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Getting to Know Skin Cancer

Some Helpful Skin Cancer Terminology:

Ultraviolet Light: 
Ultraviolet (UV) light refers to light emitted from the sun

Lesion
a region in an organ or tissue which has suffered damage through injury or disease, such as a wound,  ulcer, abscess, or tumour

Basal Cell Carcinoma (BCC)
The most common type of skin cancer

Squamous cell Carcinoma (SCC)

Second most common type of skin cancer

Malignant Melanoma (MM)

A skin cancer, dangerous and lethal if not attended to as early as possible

Excision: 
To remove a lesion from the skin

Local Anaesthetic

A drug injected directly to the site of a planned incision during an operation to relieve pain and create numbness

General anaesthesia: 
Drugs and/or gases used during an operation to relieve pain and alter consciousness

Haematoma:
Blood pooling beneath the skin

Keratoses:
Solar or actinic keratoses are rough, red or brown, scaly patches on the skin

Melanoma:
A malignant form of melanoma that can appear on any part of the body including areas that are not exposed to the sun

Moles: 
Clusters of heavily pigmented skin cells, either flat or raised above the skin surface

Squamous Cell Carcinoma: 
A type of skin cancer that frequently appears on the head, neck, hands and forearms

Skin Cancer

Skin cancer is the uncontrolled growth of abnormal skin cells. It is the most common of all cancers. South Africa has the third highest incidence of skin cancer in the world, after Australia & New Zealand. A large number of South Africans will develop a skin cancer of some kind during their lives.

Skin cancer usually occurs in people who have been exposed to too much ultraviolet (UV) light from the sun.

People in the higher risk category of developing skin cancer usually have

Some less common causes of skin cancer include:

Skin cancer needs to be treated promptly as it can be just as life threatening as any other cancer if left untreated. The danger of skin danger of skin cancer is that it can spread (metastasise) to other parts of the body if treatment is not undertaken

Types of Skin Cancer

There are three main types of skin cancer:

The first two are often called “non-melanoma skin cancer”.

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC) is by far the most common type of skin cancer. Fortunately, it’s also the least dangerous. Three-quarters of South Africans who have skin cancer have BCC. It tends to grow very slowly, and rarely spreads beyond its original site. However, if left untreated, it can grow deep beneath the skin and into the underlying tissue and bone, causing serious damage, particularly if it is located near the eye.

Squamous Cell Carcinoma

Squamous Cell Carcinoma (SCC) is faster growing than Basal Cell Carcinoma (BCC). Of those South Africans with skin cancer, about 2 in 10 have a SCC. It frequently appears on the head, neck, hands and forearms, which typically receive more sunlight. SCC is more dangerous than BCC because it can spread to other parts of the body if not treated promptly.

*SCC can become life threatening if left untreated.

SCC looks like a red scaly spot or lump and is usually thickened. It can bleed easily and may ulcerate. It is usually tender to the touch, though can also be painless.

Melanoma

Although melanoma is usually highly malignant, it occurs in only about 5 people out of 100 with skin cancer. Melanoma can usually be treated successfully if diagnosed early. If it’s not treated quickly, however, malignant melanoma may quickly spread throughout the body and is often deadly. Malignant melanoma can occur on any part of the body, including areas that have not been exposed to the sun. In women, it is more common in the arms and legs, and in men on the face, back and chest. About half of all cases of melanoma develop from moles.

The other half develop on previously normal skin

Other skin growths you should know about

Two other common types of skin growths are moles and keratoses.

Moles
are clusters of heavily pigmented skin cells, either flat or raised above the skin surface. While most pose no danger, some-particularly large moles present at birth, or those with mottled colours and poorly defined borders, may develop into malignant melanoma. Moles are frequently removed for cosmetic reasons, or because they’re constantly irritated by clothing or jewellery (which can sometimes cause pre-cancerous changes).

Solar or actinic keratoses
are rough, red or brown, scaly patches on the skin. They are usually found on areas exposed to the sun, and sometimes develop into squamous cell carcinoma.

10 warning signs of Skin Cancer (BCC & SCC)

  1. Small, white or pink nodules or bumps that are smooth and shiny, waxy, or pitted on the surface
  2. A red spot that is rough, dry, or scaly
  3. A firm, red lump that may form a crust
  4. A crusted group of nodules
  5. An open sore that does not heal and may bleed, ooze or crust, may persist for weeks, appear to heal and then come back, often painless
  6. A shiny bump or nodule that is pearly white or clear, pink or red
  7. A bump can also be  more tan, black or brown, especially in darker-skins and can be mistaken for a normal mole
  8. A small pink growth with a slightly raised, rolled edge and a crusted indentation in the centre that may develop tiny surface blood vessels over time
  9. A raised white patch with tiny red vessels
  10. A scar like area that is flat white, yellow or waxy in color

5 Warning signs of Malignant melanoma : look for ABCDE

Asymmetry – a growth with unmatched halves

Border irregularity – ragged or blurred edges

Colour – a mottled appearance, with shades of tan, brown, and black, sometimes mixed with red, white, or blue

Diameter – a growth more than 6 millimetres across (about the size of a pencil eraser), or any unusual increase in size

Evolving – a mole or birthmark changes in size, shape color

It is important that you get to know your skin and examine it regularly, from the top of your head to the soles of your feet, including your back. Ask your partner & friends/ family members for assistance here If you note any unusual changes on any part of your body, talk to your Specialist Plastic Surgeon/ Dermatologist for an examination.

Where will the surgery take place?

Depending upon the cancer and the extent of the procedure, surgery for the removal of skin cancer can be performed either as a day case or alternatively with a short hospital stay

What do I need before surgery?

Before undergoing surgery, it is important that you:

You may be advised to stop taking certain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) eg. Ibuprofen, aspirin, and medicines that contain aspirin. You may also be asked to stop taking naturopathic substances such as garlic, ginkgo, ginseng and St John’s Wort as they may affect clotting and anaesthesia. For full list see List of Medications to stop before operation
Always tell your surgeon EVERYTHING you are taking
You may be given medicines to take before the surgery, such as antibiotics.
Your surgeon will also advise you if any other tests are required, such as

Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach. Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.
Dr Chetty-B surgeon will give directions on how to take care of your specific wound.

Basically keep the wound area clean and dry. Refer to you Post-op Instruction sheet for further details.

What do I need after surgery?

Depending on the extent of the procedure, you may be able to go home the same day. With more complex cases, you may have to stay overnight in hospital or for a day or a few days.
In the case of minor procedures, you may experience some pain and mild discomfort. If a large skin cancer has been removed or a skin graft performed, discomfort and pain may be significant. Pain relief may be required for several days, your Dr Chetty-B will prescribe painkillers or sedatives as required.

Is it normal to experience bruising and swelling post-op?

This will usually settle down in the week after surgery. Elevating and appropriate use of ice-gel to the affected area will help reduce swelling.

If you experience any of the following symptoms, notify your surgeon’s office immediately:

Your will receive a specific Post-operative care instructions sheet

With this you will get instructions that may include:

Be sure to ask your surgeon specific questions about what you can expect during your individual recovery period, such as:

Scars are an inevitable part of any invasive surgery. Your Specialist Plastic Surgeon will endeavour to minimise scarring and to keep your scars as inconspicuous as possible.

Over exposure to sunlight in childhood and adolescence is a major factor in the development of skin cancer. In recent years, more young adults and even teenagers have been diagnosed with skin cancer related to over-exposure to the sun.

How could I reduce the risk of developing skin cancer?

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