Plastic surgeons are usually asked to treat skin cancers in cosmetically sensitive areas. The primary aim is to achieve complete clearance of the tumour whilst minimising the functional and cosmetic sequelae. Often direct closure is achievable, but sometimes a reconstructive procedure such as a skin graft or local flap is required. Removed specimens are sent for histological analysis to confirm the diagnosis and completeness or excision.
A large number of pre-cancerous lesions and superficial skin cancers can be treated effectively by ablative lasers.
There are three main types of skin cancer:
1. Basal Cell Carcinoma (BCC)
A BCC is the most common type of skin cancer in the UK. It is sometimes also called a ‘rodent ulcer’. It is very rare for BCCs to spread to other parts of the body.
What causes it?
BCCs are commonly caused by too much exposure to ultraviolet (UV) light from the sun or from sun beds. BCCs can occur anywhere on your body, but are most common on areas that are exposed to the sun, such as your face, head, neck, ears, back and arms. They can also occur at sites where burns, scars or ulcers have damaged the skin.
Who is at risk of developing basal cell carcinoma?
BCCs mainly affect fair skinned adults and are more common in men than women. Those with the highest risk of developing a basal cell carcinoma are:
Those who have had a lot of exposure to the sun, such as people with outdoor hobbies, outdoor workers, and people who have lived in sunny climates.
People with fair skin, freckles and blonde or red hair.
People who have used sun beds.
People who have previously had a BCC.
Incidence increases with age.
Can basal cell carcinomas run in families?
Apart from a rare condition called Gorlin’s syndrome, BCCs are not hereditary. However, some of the things that increase the risk of getting one (e.g. a fair skin, a tendency to burn rather than tan, and freckling) do run in families.
How do basal cell carcinomas present?
Most BCCs are painless. You may notice a scab that bleeds occasionally and does not heal completely over a period of several months. Some BCCs are very superficial and look like a scaly red flat mark, others show a white pearly rim surrounding a central crater. If left for years, the latter type can “gnaw away” at the skin, eventually causing an ulcer – hence the name “rodent ulcer”. Other BCCs are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels (telangectasia).
How will my basal cell carcinoma be diagnosed?
Most BCCs have a typical appearance and a qualified dermatologist or plastic surgeon will usually have a good idea if a lesion is a BCC. However there are other skin conditions that are not cancerous which may have a similar appearance so the only way to make a firm diagnosis is to perform a biopsy. This may be an incisional biopsy (where only a small part of the lesion is removed), or an excision biopsy (where the whole lesion is removed). Where possible the whole lesion is removed, but sometimes an incisional biopsy is performed if complete removal would result in a significant defect requiring a skin graft or a flap. In the vast majority of cases, biopsy is carried out under local anaesthetic.
What is the outcome of having a BCC treated?
Removal of a BCC results in cure in the the vast majority of patients. In a small number of patients BCCs can recur in the same place or the patient may develop another BCC elsewhere (If you have one BCC, you have a higher risk of developing another one compared to someone who has never had one). Occasionally it may not be possible to cure some BCCs that have been neglected of long periods of time and other treatments such as radiotherapy may be required.
How are basal cell carcinomas treated?
Most BCCs are removed surgically. Usually, this means cutting away the BCC, along with some clear skin around it (3-4mm), under a local anaesthetic. Sometimes, a small skin graft or local flap is needed. Plastic surgeons are well placed to excise BCCs in cosmetically sensitive areas such as the face, ears, nose and trunk.
2. Squamous Cell Carcinoma (SCC)