Skin Cancer Removal & Reconstruction

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My GP is concerned I have a skin cancer.  What should I do?

If your GP is concerned that you may have a skin cancer he/she will refer you for a surgical opinion.  Many skin cancers can be treated on the first visit to Mr Kenton-Smith under local anaesthetic.

How long does treatment take?

Mr Kenton-Smith will see you for a consultation.  If he thinks your skin cancer removal will be relatively straightforward, he will then take you through to the clinic’s operating theatre.  In theatre Mr Kenton-Smith will put local anaesthetic in the lesion.  This normally stings for a minute or so and then you should not feel any pain.  You will feel pressure as the skin cancer is removed and stitched up in two layers. The deep layer takes the tension away from the skin, which Mr Kenton-Smith believes leads to a finer scar.

What if my skin cancer is more complex?

Complex reconstructions (including skin grafts and flaps) are not usually performed at the initial visit.  A biopsy may be taken to confirm the diagnosis prior to skin cancer removal and reconstruction.  Mr Kenton-Smith can advise you of the best form of reconstruction for you and can also show you examples of the form of reconstruction proposed if requested.  Complex reconstruction of the nose, eyelids and ears, in particular, can significantly improve on traditional results.  Mr Kenton-Smith avoids skin grafts on the nose as a general rule in order to avoid the “patch” appearance that can occur.

Should I seek prior approval from my insurance company?

It is sensible to contact your insurance company at the time of referral to inform them that you have been referred to Mr Kenton-Smith’s care.  This means that skin cancer removal can be treated at the first consultation.  For more complex reconstructions a price guide will be given to you at the time of consultation.

What types of skin cancer are there?

1. Basal cell cancer
   Basal cell cancer is the commonest skin cancer to occur.  Fortunately this is also the least serious in that it almost never spreads.  Typically a basal cell cancer grows slightly, then ulcerates, then heals.  Each time it heals it gradually enlarges.  It is better to have basal cell cancers removed before they become too large, so that scaring can be minimised.
    
2. Squamous cell cancer
   Squamous cell cancer is the second commonest non-pigmented skin cancer.  This generally appears as a scaly growth which bleeds and enlarges.  Squamous cell cancers can spread, however this is extremely rare when they are caught early.  It is not advised to leave these unattended.
    
3. Melanoma
   Melanoma is generally the most serious form of skin cancer, as most people know.  A great deal of effort has been put in to making people aware of the significance of changing skin lesions so that melanoma is caught in the pre-malignant stage (melanoma in situ).  Melanoma can be cured.  As the lesion becomes thicker cure rates drop significantly.

Melanoma

What should I look for in a pigmented lesion/mole?

Signs that a mole may be changing towards melanoma towards melanoma include:

1. Asymmetry
2. Irregular borders
3. Colour variegation (three or more colours present within the lesion).
4. Diameter (melanomas are rare under 5 mm in diameter).

What should I do if I have a suspicious lesion/mole?

Mr Kenton-Smith will see you and advise you at a consultation.  If a mole or dark patch is suspicious it can normally be removed at the time of your first visit.  This can usually be performed under local anaesthetic.

What happens if the lesion/mole turns out to be melanoma?

The results from the excision biopsy (analysis) of the mole are normally available within one week.  At this time Mr Kenton-Smith will advise you of the result.  Further surgery to perform a wider local excision, where more tissue is taken, is generally required.  For melanoma in situ (pre-melanoma) a 5 mm margin around the whole of the excision biopsy is required.  For frank melanoma 1-2 cm is required around the whole of the lesion.  The second procedure significantly improves survival. 

What is sentinel node biopsy?

Sentinel node biopsy is a technique used to identify which lymph glands (lymph glands) your melanoma is most likely to spread to, if it were to spread.  This gives useful prognostic information.  At this stage it is not known whether there is a definite survival advantage with the technique.

How is sentinel node biopsy performed?

Sentinel node biopsy must be performed at the same time as wide local excision and cannot be performed at a later date.  A very low dose of radioactive dye is injected into the site of the excision biopsy and a scan taken to identify the suspicious nodes.  In theatre, under general anaesthetic, Mr Kenton-Smith will identify the relevant lymph node(s) which are suspicious and these will be removed.  They will be analysed carefully.  These nodes may be present in the neck, axilla (armpit) or groin.  90% of patients find that their sentinel node biopsy is negative.  This gives them a much better outlook.  For patients with a positive sentinel node, removal of the other glands in that region (lymph node dissection) will be required.

Where else can I seek support?

Our patients are gently and sentively cared for when they come to our practice, we understand how worried people are when they face the possibility of having Melanoma.  It is also nice to know there are other avenues of support to explore too.  We receommend:

The Melanoma Foundation.  Their Website is full of facts and information on Melanoma.  www.melanoma.org.nz

The Melanoma Foundation now has a free nurse led information service who can help clarify your understanding around Melanoma.

You can contact Lyn:

By email: nurse@melanoma.org.nz

Freephone: 0800 4 Melanoma (0800 463 526)

Via their website on the contact us form: www.melanoma.org.nz

If you would like more information on any of these surgical options, please telephone 03 355 6815 and talk to our receptionist.

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