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Skin Cancer Surgery

Skin cancer is a significant health concern in Australia, which has one of the highest rates of skin cancer in the world. Surgical intervention is often a critical component of skin cancer treatment, aimed at removing cancerous lesions and preventing their spread.
The primary cause of skin cancer is exposure to UV radiation, which damages the DNA in skin cells and leads to mutations. Other contributing factors include genetic predisposition, exposure to carcinogenic chemicals, chronic skin inflammation, and a weakened immune system.

Symptoms of skin cancer vary depending on the type and stage but commonly include:

  • A new growth or sore that doesn’t heal
  • Changes in an existing mole or lesion
  • A pearly or waxy bump (common in BCC)
  • A firm, red nodule or a scaly, crusted lesion (common in SCC)
  • A mole that changes in colour, size, shape, or texture (common in melanoma)
  • Itching, tenderness, or pain in a lesion

Several risk factors increase the likelihood of developing skin cancer, including:

  • Fair Skin: Less melanin in the skin provides less protection from UV radiation.
  • Excessive Sun Exposure: Spending a lot of time in the sun or using tanning beds.
  • History of Sunburns: Especially blistering sunburns in childhood or adolescence.
  • Living in Sunny or High-Altitude Climates: Higher UV radiation exposure.
  • Moles: Having many moles or atypical moles.
  • Family History: A family history of skin cancer increases risk.
  • Weakened Immune System: Conditions that weaken the immune system, such as HIV/AIDS or medications that suppress the immune system.
  • Exposure to Carcinogens: Such as radiation or certain chemicals.

Types of Skin Cancer

Skin cancer is broadly categorised into three main types: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Each type has distinct characteristics and treatment approaches.

BCC is the most common and least aggressive type of skin cancer. It arises from the basal cells in the epidermis and tends to grow slowly.

  • Causes: The primary cause of BCC is prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds. UV radiation damages the DNA in skin cells, leading to uncontrolled cell growth.
  • Symptoms: BCC often appears as a pearly or waxy bump, a flat, flesh-coloured or brown scar-like lesion, or a bleeding or scabbing sore that heals and then reopens.
  • Risk Factors: Risk factors for BCC include fair skin, excessive sun exposure, a history of sunburns, older age, and a family history of skin cancer.
  • Treatment Options: Treatment for BCC typically involves surgical removal. Techniques include excisional surgery, Mohs surgery (a precise method that removes cancer layer by layer), and curettage and electrodessication (scraping away cancer cells followed by cauterising the area). Other treatments may include topical medications, cryotherapy (freezing the cancer cells), and photodynamic therapy (using light to activate a drug that kills cancer cells).

SCC is the second most common type of skin cancer and can be more aggressive than BCC. It originates in the squamous cells of the epidermis and can spread to other parts of the body.

  • Causes: Like BCC, SCC is primarily caused by prolonged UV radiation exposure. Other factors include exposure to carcinogenic substances, chronic skin inflammation, and a compromised immune system.
  • Symptoms: SCC often appears as a firm, red nodule, a flat lesion with a scaly, crusted surface, or a sore that does not heal.
  • Risk Factors: Risk factors for SCC include fair skin, excessive sun exposure, history of sunburns, older age, a weakened immune system, and a history of precancerous skin lesions (actinic keratosis).
  • Treatment Options: Treatment for SCC usually involves surgical removal. Options include excisional surgery, Mohs surgery, and curettage and electrodessication. In cases where surgery is not feasible, radiation therapy, cryotherapy, or topical medications may be used. Advanced SCC may require more extensive surgery or systemic treatments such as chemotherapy.

Melanoma is the most dangerous type of skin cancer, originating in the melanocytes, the cells that produce pigment. It is known for its potential to spread to other parts of the body.

  • Causes: The main cause of melanoma is UV radiation exposure, which causes DNA damage in melanocytes. Genetic factors and certain inherited conditions also play a role.
  • Symptoms: Melanoma often appears as a new mole or an existing mole that changes in size, shape, or colour. Key signs include asymmetry, irregular borders, multiple colours, diameter larger than 6mm, and evolving appearance (ABCDEs of melanoma).
  • Risk Factors: Risk factors for melanoma include fair skin, excessive sun exposure, history of sunburns, numerous moles or atypical moles, family history of melanoma, and a weakened immune system.
  • Treatment Options: Treatment for melanoma depends on the stage and may include surgical removal (wide local excision), sentinel lymph node biopsy to check for spread, and, in advanced cases, lymph node dissection. Other treatments include immunotherapy, targeted therapy, chemotherapy, and radiation therapy. Early detection and surgical removal are critical for a favourable prognosis.

Treatment Options

Treatment options for skin cancer depend on the type, stage, and location of the cancer, as well as the patient’s overall health. The main treatment modalities include:

  • Excisional Surgery: Removal of the cancerous tissue along with a margin of healthy tissue. It is commonly used for BCC, SCC, and early-stage melanoma.
  • Mohs Surgery: A specialised surgical technique used primarily for BCC and SCC, especially in cosmetically sensitive areas like the face. It involves removing the cancer layer by layer and examining each layer under a microscope until no cancerous cells remain.
  • Curettage and Electrodessication: Scraping away the cancerous tissue with a curette and then using an electric needle to destroy any remaining cancer cells. This method is typically used for small BCC and SCC.
  • Wide Local Excision: Used for melanoma, this procedure involves removing the tumour along with a wider margin of normal tissue to ensure all cancer cells are removed.
  • Cryotherapy: Freezing cancer cells with liquid nitrogen. It is typically used for precancerous lesions like actinic keratosis and small, superficial skin cancers.
  • Topical Medications: Creams or gels that contain cancer-fighting drugs, such as imiquimod or 5-fluorouracil. These are used for superficial BCC and actinic keratosis.
  • Photodynamic Therapy (PDT): Involves applying a photosensitising agent to the skin, which is then activated by a specific type of light to destroy cancer cells. It is used for BCC and actinic keratosis.
  • Radiation Therapy: Uses high-energy rays to target and kill cancer cells. It is often used when surgery is not an option or as an adjunct to surgery.
  • Chemotherapy: Systemic or localised use of drugs to kill cancer cells. It is generally reserved for advanced skin cancers that have spread beyond the skin.
  • Immunotherapy: Uses the body’s immune system to fight cancer. Drugs such as pembrolizumab and nivolumab are used for advanced melanoma.
  • Targeted Therapy: Drugs that target specific genetic mutations in cancer cells. For melanoma, BRAF inhibitors (like vemurafenib) and MEK inhibitors (like trametinib) are used.

Conclusion

Skin cancer is a prevalent and serious health issue in Australia, necessitating awareness, early detection, and effective treatment. Understanding the different types of skin cancer, their causes, symptoms, risk factors, and treatment options is crucial for managing this disease.

Surgery remains a cornerstone of treatment, often complemented by various non-surgical modalities to achieve the best outcomes. With advancements in medical research and a proactive approach to skin health, the prognosis for skin cancer patients continues to improve.

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