Reconstructive Surgery

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

For more information click here

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

For more information click here

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

For more information click here

What is it?

A benign tumour like scar reaction that has extended beyond the boundaries of the original scar.

What is the cause?

• genetic (dark skinned people have a higher risk)

What are the symptoms?

• itchy painful scar
• enlarging lump

What are the treatment options?

• Step 1: silicone sheet therapy (at least 23 hrs a day for 6 months); and pressure eg compressive earrings
• Step 2: steroid injections
• Step 3: surgery

When should I see a Surgeon?

• when you are considering steroid injections or surgery

For more information click here

What is it?

A benign subcutaneous fat cell tumour.

What is the cause?

• idiopathic
• genetic
  • some people experience numerous painful lipomas (Dercum’s disease).

What are the symptoms?

• mobile slowly enlarging subcutaneous lump
• most are painless
• can be painful

What are the treatment options?

• surgery

When should I see a Surgeon?

• when it concerns you enough to require surgery
• persistently painful rapidly growing and deeper subcutaneous lumps may be a sarcoma and need urgent surgical review

What is it?

Surgery to improve the contour, colour, or thickness of a scar.  Scar revision may also be necessary when a contracted scar is causing a functional problem eg incomplete finger extension.

What is the cause?

• genetic
  • some people have a tendency to form hypertrophic or keloid scars (see above). This often runs in the family.  Dark skinned people have a higher risk.
• age
  • younger skin often forms thicker and more reactive scars
• tension
  • scars in areas of tension will more commonly produce widened and hypertrophic scars
• complication
  • wounds that have become infected or have dehisced may form bad scars.

What are the treatment options?

• improve the colour
  • red – laser
  • hyperpigmented – laser
• improve the contour or width
  • surgery

When should I see a Surgeon?

• when a scar has had 6-12 months to mature and you are unhappy with the outcome

For more information click here

What is it?

A subcutaneous cyst that arises from epidermal cells trapped in deeper layers of the skin (epidermal inclusion cyst).  Commonly known as a “sebaceous cyst”.

What is the cause?

• primary – related to a hair follicle
• secondary – skin cells can become trapped in deeper layers after trauma eg a laceration

What are the symptoms?

• enlarging subcutaneous lump
• discharges cheesy white keratin
• commonly becomes infected

What are the treatment options?

• surgery
  • acute infection – abscess drainage
  • chronic stable cyst – formal excision

When should I see a Surgeon?

• if it is acutely infected
• if it bothers you enough to warrant surgery