Reconstructive Skin Surgery
Plastic surgery is a fascinating specialty - it addresses clinical problems from head to toe and has been a wellspring of surgical creativity and innovations for centuries. Its fundamental principles – wise planning of reconstruction, creative thinking and delicate operating – represent a rock upon which a plastic surgeon's mindset is set, a solid foundation upon which all other, additional subspecialist expertise is built on later.
Skin cancer is very common. It is the second most common cancer in young people (age 15-34), but the risk of developing the disease still increases with age. It is believed that 70% of people who are over 55 will develop some form of skin cancer in their lifetime.
The cancer develops when abnormality occurs in a regular repair and life cycles of skin cells. The growth of particular cell group may become uncontrollable, and collection of abnormal cells develops forming a tumour. Skin tumour can be non-cancerous (benign) and cancerous (malignant), with a spectrum of abnormalities known also as pre-cancerous sun damage.
Skin cancer may first appears as a change in a pre-existing mole or a patch of normal skin. It needs to be treated as it will not mend itself spontaneously.
This page provides only a very brief overview of the commonest skin cancers that I treat. More comprehensive infomation is provided under the specific cancer topics.
- Basal Cell Carcinoma (BCC) is far the commonest type and represents approximately 80% of all skin cancers. It grows very slowly, usually on areas of the body often exposed to the sun, but causes local problems only. Most people simply become aware of a discrete change which “never disappears properly and for good”. BCC appears as a red, pale or pearly in colour lesions and appear as a lump or dry, scaly patch. It often ulceras and fail to heal or dissapear completely. It is very unlikely for these type of cancers to spread (metastasize) to other parts of the body, but this has been described and is seen clinically very rarely
- Squamous Cell Carcinoma (SCC) is the second most common type and usually affect people over 50 years of age. Appearances vary, but in many cases surface of the lesion is crusty. SCCs are thickened, red scaly plaques that easily bleed, crust and ulcerate. Like BCC, they also grow slowly and on sun exposed areas of the body; but unlike BCCs, these cancers can metastasise and should, therefore be recognised early and treated more radically
- Malignant Melanoma is much more serious, more deadly form of skin cancer, but thankfully less common then BCCs or SCCs. Melanoma can spread to other parts of the body (metastasise) and it contrary to a common belief, it can appear on skin not normally exposed to the sun. Melanoma arises from melanocytes (pigment producing cells) in the skin, hence the name and often darker discoloration of these lesions (dark brown/black). Rarely (5%), melanoma can be without the pigment (so called amelanotic melanoma) and appear as a lighter (pink or red) lesion. Melanoma arises from the pre-existing moles in 30% of cases. Majority, however develop as a completely new lesion. Repeated bleeding from the lesion present for over 4-6 weeks is a particularly alarming sign and such lesions must be checked by an expert at the earliest convenience.
There are other 22 types of non-melanoma skin cancers, but they are very rare and each one is treated on its own merits pending exact clinical picture.
- ultra-violet radiation (UVR) from the sun or sunbeds (outdoor work, sports and hobbies) – UVR damages the genetic material (DNA) in skin cells and interferes with normal cell cycle
- prolonged exposure to some chemicals and irritants
- long standing ulcers, burns and unstable scar tissue
- genetic predisposition – people with fair skin, lots of moles or freckles, or with family history of skin cancer
- immunosuppresion – people with transplanted tissues
You may have some moles or dark patches on your skin that are flat or slightly raised. Usually these will remain harmless all your life. Those that change in size, shape or colour over weeks or months are likely to be of clinical relevance. Especially lesions which never disappear, but enlarge slowly.
Check your skin regularly for changes; this is especially important if you are fair skinned with lots of moles or freckles. Be advised by an expert if you notice a new growth or sore that will not heal, if it persistantly itches or hurts, have a mole or skin lesion that bleeds, crusts or scabs or have noticed a change in a pre-existing mole.
The ABCD rule can help you remember what to look out for. If you notice any of the following signs, you should seek advise:
Asymmetry – the two halves of a lesion may not look the same
Border – Edges of a lesion may be irregular, blurred or jagged
Colour – The colour of a lesion may be uneven, with more than one shade
Diameter – many melanomas are at least 6mm in diameter
Evolving – lesion changes over time
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me