Skin Cancer

Most skin cancers can be removed with simple excisions under local anaesthesia.

We locate the edges of the skin cancer using a dermatoscope then mark the excision lines with a margin of normal skin in between. 

The wounds are typically closed in 2 layers using deep dissolvable sutures and nylon sutures on the surface of the skin which are usually removed a week later. 

These techniques are used to obtain tissue samples of the lesion enabling an accurate diagnosis which guides our treatment. Most commonly these are done by punch or shave technique. These procedures are done under local anaesthesia. Punch biopsies are usually closed with a single suture and shave biopsies heal on their own without any suturing required. 

We also treat benign skin lesions such as cysts or fatty lumps known as lipomas.  These lesions usually require surgical excision which is done under local anaesthesia.

There are a number of different types of skin cysts. They can look unsightly, become irritated by clothing or develop infections on a recurrent basis which are possible indications for excision.

Lipomas are very common and typically seen on the trunk or limbs. They do have potential to grow to a large size and are best removed when smaller. 

This is a surgical technique used to ensure the skin cancer is completely excised before embarking on surgical repair of the defect.

It is used primarily on the face and for cancers in difficult anatomical areas that will require more complex reconstructive surgery.

Margin control surgery involves at least two appointments.  At the first surgery, the lesion is excised but the wound left open with a dressing sutured in place to keep the wound bed healthy. We then wait for pathological analysis of the specimen to ensure the cancer has been completely removed. If not completely gone, a  wider excision is performed. Once the pathologist can confirm complete removal the wound is closed with a skin flap or graft.

Margin control surgery is usually performed under local anaesthetic.

Mr Derek Goodisson offers specialist reconstructive skin surgery for difficult skin cancers that require extensive surgery, and the repair of large defects. Margin control techniques are utilised and surgery is often performed under general anaesthetic for the larger and more complex procedures.

The type of reconstructive technique required is individual to each person and will be agreed upon with you after a thorough consultation and assessment by Mr Goodisson.  Occasionally more than one surgery will be needed to achieve the optimum outcome.

If you have a scar that has healed in an unsatisfactory manner, Mr Goodisson may be able to revise the scar to improve the area.  This can be done through further surgery, steroid injections, dermabrasion (smoothing the scar tissue with a very fine burr) or simple measures such as massage, wearing steri-strips or ultrasound treatment with a physiotherapist.

Cryotherapy can be used as a treatment for solar keratoses (common sun damage spots) and certain types of superficial skin cancers.

Liquid nitrogen is applied to the lesion freezing the surface. This causes a “cold burn”. There is mild discomfort. It usually results in an inflamed area of skin or blister which heals after a couple of weeks.

Topical chemotherapy is used to treat the same sorts of lesions that we treat with cryotherapy, solar keratoses and certain types of superficial skin cancers. 

This therapy is particularly useful for areas of skin that have extensive solar damage. For instance we may treat the whole face, we term this field treatment. 

It can also be used to treat solitary lesions.

Vitamin B3 or Nicotinamide has been shown in randomized trials to be effective in protecting the skin against damage from the sun’s UV rays and reduce the rate of development of new pre-malignant actinic keratoses. A recent phase 3 randomised trial of Nicotinamide for skin cancer chemoprevention concluded that oral nicotinamide was safe and effective in reducing the rates of non-melanoma skin cancers and actinic keratoses in high risk patients.

Vitamin B3 has been shown to reverse the adverse effects of UV light, through enhancing the repair of DNA damage to the cells within the upper layer of skin. It can reduce fine lines, hyperpigmented brown spots and redness, all signs of sun damage to the skin.  Nicotinamide also appears to prevent suppression of the body’s natural immune system that may be contributed to by damage to the skin through sun exposure.

At Scott Clinic our patients are reporting an improvement in the appearance of their skin, decreased irritation and a reduction of redness, scaling & bleeding from actinic keratoses.

Vitamin B3 is available topically and as an oral supplement and both are available from the clinic.

The vast majority of skin cancers are caused by UV radiation from the sun and in particular sunburns which may have occurred in your younger years.

Those at higher risk:

• Pale skins – ginger/blond hair, blue eyes, skin which burns easily and tans poorly
• Multiple sunburns at younger age
• Sunbed use
• History of previous skin cancer
• Older age
• Family history of skin cancer in particular melanoma
• High numbers of irregular moles on your skin

The key to avoiding skin cancer is to reduce your UV radiation exposure and most importantly avoiding sunburn.

In New Zealand the highest period of risk is September through to April, between the hours of 10am – 4pm when UV levels are high. During winter being at high altitude or in the snow is also considered high risk.

Be sunsmart – slip, slop, slap and wrap

• Slip – into the shade
  Slip on some sun protective clothing, shirt with collar and long sleeves
• Slop – on sun block with sun protection factor (SPF) of at least 30
• Slap – a hat that protects your face, head, neck and ears
• Wrap – close fitting sunglasses.

If you are worried about a skin spot get it checked.

Also consider your risk, do you tick the box’s regarding risk factors for skin cancer (see above)?

Symptoms and signs that a skin spot could be cancerous are:

• persistent sore or ulcer
• bleeding
• weeping
• itch
• pain or tenderness
• change – shape, colour
• growing nodule – pigmented or pink
• skin spot that  just stands out as being different to your other skin spots around it – ‘ the ugly duckling’.