Skin surveillance and biopsies

Who is at Risk of Developing Skin Cancer?

Skin cancer can occur in anyone, but there are some factors that can increase your risk of developing skin cancer. Skin cancer often occurs in people who are exposed to a high level of ultraviolet light. This comes from the sun, especially during the middle of the day, or artificial sources such as tanning beds or sunlamps.

Individuals with a higher risk of developing skin cancer include:

People with fair skin and who freckle easily.
Individuals with light-coloured hair and eyes.
People with a lot of moles, especially those that are abnormally shaped.
Those with a family history of skin cancer or long history of blistering sunburn.
People who work outdoors or spend a lot of time in the sun (particularly Squamous Cell Carcinomas).
People who spend a lot of time in intense sunlight, like those who live closer to the equator or at high altitudes.
Exposure to strong x-rays, radioactive substances (radium) or other chemicals such as coal tar, creosote or arsenic
People with recurrent episodes of sun burn (particularly Basal Cell Carcinomas).

Skin is the Largest Organ in your Body- Take Care of It.

If you, your GP or your Dermatologist feel that you have a concerning skin lesion, we can check it and the rest of your skin to help detect and manage skin cancers early. We offer same day biopsy procedures if necessary and will discuss the options with you as to how best to manage the lesion. Where possible, we advocate for non-surgical management, including the use of medications or ointments to manage your skin lesions. We may take clinical photographs of the lesion for future comparison if we just need to keep an eye on the spot. If surgical excision is necessary, we will work with you to determine the best pathway to ensure a timely diagnosis and management. We will then continue to monitor your skin, as necessary, until a regular preventative regimen is established with your local doctor or skin check specialist.

Do I need a Punch biopsy or an Excisional biopsy?

Punch biopsies involve taking a small, full-thickness sample of skin with a biopsy instrument that removes a short cylinder, or “apple core,” of tissue. After a local anaesthetic is administered, the instrument is rotated on the surface of the skin until it makes a small core, containing all the layers, including the dermis, epidermis, and the most superficial parts of the subcutis (fat).

When the entire tumour is removed, the procedure is called an excisional biopsy. When possible, excisional biopsy is the preferred method when melanoma is suspected so that the characterstics of the entire lesion can be used to determine what additional treatment (including skin margin and other diagnostic tests) is necessary.

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Curing Melanoma with Surgery

A wide local excision of a melanoma will minimise recurrence and will assist with determining the need for additional surgery and ongoing management.

Recovery and Rehabilitation

After surgery you may have stitches until the wound heals. One to three weeks is an average healing time, however if the wound is larger or you had a skin graft it may take longer to heal.

After your wound heals you may have a scar, which should fade with time.

You may experience some pain around the site of the wound after surgery and your surgeon may recommend some over-the-counter medication or prescribe you some pain medication.

You will receive post-operative instructions outlining when you can get back to normal activities and how to care for the wound.

We can then offer advice on scar management to minimise the visibility of your scar.

More information

What else you should know

The Difference Between Melanoma and Other Skin Cancers

The most common skin cancers are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). These are called non-melanoma skin cancers and are not usually dark in colour (not pigmented). BCC’s tend to grow locally, they may be subtle and often appear as areas of small pearl-like bumps (pearling) with extra blood vessels (telangiectasia). They almost never spread elsewhere.

SCC’s are the next most common type of skin cancer and can grow locally, but also have a risk of spreading (metastasising) to other areas. The site, size and various characteristics of the tumour will help to predict the risk of it spreading elsewhere.

Melanoma is less common but can be problematic because it tends to spread earlier than most non-melanomatous skin cancers.

In most cases (95%) melanomas are shades of brown. In 30% of cases they begin in previously ‘normal’ moles and in 70% of cases they begin as new moles.

Identifying and treating melanomas early is vital as they can be life threatening. Once the nature of your lesion is known, we will outline whether your risk of spread is low, intermediate or high and recommend appropriate tests and follow up measure to ensure timely management. We will also facilitate review by a multidisciplinary Melanoma Unit (a co-ordinated group of Melanoma Specialists) if necessary to help guide further care.

How do I care for myself at home?

After returning home from surgery you should follow the post-operative instructions provided by the Reconstructive Plastic Surgery Melbourne team.

Remember, everyone recovers differently, but you can follow these general steps to optimise your healing.

Medicine

Always speak with your surgeon to find out when you can recommence taking your existing medication and before starting any new medicine they have prescribed.
Always consult your surgeon before taking new medication, even if it’s over-the-counter.
Always follow the instructions provided with the medication.

Activity

When you have stitches, always check with your surgeon before returning to your normal activities.
After a skin graft, any exercise that stretches the skin should be avoided for at least three weeks.

Caring for your wound

Your wound will have a dressing covering it to help it heal and protect it from outside elements. If you had a skin graft you may need to change your bandages. Your post-operative instructions will outline how to care for your wound.
If you have stitches, your surgeon will let you know when or if you have to return to have them removed.
Wash the area daily with warm, soapy water and pat it dry. Ensure you don’t use any alcohol or hydrogen peroxide which can slow down the healing process.
After 24 to 48 hours you may shower, try to keep the wound as dry as possible. If it gets wet, always pat dry the wound. Baths shouldn’t be taken for at least two weeks or until your surgeon advises it’s safe.

If you had a skin graft, be sure not to rub over the wound for at least three to four weeks.

Follow-up appointments

Follow-up appointments are essential after having a melanoma removed.

What are some of the risks?

Like any surgery, there are risks and complications associated with removing melanoma.

Risks of surgery to remove melanoma include:

infection
scarring
bleeding
rejection of the skin graft
incomplete excision
re-operation.

When should I call for help?

Notify your RPS team immediately if you experience any of the following symptoms:

nausea, vomiting or diarrhoea
fever/high temperature – 38°C or higher
your stitches become loose or your wound opens
increasing pain that doesn’t improve with medication
increasing warmth, swelling or redness around incision site
pus coming from the incision site
heavy bleeding from incision site
red streaks leading to the incision site
you can’t pass stools or gas
signs of a blood clot including pain in your calf, back of the knee, groin or thigh, redness or swelling in your leg.

If you pass out or are short of breath call 000 for emergency care.