Head and Neck Surgery
Skin Cancer of Head or Neck
Skin cancer is the most common type of tumour in Australia and it is increasing in incidence. Skin cancer is the uncontrollable growth of neoplastic cells and in some cases, if not treated, will spread or metastasise.
Common types of skin cancers are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Malignant Melanoma (MM). BCC is the most common and least aggressive and MM is less common but very aggressive.
Some of the causes of skin cancer are: sun exposure, sunlamps, sunbeds, solarium, Arsenic, radiation therapy, burns, ulcers, immunosuppression, albinism, syndromic eggs. (Xeroderma pigmentosum, Nevoid BCC syndrome).
The following groups have the least melanin and are at greatest risk for developing BCCs:
- fair complexion
- light hair
- blue/green eyes
- inability to tan
- history of multiple or severe sunburns
- Celtic ancestry
- Lifetime risks of skin cancer
- Males : 33-39%
- Females: 23-28%
Diagnosis of Skin Cancer
The diagnosis can be made by your doctor if the clinical feature is typical, or by a punch or incisional biopsy. For suspected melanomas an excisional biopsy is usually performed and, depending on the type and depth, further wider margin surgery may be required.
Prevention of Skin Cancer
- Sun protection - wear a broad-brimmed hat, UV-protective sunglasses, long sleeved shirt and pants
- Use sunscreen (SPF >30) and apply before swimming or exercise and repeat every 2-3 hours. Stay under shade.
- Monitor suspicious spots or moles. Check for spots or moles that are new, grow rapidly, itch, bleed or change colour.
- See your doctor if you have any ulcers that do not heal.
Early non-melanotic skin cancer (BCC and SCC) and precancerous lesions such as Solar Keratosis can be treated by the following:
- Cryotherapy (Liquid Nitrogen) -Easy but a biopsy is not taken. Effective for solar keratosis and small superficial BCC and SCC in situ.
- Curettage with diathermy -The tumour is scraped and the defect is cauterised. This usually leaves a small contracted white scar.
- Laser ablation - for superficial cancers.
- Radiotherapy -For patients who are unfit for surgery or have skin cancers in critical areas.
- Chemotherapy - Topical Cream (Efudex, Aldara, Interferon, Solaraze) - usually needs to be applied daily for a few weeks.
- Photodynamic Therapy -A drug is used that is uptaken by cancer cells, which is then activated by light (phototherapy). The activated drug then kills the cancer cells. This is still not widely used.
Surgical treatment is most commonly used by surgeons and predominantly for invasive cancer. The extent of surgery depends on the type of cancer, size, site, depth and spread (metastasis).
- Excision -Elliptical / simple, full thickness, wedge. The defect is then closed by re-suturing the edges together.
- Skin graft -split or full thickness - if the defect cannot be closed and local flap is not the best option.
- Skin flap -The defect is repaired by moving tissue nearly (local flap) or from another region (regional flap). This is commonly very effective in the face.
- Free flap -For large defect where local flap or skin graft is not available or inadequate.
Simple cases can be treated under local anaesthesia and more complex cases are performed under sedation or general anaesthetic.
Dr Pham will discuss with you the best treatment option for your skin cancer.
Preoperative (Before Surgery) Instructions
- Please cease Aspirin, Aspirin-containing products, Plavix and non-steroidal anti-inflammatories (such as Ibuprofen) for 10 days prior to and two weeks following your surgery. If you are on any medications that affect bleeding (such as Warfarin) please notify Dr Pham.
- Smoking tobacco and alcohol increase anaesthetic and surgical risks. Please cease them for three to four weeks prior to and four weeks following surgery. They cause delayed wound healing, skin necrosis and other complications.
- Please notify us of all your routine medications and significant health history. You can remain on your daily medications, except for blood thinners unless instructed otherwise.
- Arnica, a natural herb that significantly decreases bruising, can be taken before and after surgery along with Vitamin C (ascorbic acid), which helps promote healing.
- For general anaesthetic -if you are having a morning procedure you must not eat or drink after midnight the evening before. If you are having an afternoon procedure you must not eat or drink after 6.00am on the morning of surgery. You may, however, take your normal medications and brush your teeth.
- Please shower and remove any make-up and nail polish before arriving for your procedure.
- Unless you are remaining in hospital someone will need to drive you home after surgery and stay with you that evening.
- If you have any concerns please call the office (08) 9380 4488. Remember, we are all here to give you the best possible care.