancer with immediate microscopic testing of the specimen to confirm that excision is complete.

Mohs surgery is exclusively performed by a dermatologis.  The dermatologist may be able to close the defect or will refer you on to a plastic surgeon for more complex reconstruction.

Excision and delayed primary closure is a similar procedure over a few days rather than over on whole day.

Re-excision (Wider excision)


You may need further surgery if your skin cancer is not completely removed.

Your doctor will discuss what type of surgery is needed and whether it can be performed as a local anesthetic procedure or under general anesthesia in hospital.


Further Treatments and Tertiary Referrals

Any skin cancer can spread beyond the original skin site.  Skin cancers usually spread to lymph nodes and rarely to other parts of the body. Depending on the type and stage of your particular skin cancer you may need referral for specialized treatment. Your doctor will discuss what options are open to you and refer you on if the need arises.

Fine needle aspiration


If your doctor can feel and enlarged lymph node then you may be referred for a fine needle aspiration test.

A fine needle aspiration (FNA) biopsy is performed with the help of an ultrasound or CT scan. Doctor uses a small fragment of the enlarged lymph node. This test rarely causes much discomfort and does not leave a scar.

Lymph node biopsy


In some cases a whole lymph node is removed for testing rather than only part of it. The lymph node biopsy may be a sentinel lymph node. Testing of the biopsied lymph node will determine if more surgery is required or another form of treatment is required.

Complex surgical reconstruction


When a skin cancer is fast growing or has been growing for a long time it may become too difficult or too dangerous to remove anywhere other than in a specialist cancer hospital.

Such hospitals have specialist departments such as Head and Neck units, Melanoma Units or Oncology units.

Radiotherapy


Often referral for radiotherapy for BCC and SCC is required. In these cases the skin cancer may be very large, or surgery may not be possible for numerous reasons including health reasons.

Radiation therapy can be used to cure small BCC or SCC and can delay the growth of more advanced cancers.

Radiation therapy can also be used after surgery (called adjuvant treatment) to kill small areas of remaining cancer cells that cannot be removed with surgery alone. Adjuvant radiotherapy aims to lower the risk of cancer coming back after surgery.

Radiotherapy is focused as an external beam from a machine onto the area to be treated. Occasionally a mask is made to protect surrounding areas of skin. The procedure is painless and lasts only a few minutes. It continues over 4 to 6 weeks. There are side effects of radiotherapy and these will be discussed with you prior to any treatment.


Other Services

Scar treatments


You will have a permanent scar after any cut to your skin. The scar is due to collagen formed by the body to heal the injury.

Every individual will scar differently and scars will heal differently on different areas of skin.

Scar appearance is due to a multitude of factors and is totally unpredictable.

When a scar thickens it is called a hypertrophic scar. These scars may be itchy or tender. There are numerous treatment options available.

Sometimes a scar becomes keloid and grows outside the original wound. Individuals may be prone to keloid scarring and others will just get a keloid.

Earlobe piercings commonly Keloid and can be successfully treated.

Each scar needs assessment and treatment varies from topical gels, pressure application, intra-lesional steroid injections or further surgery.

Split and Stretched Earlobes


Split earlobes occur when a piercing hole pulls through the earlobe splitting it into two.

This can occur with trauma or time due to wearing heavy earrings.

Surgery that creates a zig-zag pattern can repair a split earlobe.

Ears may be re-pierced at a later stage.

Stretched earlobes do not always return to normal after a stretcher piercing is removed. A stretched earlobe may have influence for some employment prospects or it may just have been phase in your life.

Surgery can be performed to restore the earlobe to its original shape.