Mr Adam Bialostocki
Cosmetic and Reconstructive Plastic Surgeon
MBChB FRACS (Plastics)

SKIN CANCER

Skin cancer is the most common cancer in New Zealand and this is a statistic which we need to improve. Ensuring an annual skin check is part of your health programme is imperative – it could save your life.

Each year there are thousands of new malignant skin tumours diagnosed, meaning there has never been a more important time to have your skin checked. Any new skin spot or change in an existing mole needs to be assessed immediately and we ensure times are made available for you to be seen. Moles with irregular borders, irregular colours, thickening or bleeding should be seen urgently. Avoiding over exposure to the sun is the best anti-ageing method available. The most common skin cancer types are Squamous Cell Carcinoma and Basal Cell Carcinoma. Potentially the more serious skin cancer is Melanoma which is responsible for over 450 deaths each year in New Zealand.

The midst of summer is usually when we think most about the dangers of developing skin cancer, however the New Zealand sun is strong all year round. As a sun seeking nation, many New Zealanders enjoy tropical getaways in our winter, resulting in some severe sunburns.

How can you protect your skin? 
Avoiding exposure is the best defence, and this usually means staying out of the sun between 11am and 3pm. Cover up with wide-brimmed hats, and loose fitting, long sleeve, tight-woven clothes or ‘rash-shirts’.

Apply sunscreen containing Zinc or Titanium Dioxide, to provide broad spectrum UVA and UVB protection, should be applied generously and reapplied every 3 - 4 hours, regardless of instructions on the label.

As with any medical condition, the best defence is early intervention. If you are at all concerned about a change in an existing mole or the appearance of a skin spot, please make an appointment to have it assessed, now! Do not put off having your skin checked. Enjoy the benefits of having a Plastic Surgeon involved, a specialist surgeon dedicated to achieving the best optimal aesthetic outcome should you need to have something removed.

Skin Cancer Reconstruction

Should you need to have a skin cancer or melanoma removed, reconstruction of the area may be required, depending on the extent of the cancer.

Once a skin cancer has been surgically removed, it is important to repair the hole immediately and skilfully to avoid unnecessary disfigurement. All surgery leaves scars, and these scars can take up to 12 months to fully mature. Factors that will influence the scarring include smoking and genetic make-up. Considerable training and skill are also required to plan and perform surgery in such a way that the inevitable scar is as inconspicuous as possible. The simplest repairs can involve a straight-line scar, but even these can be disfiguring if it is puckered, placed in the wrong direction or has train-track marks. More complex repairs involving a skin flap (moving local tissues to fill the hole ) or skin grafts (borrowing skin from another part of your body and placing it into the hole) are best left to Specialist Surgeons with qualifications in Reconstructive techniques. Please visit the website for the New Zealand Association of Plastic Surgeons at www.plasticsurgery.org.nz for further information.

How much Skin Cancer is out there? The facts!
(Facts from SkinCancer.org.nz)
> 80% of all new cancers diagnosed in NZ per year
> Over 90% of all skin cancers are attributed to excessive sun exposure
> 67,000 non-melanoma cases per year
> 2200 melanoma cases per year
> 60 New Zealanders a day told they have some form of skin cancer
> Severe burns in childhood double your risk of developing skin cancer

Melanoma

This is the most well-known of the serious skin cancers, and New Zealand has one of the highest rates of Melanoma in the world.

Melanoma are potentially life-threatening, making early diagnosis and urgent surgical excision of the utmost importance. Since safe and correct removal will give the best chance of survival, it is important to have melanomas treated by Fellowship-trained Specialist Surgeons (FRACS) who are able to perform the necessary wider excision and can proceed with further surgery if required - i.e Sentinel node biopsy or lymph node clearance, which is done under General Anaesthetic in a Hospital. Investigations may include blood tests and CAT/PET scans. Unfortunately, Melanomas are not particularly well suited to being treated by Radiotherapy, but recent advances in Immunotherapy medicines have shown great promise.

Melanomas are removed surgically. The extent of surgery depends on the thickness of the tumour which is determined after the initial biopsy. After the treatment, regular follow-ups are arranged. These checks are important to detect any further problems from the Melanoma and to detect any new Melanoma early.

Melanoma in NZ
Intermittent pattern of sun exposure more closely related to Melanoma cf. farmers, outdoor workers etc
Sun beds associated with 4 x increase in Melanoma risk

Melanoma affects the young
Amongst 25 – 44 yr olds
The leading cancer among males
Second leading cancer in females

For people under 25
Third most common cancer in females
Fourth most common in males

Melanoma in males
Higher incidence
Thicker tumours
Poorer outcomes: 90% higher death rate in 2007
Especially in > 59 yr olds

Melanoma ethnic differences 
27 cases in Maori in 2007
7 deaths – rates are increasing
6 cases in Pacific Islanders in 2006
2 deaths
Usually detected later at a more advanced stage

Risk factors
Caucasian, red hair, i.e. Fitzpatrick skin types 1 and 2
Severe sun burn, 80% < 18yrs old
Previous Melanoma ^ risk 200%
Wealthier, more educated (more leisure time)
Pre-existing naevi
1st degree relative – 10% 

Squamous Cell Carcinoma (SCC)

This is a very common type of skin cancer, usually affecting sun-damaged fair skin. Squamous Cell Carcinomas can be only a few millimeters across to tumours many centimeters in size, with either a slow growth pattern or very rapidly enlarging over a matter of weeks. They are often crusty, red and can be tender. SCC involving the lip can be very serious with spread to local lymph nodes, although the majority of SCC’s involving other skin sites are usually less aggressive with spread (metastasis) being quite uncommon. While very early SCC’s can trial non-surgical treatments, most will require surgical treatment. It is common for a patient with one skin cancer to develop others, usually because of a history of high sun exposure to all sun-exposed skin.

Surgery can range from being very minor, requiring only a few stitches, to more involved and complex reconstructions utilising skin grafts or movements of skin flaps. While the primary focus is on complete removal of the tumour, a reconstruction with the least cosmetic impact is always planned.

SCC facts
> 20% of skin cancers
> Male: Female 2:1
> Sun exposed areas
> 250% more common in organ transplant patients
> Can be smoking related (appear on lips) 

Basal Cell Carcinoma (BCC)

This is the most common type of skin cancer, and fortunately is the least likely to spread.

Again, these are usually in sun-exposed areas and more common in fair-skinned patients. They can occur during your 20’s but are more common later in life. Their appearance is quite variable, sometimes presenting as a pearly nodule, or a crusty ulcer, or even as a pale / waxy thickening not unlike a scar. They do not grow very rapidly, and because of their slow nature, can often be left until they are quite large and therefore complex reconstruction is required.

Once the BCC is removed and the laboratory has confirmed an adequate safety margin, they are very unlikely to recur, however, the same sun-exposure that allowed one to grow will also effect other areas and a second BCC may grow elsewhere. Regular skin checks are important once a skin cancer has been diagnosed, and sun protection becomes even more important.

BCC facts
> 65 – 80% of all skin cancers
> 85% in the head and neck region
> Usually slow growing. Only rarely has an aggressive, invasive phase
> Related to chronic sun exposure
> Fair skin a risk factor
> Surgery is treatment of choice
> Recurrence risk is ~ 4.5%