Skin Cancer Treatments
1 in 2 Australians will have a skin cancer in their lifetime. Almost all skin cancers are curable if diagnosed early and treated appropriately. You are at increased risk if any of the following apply to you:
+ Over 40 yrs old
+ Previous skin cancer or sun spots
+ Previous sun burns or excess UV exposure
+ Family history of melanomas or other skin cancers
+ Multiple moles or fair skin
+ Changing or varied spots on your skin
We offer a complete assessment and treatment facility for skin cancer. Dr Morley has a diploma in skin cancer medicine and surgery and is accredited by The Skin Cancer College of Australasia. Uniquely Dr Morley combines this advanced training with his cosmetic training to ensure an aesthetically pleasing and medically safe result.
- Full skin checks
- Dermatoscopic mole analysis
- Both medical and surgical skin cancer treatment
- The latest treatment for advanced sun damage and actinic ketatoses called Photo Dynamic Therapy (PDT)
All procedures are performed on site, including surgical excisions and treating pre-cancerous sunspots.
The most dangerous form of skin cancer is malignant melanoma, and the incidence of melanoma in Australia is the highest in the world. Most skin cancers are linked to sun exposure. Your best defence against skin cancer is therefore sun protection and regular skin cancer checks – especially if you have fair skin, a family history of skin cancer, or a history of sun exposure. If diagnosed early, skin cancer can be easily treated.
WHAT TO LOOK FOR
Types of skin cancer include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Non-melanoma skin cancers (BCC and SCC) are more common and less dangerous than melanoma, and may present as an enlarging translucent or skin-coloured lump or ulcer, or red-coloured patch. Melanomas may arise from pre-existing moles or from normal skin, and can spread throughout the body if undetected and untreated.
The most important feature to look for is a change in what looks like a mole. This may be a change in size, shape, or colour, or perhaps itching or bleeding. Any of these features are a cause for concern. Unfortunately, some melanomas are difficult to detect. Some benign dark spots can be confused with melanoma, and some melanomas may appear to be quite harmless.
AcTINIC KERATOSIS (Sun Spots)
Actinic keratoses, also known as solar keratoses or sun-spots are pre-malignant skin lesions, meaning that although they aren't yet cancers, they have the potential to turn into cancers such as SCC.
Australia has the highest prevalence in the world, with most older people expected to develop the lesions at some stage. Usually patients are over the age of 40 before the lesions start to appear. Actinic keratosis is strongly associated with sun exposure (actinic means radiation-induced) and the face, scalp, backs of hands, arms and leg are the commonest sites. They usually start as a small pink patch, which can then develop a thin crust, which can be scaly or feel rough. The AK's can be difficult to see and might need to be diagnosed by touch. There is usually no pain but they may be sensitive to sunlight or if they are rubbed. These lesions can be solitary or numbered in the hundreds, depending on the skin type and the amount of previous sun exposure.
As most squamous cell carcinomas arise from AK's, anyone with multiple AK lesions should have regular follow ups, because they have a greater risk of skin cancer in general. AK's should be removed at an early stage rather than waiting to see if they become cancerous. It can be difficult to distinguish these lesions clinically from squamous cell carcinoma. Clues that AK's may have become cancerous are thickening, tenderness, bleeding or ulceration of the lesion. Where there is doubt, or if an SCC is suspected, a punch biopsy may be performed.
Actinic keratoses must be treated with sun avoidance, and either with cryotherapy (liquid nitrogen freezing), or by using creams such as Efudix, Solaraze or Aldara. We also offer the latest therapyfor this problem, ie PDT or Photo Dynamic Therapy.
BCC (basal cell carcinoma) is the most common form of skin cancer. It accounts for 50 to 70% of all skin cancers treated in Australia. The tumor starts from the basal cells of the skin, taking many months to develop.
Long-term sun exposure plays a crucial part in its development, with most BCC's occurring on areas such as the face, neck, trunk or limbs, although they can also occur on less exposed areas. Age is also an important factor, with 96% of BCC's occurring in those over 40 years old, though recently it has become more common in younger persons. It rarely ever metastasizes (spreads via the blood stream) to distant body sites, but it can still be a very serious cancer. It can grow down and damage structures in the tissues beneath it.
The commonest forms are superficial and nodular BCC's. Superficial BCC's look more like a flat scaly pink area. Nodular BCC's appear as small pale or pearly lumps, which are painless and may bleed or ulcerate . There are rarer forms such as micro-nodular and morpheic, which are much more serious, harder to diagnose and to treat. As with all forms of cancer, early detection and early treatment provide the best chance of a full cure. In most cases BCCs are cured, and excellent cosmetic results can be achieved.
Diagnosis of larger BCC's may be relatively straight-forward but early BCC's may be quite subtle and require a biopsy and subsequent histological diagnosis. Biopsies are frequently necessary, even in larger lesions, to accurately classify the type of BCC, so that the correct treatment is chosen. Usually treatment is by simple surgical excision. Other options include Aldara (topical cream) or PDT for superficial BCCs. Occasionally, Mohs surgery (a more complex procedure) or radiotherapy is used in more aggressive BCC types. After experiencing an initial basal cell cancer, the patient has a one in three chance of developing a second BCC within five years. Therefore once a BCC has occurred, follow up visits are necessary and important.
For prevention the most important thing is to protect your skin from the sun.
SCC (squamous cell carcinoma) is the second most common skin cancer, after BCC. It is twice as common in men compared to women. Rare under the age of 40, it becomes more common with advancing age.
SCC's arise from the squamous layer of the epidermis and are more serious than BCC's as they more easily invade the underlying tissues and may spread to lymph glands or distant organs. They tend not to be as dangerous as melanomas. Around 250 Australians die annually from SCC, but most of these patients are immunosuppressed. Aktinic keratosis is the pre-malignant form of SCC. If untreated, a small proportion of these lesions will transform into SCC's. People with large numbers of AK's are at a much greater risk of SCC, along with people with fair skin, smokers, outdoor workers, those with the HPV virus, those exposed to some chemical carcinogens, or with chronic scars or ulcers.
These cancers are mostly caused by ultraviolet radiation (UVA and UVB) from the sun therefore, they occur most commonly on the head and neck, scalp, lower lip, and upper portion of the ear. However, the back of the hands, the arms and legs are also often affected. SCC's usually grow over months; but can occasionally grow very rapidly over weeks. Early forms of these tumors may be flat and look a little like eczema. Usually they will then develop a raised, scaly lump that may bleed easily, crust or ulcerate. The appearances of SCC are more inflammatory and thickened than BCC and they tend to ulcerate sooner. There are a few different subtypes, including bowenoid solar keratosis, SCC in situ or Bowen's disease, keratoacanthoma and invasive SCC. Bowenoid solar keratosis and SCC in situ can be treated with either cryotherapy or excision. Keratoacanthoma is usually excised, though occasionally is observed, as they can spontaneously resolve.
Most SCC are treated with simple surgical excision. A squamous cell carcinoma can recur even when it has been carefully removed the first time, so it is crucial to pay particular attention to any previously treated site by attending to regular check-ups.
Melanoma is by far the most aggressive of the common skin cancers.
It is responsible for most skin cancer-related deaths. It is also the most common form of cancer diagnosed in younger people. Between the ages of 17 and 44 years it is the number one cancer killer. After the mid 40's, it is taken over by breast and prostate, lung and bowel cancer. It still remains the number four cancer killer, giving Australia and New Zealand the highest occurrence of melanoma in the world. Early detection is crucial and can result in complete cure of melanoma.
In Australia, one in fourteen males and one in twenty three females contract melanoma, yet a little less than 1 in 9 melanoma patients die from the disease, so we do cure the majority of melanomas. When the lesions are found early, the prognosis is favourable. When the disease is found late, the prognosis is not as good. For this reason, we recommend annual professional skin checks, along with monthly self skin examinations.
Melanoma usually presents as a brown or black lesion, though they can also be pink, red, skin coloured or even scar like. Around 30% of melanomas develop from benign pre-existing moles. Around 70% of melanomas grow without being pre-existing moles. It is possible to develop new non cancerous moles, both during childhood and as younger adults. New spots could be malignant and should be assessed. The signs to look out for that can indicate that a mole may be melanoma vary. It can be an area of skin that feels different, develops an itch, becomes painful, ulcerates or bleeds. It can also be a mole that has enlarged, become raised, darkened or even faded. Any moles that are not symmetrical, have an irregular border, have multiple colours (ranging from black, brown, blue, red, pink or grey) should be examined by a qualified practitioner. 4% of melanomas are amelanotic, meaning that they aren't brown or black. These may become nodular or raised. Nodular melanoma form only 8%-10% of melanoma, yet cause 45% of the deaths. Not being the classic pigmented lesions, they are often ignored and diagnosed late. Melanoma can be found on any area of the skin, not just skin which sees the sun. They can also rarely be found on mucous membranes, on the hands and soles of feet and in finger nails.