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’.

When having a procedure to remove a skin lesion we recommend patients follow these instructions to help your skin heal effectively and without complication.

•Please leave the dry dressing in place for 24 hours after your surgery. Once you have removed the dry dressing you can bathe or shower as normal, ensuring that you gently dab your suture line(s) dry (do not allow the area to remain wet).

•Apply Chlorsig ointment to the suture line (s) as prescribed.

•You do not need to cover your suture line (s) unless they are in an area of friction such as on your chest or neck or you are working in a potentially dirty environment.

•Antibiotics - You may have been prescribed a course of antibiotics to take following the surgery. Please stop taking the medication if you feel you are having a bad reaction to it and call us.

•Pain relief – you may have some discomfort after the anaesthetic wears off. Paracetamol, taken as per the recommended dosage generally works well.

It is normal for the area to be a little reddened immediately after surgery and you may experience some bruising, especially if your surgery is around your eye. The sutures may also feel quite tight. If you do have any problems, particularly with bleeding, significant pain or signs of infection such as redness, swelling or an offensive discharge please contact Mr Goodisson directly.

•Continue to apply the Chlorsig ointment for another week or as directed.

•You may have steri-strips placed on the suture line to support the skin while it continues to heal. Please purchase these from your local pharmacy and please apply daily for two weeks. Once the suture line is well healed, please start twice daily gentle circular massage with your fingertips. Continue for at least four weeks to help your scar to heal in a nice flat and even manner.

•Please note your wound may feel tender and/or tight for a number of weeks after your surgery. You may even still have some areas of numbness which can last a while. This is normal but if you have any signs of infection as above, please contact the clinic.

The sample of skin or lesion that was removed will be sent to the laboratory for testing. This can take up to two weeks but once we have the results either the Surgeon or the Nurse will be in contact with you. If you have not heard anything about your results three weeks after your surgery please contact the rooms and we will follow up on this for you.

You will be advised of the date and time of this appointment at the end of your surgery.

If you have had stage one of a staged procedure to safely remove a skin lesion please follow the following instructions to help you manage the wound between the surgeries:

• You currently have an open wound in your skin. There is a special dressing stitched in place to keep the wound healthy. Do not worry about this falling out, it will not happen.

• You will very likely experience some bleeding from the wound as the anaesthetic wears off – please apply direct pressure to the wound with the gauze that you will have been given. You will need to sit quietly and apply the pressure for 15-20minutes. If the bleeding will not stop, please phone Scott Clinic for advice or if after normal operating hours phone Derek Goodisson directly on 0272343472.

• It is important you keep your wound as dry as possible. Please try to shower without getting the wound completely wet – if you do, take the top dressing off and allow the wound to dry.

• The dressing on top of your wound can be changed if it gets bloodied, wet or dirty and it is not mandatory to keep a dressing on there if you do not want to.

• You may have been given a tube of ointment to put on the wound. If so, please apply the ointment directly onto the dressing that is stitched into place. You only need a small amount and please apply with a clean cotton bud or piece of gauze.

• The wound may look a bit crusty which is completely normal. Please avoid the temptation to pick at it.

If you have any questions about your wound, please phone the clinic on 06 974 8150 and ask to speak with one of the nurses.

This is where the tissue has been placed. Leave this dressing on until you return and it is very important to keep this dressing dry at all times.

This is where the tissue has been taken from. Please leave this dressing on for 48hrs after your surgery. Once you have removed the dressing you can shower as normal, ensuring that you gently dab your suture line dry (do not allow the area to remain wet).

- You do not need to cover your suture line unless it is in an area which rubs on clothing or you are working in a potentially dirty environment.

-If you do have any problems, particularly with bleeding, significant pain or signs of infection such as redness, swelling or an offensive discharge please contact Scott Clinic.

• Recent studies have shown that the addition of vitamin D to efudix cream in the treatment of sun damaged skin has some significant advantages.

• Our Skin Cancer specialists can prescribe this course of treatment for you if deemed suitable.

• On the face and scalp a short course of efudix/vitamin D can be used to achieve a better clearance rate of actinic keratoses than 4 weeks of efudix on its own. Studies also suggest that the risk of developing squamous cell carcinoma (scc) for at least the next 3 years is reduced. The combination course is better tolerated and patients are a lot happier.

• It is all to do with the immune system. The addition of vitamin D enhances the immune system attack on the sun damaged cells. The good news is that this effect induces a long-lasting skin immunity making the development of new scc’s less likely.

• We recommend you apply the cream twice daily until an inflammatory response is induced. Duration of treatment will be longer on the limbs. Treatment will work better if any dry overlying scaly skin is removed prior.

• If you are going to be treating large areas, it’s good to start with a test area first e.g. the nose, to gauge your skins reactivity. If the reaction is mild/moderate you can go on to treat a larger area.

• Face and limbs cannot be treated at the same time. We will advise you as to size of the treatment area.

• Apply the cream with your fingers but make sure you wash them afterwards.

• You should expect to see the skin go red. This may be associated with a burning sensation and potentially some scaling and itching.

• For most patients the redness gets worse after you stop the cream and peaks around day 11. You may get some peeling of skin then.

• A small number of people can be very sensitive to the cream and react very quickly, especially on the face. If you develop a marked reaction after 2 applications of the cream you should stop it and contact us.

not to be used in pregnancy

If you have any concerns while on treatment you can contact Dr Peterson on 0274435864