> Skin Cancer

 

Skin Cancer

 

 

 


Surgically removing cancerous and other skin lesions using specialized techniques to preserve your health and your appearance.


Skin cancers tend to occur on sun-exposed parts of the body and their incidence increases with age. There are three types of skin cancer that people need to be aware of.  These are basal cell cancer and squamous cell cancer; both of which are classified as non-melanoma skin cancer, and the third, which is known as melanoma.

 

 

Basal cell cancer
Basal cell cancer is usually found on the head and neck in the elderly , but can occur at other sites.

The patient will usually notice a spot, red patch or scaly crusted area.  It may itch or bleed.  As it grows very slowly and does not spread, basal cell cancer generally causes few problems. However, it does need to be treated, as the cancer can slowly get bigger and cause problems. Diagnosis is made by a small biopsy.

Excision surgery for basal cell cancer is a simple and safe procedure performed under local anaesthetic.  You will be treated on an outpatient basis, ie, treated and discharged all in the same day. Radiotherapy, creams and freezing techniques are also available, but by and large surgery is the preferred and most effective treatment option.


Squamous cell cancer
Squamous cell carcinomas are uncommon. and often present as a scaly patch or ulcer.  Caused by long-term exposure to the sun, squamous cell cancer is more serious.

Most patients will present with an early, small, thin lesion that can be cured by a simple local anaesthetic operation.Excision surgery is performed and if on the face, surgical grafts or flaps may be needed to fill the defect. Non-surgical options include topical chemotherapy, topical immune response modifiers, radiotherapy, and chemotherapy. The use of topical therapy, such as Imiquimod cream and PDT is generally limited to premalignant and in situ lesions.                           

Malignant melanoma
Melanoma is the type of skin cancer that arises in brown spots and is caused by short, intense bursts of exposure to the sun.
The main risk factors for developing melanoma include:

  • Sun exposure/Sunburn, particularly during childhood

  • Fair skin that burns easily

  • Previous melanoma/ non-melanoma skin cancer, such as basal cell or squamous cell cancer

  • Family history of melanoma, especially if two or more members are affected

  • Large numbers of moles (especially if there are more than 100)


How to spot melanoma
The most important symptom in melanoma is a history of significant change over a few months so you should keep an eye on your moles :

  • Change in shape or size

  • Change in color

  • Bleeding

  • Itching

  • Ulceration


Most thin melanomas require only a wide local excision. For thicker melanomas (more than 1 mm), a wider area of skin is cut out.  A skin graft or flap might be necessary, which replaces the removed skin with skin taken from another part of the body.  A sentinel node biopsy may also be carried out on the lymph glands in the area, and these glands may be removed depending on the result.

What surgery is available, and what techniques are involved?
In all three cases, excision surgery, whereby the cancer is removed, is the mainstay of treatment and by far the most definitive option.

What is the Longterm outcome ?
For basal cell cancer and squamous cell cancer, surgical and treatment success rates are high.  Patients with squamous cell cancer and melanoma will be kept under review for 2-5 years, with appointments at six-monthly intervals to check on your scars and lymph nodes. For patients with melanoma, 20% may experience further recurrence. Cure is by far the most likely outcome if the thickness of the tumour is less than 1mm at the time of diagnosis.

Genital Tract Surgery
Patients requiring reconstructive genital tract surgery will be seen by a multi-disciplinary team of a Plastic surgeon, and a Gynaecologist, and occasionally Oncologist, and Pathologist.

What conditions might affect a patient in this area?

  • Labiaplasty - A labiaplasty is a surgical procedure to reduce the size of the inner or outer lips of the vulva. Most patients find that the area is fully back to normal after six weeks.

  • Vaginal tightening

  • Hymenoplasty - The Hymen gets disrupted after the first intercourse or even after strenuous physical activity or use. Many woman would like to restore their hymen which represent their virginity. Simple Hymenoplasty involves piecing together the hymen remnant by closing the tear or using local flaps. Physical intimacy is advocated once healing has taken place in 3-4 weeks time.

  • Vaginoplasty - For Vaginal Stenosis or Vaginal Atresia

  • Vulval Reconstruction - For Vulval Cancer


Pressure Sores

What does this condition involve?
Pressure sores occur when skin overlying a bony prominence breaks down following contact with a surface, such as a mattress or a wheelchair seat for prolonged  periods of immobilization. Over prolonged periods of time pressure is generated by the interface between their body and the surface on which they are sitting or lying.  This pressure further reduces an already reduced blood-flow to the contact area, and over a protracted period the surrounding tissue dies and an ulcer results

Who is at risk for developing pressure sore?
1. Paraplegics/Quadriplegics
2. The sick and the elderly

Susceptible areas are the heels, buttocks, lateral hips, the back of the head, the lower back, and the shoulders.

What treatment is available?
Specialists include, a Reconstructive Plastic surgeon, a wound care nurse, and a Physiotherapist.

Nurses closely monitor patients for sores. Wheelchair users are often supplied with special cushions designed to alleviate some of the pressure that causes sores.

Initial treatment of pressure sores is with dressings. Managed in this way most pressure sores will eventually heal up although this can take many weeks or months. Sometimes surgery maybe required in grade 3 or 4 sores.
 



What should I expect in terms of treatment, procedure and outcome?
Most Grade 1 and 2 patients should expect to be healed by pressure relief and dressings. It is essential to keep the area moisture free. The posture must be changed frequently and patient must be kept on an alpha mattress.

Bigger Pressure sores are managed effectively by Wound Vac therapy wherein a continuous vacuum is created with the help of a mobile home use device which helps to not only drain out secretions but also helps in keeping wounds dry and infection free and promotes granulation tissue and early healing.

For carefully selected patients surgery is helpful.  You will be in hospital for at least 2 to 3 weeks after the operation.

Tissue Expansion
Tissue expansion is a procedure that enables the body to "grow" extra skin for use in reconstructing almost any part of the body.

A silicone balloon expander is inserted under the skin near the area to be repaired and then gradually filled with salt water over time, causing the skin to stretch and grow.


Who is a Candidate for Tissue expansion?
The procedure is used widely in breast reconstruction but  it is also an option for repairing or replacing areas of the scalp, large hairy Nevi, large post traumatic or post burn scars on the face chest and extremities.

Advantages and Disadvantages
1. Expansion offers a near-perfect match of color, texture, and hair-bearing qualities.

2. Because the skin remains connected to the donor area's blood and nerve supply, there is a smaller risk that it will die. In addition, scars are often less apparent.

Drawback of tssue expansion is that it can take as long as 2-4 months to grow additional skin. During this time, the expander creates an unsightly bulge which can be quite noticeable for someone requiring repair of the scalp or other areas of the body.  The procedure requires repeated visits to the surgeon for injection of the saline water that inflates the balloon. For some people, the inconvenience and obvious appearance of an expander are enough for them to consider other options.

Operative Steps
Tissue expansion is done in a major hospital or accredited centre under General Anaesthesia.

The First Surgery
In most cases, the initial operation will take one to two hours, depending on the size and area of skin to be expanded. Your surgeon will begin by making a small incision next to the area of skin to be repaired, and will do everything possible to make the incision as inconspicuous as possible.

He or she will then insert the silicone balloon expander in a pocket created beneath the skin. The expander includes a tiny tube and a self-sealing valve that allows the surgeon to gradually fill the expander with saline solution. The valve is usually left just beneath the surface of the skin.
 

Expander Injection
Once the incision has healed, (2 weeks or so) you'll be asked to return for expander injection with additional saline. As the expander enlarges, your skin will stretch. In some people, this procedure can causes minor discomfort.


The Second Surgery
When the skin has stretched enough to cover the affected area, you'll have a second operation to remove the expander and reposition the new tissue. More complex surgery to repair skin on the face or scalp may require more than one expansion sequence to complete.

Post Operative Period
You may feel some minor discomfort each time saline is injected into the expander for 1-2 hours. Most tissue expansion patients find they can keep up with their normal routine while the expander is in place. Following the second surgery, most patients are up and about within a week.

Generally, the results of tissue expansion are superior to other methods used to reconstruct or repair damaged skin. For most tissue expansion patients, the procedure dramatically improves their appearance and quality of life following surgery.