Skin Cancer

Basal cell carcinoma (BCC)

What is it?

A basal cell carcinoma arises from the basal cells in the basal layer of the epidermis.  They are the most common type of skin cancer (80%).  They recur locally but do not spread to lymph nodes or the blood stream.

What is the cause?

  • chronic sun exposure

What are the symptoms?

  • pearly lump with telangiectasia
  • usually painless

What are the treatment options?

  • superficial BCC – Aldara cream (imiquimod)
  • BCC – surgery
    • if LOW RISK of local recurrence (eg nodular) – narrower margin
    • if HIGH RISK of local recurrence (eg morpheic, micronodular, infiltrative, basisquamous) – wider margin

When should I see a Surgeon?

  • when my GP or Dermatologist is unable to excise the lesion
  • in a cosmetically important area
  • when surgery will require reconstruction with a flap or a graft

Squamous cell carcinoma (SCC)

What is it?

A squamous cell carcinoma arises from the squamous cells in the epidermis.  They are the second most common type of skin cancer (15-20%).  They can spread to the lymph nodes and bloodstream but are usually slow growing and slow to spread.

What is the cause?

  • chronic sun exposure

What are the symptoms?

  • scabby keratotic plaque or lump
  • often painful and bleeds easily

What are the treatment options?

  • SCC in situ – Efudix cream (fluorouracil)
  • SCC – surgery
    • if LOW RISK of local recurrence (eg well differentiated) – narrower margin
    • if HIGH RISK of local recurrence (eg poorly differentiated) – wider margin
      • occasionally SCCs will require radiotherapy after surgery

When should I see a Surgeon?

  • when my GP or Dermatologist is unable to excise the lesion
  • in a cosmetically important area
  • when surgery will require reconstruction with a flap or a graft
  • when there is concern about spread to the lymph nodes

Melanoma

What is it?

A melanoma arises from melanocytes in the basal layer of the epidermis.  They are less common than BCCs or SCCs (1-2% of skin cancer), but Australia has the highest rates of melanoma in the world.  Their behaviour is aggressive and unpredictable, and they spread to lymph nodes and the bloodstream.

What is the cause?

  • short periods of high intensity sun exposure eg blistering sun burns

What are the symptoms?

  • a pigmented lesion that changes rapidly
    • A asymmetry
    • B border irregularity
    • C colour variation
    • D diameter > 6 mm
    • E evolving
  • some melanomas can be skin coloured (amelanotic)

What are the treatment options?

  • melanoma in situ
    • surgery (5 mm margin)
  • melanoma
    • THIN (< 1 mm thick) – 10 mm margin
    • INTERMEDIATE (1-4 mm thick) – 10-20 mm margin
    • THICK (> 4 mm thick) – 20 mm margin
  • Sentinel lymph node biopsy (SLNBx)
    • all intermediate and thick melanomas should be considered for SLNBx
    • some thin melanomas may require SLNBx as well

When should I see a Surgeon?

  • when my GP or Dermatologist is unable to excise the lesion
  • in a cosmetically important area
  • when surgery will require reconstruction with a flap or a graft
  • when a sentinel lymph node biopsy may be required