Skin & Skin Cancer Info

 

What is cancer?

Cancer is not one disease. It is a group of different diseases where there is abnormal cell growth. These abnormal cells have the potential to invade or spread to other parts of the body.

Because there are many different types of cells in the body, there are many different types of cancer which all have different types of behaviour. Some can be very aggressive, while others are so slow growing that they never really cause any harm.  Each type of cancer should be considered its own disease with its own behaviour and risk.

Normal cells can develop into cancer cells by accumulation of mutations, which may be caused by certain infections, the environment or inherited.  Multiple mutations can lead to more and more abnormal cell growth (dysplasia) and can lead to cancer in situ, where the cancer cells are present but have not invaded the nearby tissues. With further mutations, these cancers then can invade into nearby tissues and even into the blood stream and spread to far off places in the the body (metastasis).

 

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What is skin cancer?

Skin cancer is cancer of the cells of the skin. The most common agent leading to the mutations in the cells is exposure to ultraviolet radiation from the sun. Skin cancers account for around 80% of all newly diagnosed cancers in Australia.

 

 

The three common types of skin cancer are (1) basal cell carcinoma, (2) squamous cell carcinoma and (3) melanoma. Basal cell and squamous cell carcinomas are also know as non-melanoma skin cancers or keratinocytic skin cancers as basal cells and squamous cells both start from a cell type called a keratinocyte. Melanomas come from a type of cell call a melanocyte. As these cancers come from different cell types, they have different behaviours.

Basal cell carcinoma (BCC)

  • Tend to appear as a  slow growing pearly nodule that may ulcerate

  • Account for 70% of non-melanoma / keratinocyte cancers

  • Can appear anywhere on the body but most commonly occur on the parts of the body that receive high or frequent intermittent sun exposure (head, face, neck, shoulders, back)

  • Tend to invade locally (i.e. the tissues next to the tumour) rather than spread to other parts of the body and is very rarely a threat to life

 
Squamous Cell Carcinoma (SCC)

  • Tend to appear as enlarging scaly or crusted lumps

  • Typically arise in precursor lesions called actinic or solar keratosis

  • Accounts for 30% of non-melanoma/ keratinocyte cancers

  • Typically appear where the skin has had the most exposure to the sun (head, neck, hands, forearms and lower legs)

  • Most SCCs are cured by treatment but have the risk of spreading elsewhere in the body; more likely if >2cm or in particular high risk locations

  • About 50% of people with one SCC develop another one within 5 years of the first

 
Melanoma

  • Typically starts as a funny looking mole or freckle

  • Melanoma is the 3rd most common cancer in Australia (excluding the keratinocyte cancers as these are not usually captured in cancer data)

  • It is a potentially serious and life-threatening cancer, fortunately, most melanomas are detected at the in-situ stage which are cured by cutting them out

  • 70% of melanomas start in normal appearing skin; 30% start in  a pre-existing mole

  • They can occur anywhere on the body, not just the high sun exposed areas

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Early treatment of skin cancer usually cures it. Most treatments involve minor surgery with local anaesthetic to numb the skin and can usually be performed at the clinic by Dr Holly. Other non-surgical treatments are available for some superficial skin cancers

Types of skin cancer surgery

 

  • Biopsy - removal of a sample of skin for diagnosis; there are different ways to take a sample including punch, shave or excision and the choice depends on the type and location of the lesion
    Excision - simple means "cut out"; you can have an 
    excision biopsy which is a type of biopsy where the whole lesion is removed (commonly done for suspicious moles) or you can have a wide local excision which is the definitive cut out of a lesion plus a margin of normal skin with the aim of cure (commonly done after cancer has been confirmed with a biopsy).

  • Flap - a type of wound closure where skin adjacent to the wound is moved to cover a defect caused by an excision; used when the wound is not able to be closed by simply suturing the edges together

  • Graft - a type of wound closure where skin is cut out from another part of the body with spare skin and used to cover the defect caused by an excision; results in two wounds, one at the site of the excision and one at the site of the donor skin.

Risk and complications of skin cancer surgeries include but are not limited to pain, bleeding, infection, scarring, nerve damage, need for further surgeries and allergic reactions.

Non-surgical skin cancer treatment

  • Cryotherapy - a minimally invasive treatment which uses very cold liquids or implements to freeze the surface of the skin; Dr Holly uses liquid nitrogen which is the most common method of cryotherapy

  • Flurouracil (5-FU/ Efudix) - a prescription cream that is toxic to living cells, especially certain cancer or precancerous cells; used to destroy sun-damaged skin cells, actinic keratoses, and certain surface skin cancers; causes significant redness and scabbing during treatment but typically improves the skin appearance after treatment and can reduce skin cancer risk

  • Imiquimod (Aldara™) - another prescription cream that works by stimulating the immune system to causing inflammation which destroy the lesion; used to destroy actinic keratoses, certain surface skin cancers and also genital warts

 

Smoking is harmful to the skin. Tobacco smoke consists of thousands of substances that damage the skin, and nicotine itself is harmful. It causes premature skin aging, delayed wound healing and increased infections.
More information on smoking and its effects on the skin

 

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Quitting smoking will have huge benefits for your health but it is very hard. Nicotine replacement is a way to aid with quitting but is often not used correctly. If used properly nicotine replacement therapy can be use to manage your smoking and reduce risk of smoking with little effort and hopefully put you on an easier road to quitting.
More information on nicotine replacement for smoking management and harm minimisation