Skin Cancer

Skin Cancer


With thousands of new malignant skin tumours each year in New Zealand, there has never been a more important time to have your skin checked, particularly any changes you have noticed. Any new skin spot or change in an existing mole needs to be assessed. Moles with irregular borders, irregular colours, thickening or bleeding should be seen urgently.

The midst of Summer is usually when we think most about the dangers of developing skin cancer. While it is timely to remind ourselves of the danger of developing skin cancer from the accumulation of Ultraviolet radiation which often reaches extreme levels at this time of year, the danger of sun exposure is not only limited to Summer. Avoiding exposure is the best defense, and this usually means staying out of the sun between 11am and 4pm. The next level of protection is ‘covering-up’, with wide-brimmed hats, and loose fitting, long sleeve, tight-woven clothes or ‘rash-shirts’. Sunscreen containing Zinc or Titanium Dioxide, to provide broad spectrum UVA and UVB protection, should be applied generously and reapplied every 3 - 4 hours, regardless of instructions on the label.

The most common skin cancer types are Squamous Cell Carcinoma and Basal Cell Carcinoma. Potentially the more serious skin cancer is Melanoma which is responsible for around 270 deaths each year in New Zealand.

As with any medical condition, the best defense is early intervention. If you are at all concerned about a change in an existing mole or the appearance of a skin spot, please make an appointment to have it assessed, now! Do not put off having your skin checked.

Basal Cell Carcinoma

This is the most common type of skin cancer, and fortunately is the least likely to spread.

Again, these are usually in sun-exposed areas and more common in fair-skinned patients. They can occur during your 20’s but are more common later in life. Their appearance is quite variable, sometimes presenting as a pearly nodule, or a crusty ulcer, or even as a pale / wax thickening not unlike a scar. They do not grow very rapidly, and because of their slow nature, can often be left until they are quite large and therefore complex reconstruction is required.

Once the BCC is removed and the laboratory has confirmed an adequate safety margin, they are very unlikely to recur, however, the same sun-exposure that allowed one to grow will also effect other areas and a second BCC may grow elsewhere. Regular skin checks are important once a skin cancer has been diagnosed, and sun protection becomes even more

BCC Facts

  • 65 – 80% of all skin cancers
  • 85% in the head and neck region
  • Usually slow growing. Only rarely has an aggressive, invasive phase
  • Related to chronic sun exposure
  • Fair skin a risk factor
  • Surgery is treatment of choice
  • Recurrence risk is ~ 4.5%
Squamous Cell Carcinoma

This is a very common type of skin cancer, usually affecting sun-damaged fair skin.

Squamous Cell Carcinomas can be only a few millimeters across to tumours many centimeters in size, with either a slow growth pattern or very rapidly enlarging over a matter of weeks. They are often crusty, red and can be tender. SCC involving the lip can be very serious with spread to local lymph nodes, although the majority of SCC’s involving other skin sites are usually less aggressive with spread (metastasis) being quite uncommon. While very early SCC’s can trial non-surgical treatments, most will require surgical treatment. It is common for a patient with one skin cancer to develop others, usually because of a history of high sun exposure to all sun-exposed skin.

Surgery can range from being very minor, requiring only a few stitches, to more involved and complex reconstructions utilising skin grafts or movements of skin flaps. While the primary focus is on complete removal of the tumour, a reconstruction with the least cosmetic impact is always planned.

SCC FACTS

  • 20% of skin cancers
  • Male: Female 2:1
  • Sun exposed areas
  • 250% more common in organ transplant patients
  • Can be smoking related (appear on lips)
Melanoma Symptoms

This third most common type of skin cancer is also the most notorious due to its high risk and potential to affect both the young and the old. As the Bay of Plenty has one of the highest Melanoma risks in the world regular skin checks are essential.

Melanoma are potentially life-threatening, making early diagnosis and urgent surgical excision of the utmost importance. Since safe and correct removal will give the best chance of survival, it is important to have melanomas treated by skilled medical professionals who are able to perform the necessary wider excision and can proceed with further surgery if required - i.e lymph node clearance, which is done under General Anaesthetic in a Hospital, Fellowship-trained Specialist Surgeons (FRACS) and specifically trained Dermatologists. Investigations may include blood tests and CAT scans. Unfortunately, Chemotherapy, Radiotherapy and recent work in vaccine therapy have yet to show any advantage compared with thorough surgical removal.

Typical melanoma symptoms can be easily remembered using the ABC below:

Asymmetry – one half of the mole looks different from the other.

Border irregularities – the edge of the mole appears ragged.

Colour variegation – the mole has different colours or hues.

Diameter – this is typically larger than 6mm.

Enlargement or evolution – the colour, shape or appearance has changed.

It is essential to pick up the early melanoma symptoms developing in the skin as the only cure is early surgical removal.