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Skin cancer is a health problem that occurs when the cells in the skin grow abnormally and uncontrollably. When the cells multiple, they form cancerous lumps. People can get skin cancer on different areas of their body. The skin features two layers, the dermis and the epidermis. The subcutaneous tissue, which is a deeper layer of tissue, supports them.
- It is more common people with light skin tone to be affected by cancer
- Men between 15 and 39 are 55% more likely to experience melanoma than women
- Women over 49 have a higher probability of developing skin cancer
- One in 44 white women and one in 24 white men are likely to develop melanoma in their lifetime
When seeing the doctor the patient will have a full body skin examination. The first consultation at Centre for Surgery will not last more than 45 minutes. The doctor would want to find the patient’s medical history, as allergies, illnesses, medications and operations, in order to identify the skin cancer factors.
- Full body examination – the doctor will carefully look for moles and abnormal skin lesions
- Individual spots – in case the patient is concerned about certain spots the doctor will examine them
- Dermoscopy – the spots that may develop cancer will be examined under a dermoscope.
The treatment for this type of cancer depends on certain factors:
- The general health status of the patient
- The type of skin cancer they suffer from
- The size and position of the cancer and how deeply it grows into the skin and surrounding areas
- If the cancer affects other parts of the patient’s body
The first treatment option for skin cancer is to remove the affected skin and tissue. But according to the specific situation the doctor will discuss with the patient the treatment variants. Local anaesthesia can be used in case of small cancers, but large ones need to be done under local anaesthesia.
What surgery implies?
- Excision – The patient can have an excision, when the cancer area and the surrounding skin are removed. This procedure can reduce the squamous cell carcinoma (SCC) or the basal skin carcinoma (BCC). According to how deep the cancer is the doctor will decide the amount of healthy skin that has to be removed. In case of a small wound, there will be used stitches to close it, but for larger ones there are used skin grafts.
- Mohs surgery – This procedure implies the removal of the layers of the cancerous skin in different stages. The doctor will look at the removed layer under a microspore to make sure that the cancer has been removed. The procedure will be repeated until the left layer of skin is healthy. This procedure is used in case the cancer has come back, or if it is located in an area where it is difficult to reach, as the neck or head.
- Electrodessication and curettage – this procedure implies cutting the affected part of the skin away. The cancer cells left behind will be destroyed with an electric needle. During one appointment, this technique can be used for maximum three times.
In case of melanoma skin cancer, the treatment will be decided according to the same factors as for the non-melanoma cancer.
When it comes to melanoma, it is recommended to choose surgery as treatment. There are cases when the surgeon even suggests the patient to have a second operation to remove more skin around the affected area. The purpose of the wide local excision is to ensure that all the cancer cells are removed.
The doctor will decide if they will make a lymph node biopsy at the time of the surgery, because it is important to know from the beginning if the cancer has spread to the lymph nodes of the patient. In case the cancer cells affect the lymph nodes, then the patient will need to have a lymphadenectomy, in order to remove the nodes from the affected area, and the ones from the healthy surrounding area. This procedure is essential to prevent cancer to come back or spread.
How is skin biopsy carried out?
The dermatologist from the Centre for Surgery will perform the skin biopsy. Before the procedure is done, the patient will get an injection of local anaesthetic. The patient will not experience pain in the area where the skin will be removed, but they will stay awake during the operation. The doctor will take a sample of their skin by using one of the following techniques: excisional biopsy, incisional biopsy, punch biopsy o shave biopsy. The wound would be closed with stitches if the patient will have excisional, incisional or punch biopsy. In some cases, there are used dissolvable stitches.
How is the skin replaced after the cancer has been removed?
When the patient has the skin cancer removed, some of the surrounding healthy skin will also be removed. In case the area is too large and it cannot heal on its own, or by using stitches, it will be replaces with skin flap or skin graft.
- The skin flap is taken from an area located close to the place where the cancer has been removed. For a better healing the blood supply to the layer of skin is left intact. Stitches are used to keep it in place and a dressing is placed over it. Because the skin flap is taken from the same area, it will have a better cosmetic effect.
- The skin graft is taken from a different area than the one where the cancer appeared. Depending on the texture and colour of the patient’s skin, the area of skin may differ. Sutures and a dressing would be used to place the skin graft and to keep it in place. The area from which the skin is taken can be left to heal by itself, and a special dressing can be placed over, or it can be closed with stitches. There are times when the colour of the surrounding skin looks different in terms of colour.