Services Overview

Treatments

There is no single method to treat all skin cancers and precancerous lesions. Choice of method is dictated by the size of the lesion, its location, its type (often confirmed by biopsy), and whether it is a primary or recurrent lesion. Also considered is the patient’s age, health, occupation and preference for treatment method.

• Surgery – lowest recurrence rate, best long term cosmetic result
• Cryotherapy – good for small lesions, pre-maligant or sun spots
• Non-surgical treatments – PDT, Aldara, Efudex
• Radiotherapy – low efficacy
• Chemotherapy – low efficacy
• Palliative care

Digital diagnostic computers including Molescans, Solarscans etc. are computers that indicate if the structure of a lesion is similar to a known cancerous structure. These computers need doctors to use them and interpret their recommendations.

Because of the atypical nature of skin cancers the machines have less than a perfect efficacy rating.

• Biopsy

  What is biopsy?

  Early detection of skin cancer is critical if it is to be properly treated.

  If you have a suspicious or unusual mole or growth your doctor may want to obtain a sample of the skin for diagnosis, this procedure is called a biopsy.

  A biopsy helps your doctor tell the difference between a benign, non-cancerous growth and a skin cancer.

  Performing a biopsy can help your doctor to be sure about the correct diagnosis of the growth, mark or lump on your skin.\

  The biopsy procedure is performed in the doctor’s office and usually no preparation is required on your part.

  What is the process?

  Before the biopsy is performed you will be given a small injection of local anaesthetic to numb the area. This may sting briefly, but the anaesthetic usually takes effect very quickly, and the rest of the procedure is painless.

  Depending on the type and size of the mole or growth, one of the following forms of skin biopsy may be performed:

  Excisional Biopsy: The entire mole or growth is removed in this procedure (excised), along with a small surrounding margin of normal skin. This method is usually performed when a mole or growth could possibly be a melanoma.

  Shave Biopsy: A shave biopsy is usually performed when the lesion is thought to affect the top layer of the skin only or if the lesion is very large. A slice of skin is taken from the affected area using a scalpel or biopsy cutter. Stitches are usually not required for this procedure. However, a small scab will form, which will heal within a week or so.

  Punch Biopsy: A punch biopsy is used to diagnose many less serious skin cancers.

  This is a quick, convenient procedure, which generally produces only a small wound. Punch biopsies provide a sample of cells from the full thickness of the skin.

  An instrument called a punch biopsy cutter is used in the procedure. This is a straw-like instrument with a sharp end, which works like a cookie-cutter.

  The punch biopsy cutter is pushed through the skin and twisted, producing a cylindrical sample of skin, which is then cut from its base with scissors or a scalpel.

  Band-aids, steri-strips or stitches may be used to close the incision. Stitches are generally not required for punch biopsies unless bleeding is slow to stop or the biopsy has to be large.

  Incisional Biopsy: If you have a larger mole or growth your doctor may perform an elliptical incisional biopsy.

  The end sample yielded by this procedure is bigger than that of a punch biopsy.

  The doctor will use a scalpel to cut an elliptical sample from the area. Stitches may be required with this procedure and a fine-line scar may remain.

  Any band-aids or steri-strips can be removed after a day or so and the wound should then be cleaned with antiseptic.

  Once it has been cleaned, the wound can be left open to form a crust, which usually falls off in a few days to a week.

  If you experience any delayed bleeding, or your work requires heavy or dirty duties, you should keep the wound covered.

  If stitches were used to close the incision, you will be asked to make an appointment with your doctor about a week after your biopsy for them to be removed.

  What happens to the sample?

  The biopsy sample is sent to a laboratory where a Pathologist examines it under a microscope.

  The pathologist will determine whether the mole or growth is benign (harmless) or malignant (a skin cancer). The result will take about a week to get back to your doctor.

  So what happens next?

  There are three possibilities: the biopsy may show something which requires no treatment at all; the biopsy may show something which is not a skin cancer but which needs to be treated (often a sun-spot, which needs to be frozen); or the biopsy may show a skin cancer, which always needs to be treated.

  Your doctor will discuss the treatment options with you.

  If the biopsy shows a skin cancer, the treatment recommended by your doctor will depend on the type and stage of the cancer, the size and place of the growth and also your medical history and general health status. In the majority of cases, the treatment will be to remove or destroy the cancer entirely.

  You and your doctor can work together to tailor a treatment plan that suits your needs best.

• Cryotherapy

  What is cryotherapy?

  Cryotherapy is a method that uses extremely cold liquid, liquid nitrogen, which has a temperature of -196°C, to freeze and destroy skin cells that need removal. It is usually used to remove a variety of pre-cancerous lesions, such as sunspots (actinic keratoses), and some early, superficial skin cancers.

  Lesions suspected of being melanoma must not be treated with cryotherapy.

  Melanoma must be removed surgically.

  The goal of cryotherapy is to freeze the skin as quickly as possible, and then allow it to slowly thaw in order to destroy the affected skin cells. New healthy skin cells will then grow in their place.

  How is it performed?

  A special cryospray unit is used to spray liquid nitrogen on to the skin to destroy the area of skin involved.

  Cryotherapy does sting and may be slightly painful at the time of the procedure and for a short time afterwards. The amount of discomfort varies a great deal from person to person. The procedure does not require anaesthesia, as freezing itself has considerable local anaesthetic effect.

  What happens after the procedure?

  After the procedure there may be some redness and swelling, and the area may also blister. Once this blister stage is over, usually within a few days, a crust will form which will fall off in a week or so.

  Activities such as swimming or bathing should be avoided for at least 3 days but gentle showering is allowed and the area should be kept clean to avoid any possible infection.

  Infection is, however, rare. Some sores or scabs may persist for as long as a month or two in lesions frozen on the lower leg, as healing at this site is often quite slow.

  What can I expect in the end?

  Well-performed cryotherapy for sunspots usually produces no significant mark on the skin in most people. However, some people are very sensitive to cryotherapy, and they may be left with a pale discolouration of the skin. Deeper cryotherapy for skin cancers is likely to produce a pale scar, which will last lifelong.

  In most cases the lesion will be removed with the initial procedure. However, in some cases, a second, or even third, treatment may be necessary if the whole lesion has not cleared, especially if it was large or thick to begin with, or if it has recurred.

  Skin lesions which survive two or three treatments with cryotherapy usually need to be biopsied, to ensure that they are not skin cancers.