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Beauty is eternity gazing at itself in a mirror. Kahlil Gibran

Skin Cancer

Types
Basal cell carcinoma
Basal cell carcinoma (BCC, rodent ulcer) is probably the commonest form of cancer. It is normally caused by significant exposure to the sun but there are a variety of other causes.

BCC’s can present in as many different types of skin lesions from small nodules, ulcers, pigmented areas to large red patches.

Squamous cell carcinoma
Squamous cell carcinoma (SCC) is the second commonest form of skin cancer. These cancers are usually caused by sun exposure but like BCCs there are a number of predisposing factors to their development.

SCCs can like BCCs present in a variety of ways but normally start as small red nodules which then develop into ulcers.

Malignant melanoma
Malignant melanoma is the rarest form of skin cancer but the most serious. Like the other skin cancers exposure to the sun is thought to play a role in its development but there are many other factors involved. The tumour can develop in patients who have had very little sun exposure.

Melanomas present, usually, as pigmented lesions but can look like red flashy lumps. They can develop in pre-exsisting pigmented lesions or arise de-novo. Changes in size, shape and colour are all indicators that a pigmented lesion is suspicious.

Treatment
Excision
The treatment of skin cancer at the present time is surgical. Depending on the type the skin cancer is usually excised with a margin of normal skin surrounding it. The size of this margin of normal skin depends again on the cancer type.

The vast majority of these procedures can take place under a local anaesthetic and the wounds are closed directly with either very fine nylon-type sutures or buried dissolving sutures. In cases where the defect is too large to close directly skin grafts or flaps of skin are used to close the wounds.

In all cases where there is a suspicion of skin cancer the tissue excised will be sent away for analysis.

Skin Grafts
Skin grafts are thin pieces of skin that are detached from the body transferred to a new position where they pick up a new blood supply.
There are two types of skin graft: split thickness grafts and full thickness grafts.

Each requires to be securely held in place by dressing for approximately 5-7 days to enable the graft to “take” (pick up its new blood supply). When the dressings are remove the graft often looks very red but then matures to leave a patch of skin which can look very similar to the surrounding skin.

The donor site of a split thickness graft takes 10-14 days to heal and leaves a red patch which then fades. The consistency of the skin in that area may be different from the normal skin. The donor site from a full thickness graft is closed by sutures and leaves a thin line.

Adverse effects

  • Bleeding
  • Graft loss (around 2-5%)
  • Scarring – thickened scars from the donor site
  • Infection.

Skin flaps
Skin flaps are pieces of skin with or without muscle that are moved to fill defects caused by excision of tumours. The flaps can come from an area local to the defect or more distant areas of the body.

The donor sites for these flaps can either be closed directly to leave a thoin line scar or sometimes need skin grafting.

Adverse effects

  • Bleeding
  • Infection
  • Donor site scars
  • Flap loss – rare.
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