Skin Cancer Clinic

The incidence of skin cancer is increasing the world over especially among persons of Caucasian origins. Sun exposure is an important factor. Fortunately, as they are on the surface, with some knowledge, one can nip them in the bud. However, since skin lesions are also very common, a cancerous one may exist but not be noticed for a long time. Here are some tips and pointers that will help you to suspect skin cancers and seek timely and early help. Remember that plastic surgeons are best equipped to diagnose and treat all types of skin cancers.

There are many types but the three commonest ones are Basal Cell Cancer (BCC), Squamous Cell Cancer (SCC) and Malignant Melanoma(MM). BCC is the commonest and MM is the rarest but also the most dangerous and usually look like common moles. Some skin cancers originate in the deeper part of skin such as dermatofibrosarcoma (DFS).

Some general points: Cancerous skin lesions tend to grow steadily and even rapidly, are usually painless, may develop a break in the surface (ulcer) and then may bleed on minor trauma. They may appear to heal but recur in the same spot again. Specific parameters for moles that point to malignancy are noted inside.

Basal Cell Carcinoma (BCC)
Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. Sometimes small blood vessels can be seen within the tumour. They may also just be flat patches. Crusting and bleeding frequently develops in the centre. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be eliminated, often with minimal scarring. As they burrow deeply they are called rodent ulcers.

Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped (keratoacanthomas). Ulceration and bleeding may occur often. When SCC is not treated, it may develop into a large mass. Squamous cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a MM.

Melanoma Malignum (MM)
Most melanomas look like moles of various colours from shades of brown to black. A minority are pink, red or fleshy in colour (amelanotic variant). Warning signs of malignant melanoma include change in the size, shape, colour or elevation of a mole. Since everyone has a few moles on the body (which are benign) it is important to separate the ‘suspicious’ ones from the common benign variety. Persons with more than 10 moles on their body are 10-12 time more at risk of developing malignant ones [Dysplastic Nevus Syndrome] Expert Task forces have suggested several suspicious features which can be remembered by the mnemonic “ABCDE”:
A is for asymmetry in the shape. If you draw a line through the mole the two sides do not match
B is for boarders; we are looking for notching, scalloping or irregularity in form.
C is for colour; variations in shade or frankly different colours in the same mole should make you suspicious. Even a colourless halo around a colour mole.
D is for diameter and any lesion exceeding 6 mm in diameter is potentially suspicious (more than the eraser on your pencil).
E is for evolving; any change in any of the ABCD traits or any new symptoms such as itching, bleeding, crusting or pain etc point to potential seriousness.

If any of these signs is noticed in a lesion, it should be referred to a dermatologist or Plastic Surgeon for further analysing (dermoscopy/biopsy) or excision.

What is a biopsy?

A sample of the lesion is removed under local anaesthesia and sent to the pathologist to be examined under microscope. Results take about 5 days to arrive. Based on the verdict, the entire lesion is removed with normal margins if found benign or with much wider margins if found malignant. In the latter case some sort of reconstruction may also be needed.
How does a plastic surgeon approach this? We plastic surgeons are able to combine the needs of cancer elimination with the desirable goal of doing this with the least scarring or deformity. We are also best equipped to re-build the lost tissues.

Dermascopy, Radiofrequency, laser, outpatient and day-case surgery under deep sedation and local anaesthetic are routinely available. If required, hospital and GA facilities are available throughout affiliate hospitals.

Plastic surgery principles of treating Benign and malignant skin tumours the aim of surgery for a benign lesion is to remove it (to prevent any recurrence) and to minimize the scar. The scars are minimized by either choosing a conservative technique such as laser ablation or superficial shaving and radiofrequency.

Or, if complete excision is required with wound repair the Incisions are placed along the Langer’s Line (Relaxed skin tension lines) so the scar is hidden in natural skin crease.

Plastic surgery principles in treating Malignant skin lesions the aim is to remove it with a wide margin so that any cell intrusions [invasion] are also removed. This produces a larger defect. It is better to get the removal done by a plastic surgeon (PS). By careful planning in reverse, a PS can do the removal without compromising the possibilities for the best reconstruction. If another surgeon has done the excision, we may already have lost some of the blood supply of potential adjacent flap tissues; or the cut lines may fall in bad scar directions. Plastic surgeons have a vast array of techniques to reconstruct the defects with surprisingly acceptable scar in many cases (see pictures).

Various kinds of repairing techniques include:

Elliptical closure


Z plasty

Limberg flap

Transposition & Rotation flaps

Island flaps