Skin cancer

Australia has one of the highest rates of skin cancer in the world. Two in three Australians are diagnosed with some form of skin cancer by the age of 70. Most are treatable when found early; the danger comes from lesions that are ignored, or from lesions that are destroyed without ever being examined.

If you are worried about a spot, have it looked at. Not next season - now. That is the whole message of this page.

The three main types

Basal cell carcinoma (BCC)

The most common skin cancer and the least dangerous. Grows slowly and rarely spreads elsewhere in the body, but will keep enlarging locally and can destroy surrounding tissue if left - which matters a great deal on the face, near the eye, nose or ear. Often appears as a pearly or shiny lump, a flat scaly patch, or a sore that bleeds, scabs and never quite heals.

Squamous cell carcinoma (SCC)

Less common than BCC and more serious - SCC can spread to lymph nodes if neglected. Often a thickened, scaly, red or crusted spot that may be tender. Frequently arises on skin already showing solar keratoses.

Melanoma

Much less common than the other two, and responsible for most skin cancer deaths, because it can spread early. It can arise in an existing mole or on previously normal skin. Melanoma found early and removed while thin has a very different outlook from melanoma found late - which is why any changing pigmented lesion is a reason to be seen promptly.

Warning signs

For pigmented lesions, the ABCDE guide:

• Asymmetry - one half unlike the other
• Border - irregular, notched or blurred
• Colour - more than one colour, or uneven colour
• Diameter - larger than about 6mm, or growing
• Evolving - changing in size, shape, colour or sensation

Also worth acting on:

• A spot that looks different from all your other spots (the "ugly duckling")
• A sore that does not heal within a month
• Any lesion that bleeds, itches, crusts or is tender
• A new pigmented lesion appearing in adulthood
• A lump that is growing

Melanoma also occurs where the sun does not reach - under nails, on the soles of the feet, on the scalp. Any changing spot in those places warrants review.

Who is at higher risk

• Fair skin, light eyes, red or fair hair, skin that burns rather than tans
• A history of sunburn, particularly blistering sunburn in childhood
• Solarium use
• Many moles, or unusual-looking moles
• A personal or family history of skin cancer or melanoma
• Outdoor work or recreation
• Immunosuppression, including after an organ transplant
• Increasing age - though melanoma also affects young adults

Having darker skin lowers risk but does not remove it, and skin cancer in darker skin is more often found late.

How a suspicious lesion is handled here

The principle governing everything on this site: a lesion that may be a skin cancer is not lasered, frozen or burned off.

Those methods destroy the tissue. If the lesion was a cancer, there is nothing left for a pathologist to examine, no way to confirm what it was, no way to know whether it was completely removed, and no record in your file that it ever existed. If it recurs years later, that missing information matters.

Instead, a lesion of concern is:

1. Examined clinically, with dermoscopy where appropriate
2. Biopsied or excised whole, with an appropriate margin
3. Sent to pathology for diagnosis and assessment of margins
4. Reviewed with you, with a plan based on the result - which may include further excision, referral, or ongoing surveillance

Where excision would leave a defect that needs reconstruction - common on the nose, eyelid, lip and ear - that is planned as part of the procedure rather than dealt with afterwards.

What we do and do not do

Me Clinic is a cosmetic medicine and surgery practice. We assess lesions, remove and send them for pathology, and perform reconstruction after removal. Dr Tim French (MED0001790529) has clinical experience in skin cancer medicine alongside his phlebology practice, and our Specialist Plastic Surgeons perform reconstruction after skin cancer removal.

We are not a substitute for a dedicated skin cancer clinic or a dermatologist, and we do not have a dermatologist on the team. If your situation calls for specialist dermatology, oncology or ongoing whole-body surveillance, you should be referred, and we will say so. A second opinion is always reasonable.

Medicare

Skin cancer assessment, removal and reconstruction are medical procedures and generally attract Medicare rebates where clinically indicated - unlike the cosmetic procedures elsewhere on this site. MBS item 45060 covers removal of a skin cancer with flap or graft repair, among other items that may apply.

Me Clinic is not a no-gap provider, so an out-of-pocket cost will usually apply. You are given the item numbers and the expected gap before you proceed. If cost is a barrier, a GP or a public hospital pathway is a legitimate route and we would rather you take it than delay.

Risks of removal

• Scarring - permanent with excision
• Infection
• Bleeding and bruising
• Wound separation or delayed healing
• Numbness or altered sensation at the site
• Damage to nearby structures, or distortion of a nearby feature
• Incomplete excision requiring a second procedure
• Recurrence
• Graft or flap failure where reconstruction is needed

See risks and complications.

Prevention and early detection

• Broad-spectrum SPF 30 or higher daily, hat, sunglasses, long sleeves, shade
• No solariums
• Check your own skin regularly, including areas you cannot easily see - ask someone to check your back and scalp
• Photograph moles you are watching, so change is obvious
• Have a professional skin check at an interval appropriate to your risk

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Related: skin cancer and mole removal, solar keratosis, sun damage, mole removal.

This page is general information and is not a diagnosis. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.