DR RUGHANI | PLASTIC SURGEON | BRISBANE | NORTH LAKES

Brisbane is the capital of the state of Queensland. Queensland is known as the ‘sunshine state’ as it boasts approximately 300 days of sunshine per year. Queensland is famous for blue skies, sandy beaches and much more. 

However Queensland also has one of the highest rates of skin cancer in the world and double the national average. Overall about two in three Australians will be diagnosed with some form of skin cancer by the age of 70 years. 

The skin is the largest organ is the body and has the important role of protecting the body from external injury and covering the underlying tissues and vital structures. 

There are several layers to the skin. Damage to cells in the superficial layer leads to a normal cells changing to become abnormal. If these abnormal cells continue to grow in size or number they can lead to skin cancers.

Queensland's high rates of skin cancer are linked to high sun intensity and peoples genetic background.

The majority of Skin Cancers are related to ultraviolet (UV) radiation. Most commonly UV radiation comes from high intensity sun exposure but can also occur from artificial lights, certain industries and sun lamps. 

In general, prolonged unprotected sun exposure in susceptible individuals can lead to sun burn, which can damage cells in the skin and may lead to skin cancer. 

Best practice is to be sun smart take good sun protection

Skin cancer can be classified into the following:

• Non-Melanoma skin cancers (these include)

1. Basal Cell Carcinoma
2. Squamous Cell Carcinoma 

• Melanoma 

Other types of cancers that involve the skin include:

• Merkel Cell Cancer
• Dermal Sarcoma
• Atypical Fibroxanthoma
• Undifferentiated Pleomorphic dermal sarcoma
• Superficial malignant fibrous histiocytoma (this diagnosis is no longer used)
• Dermatofibrosarcoma protuberans 

The most common type of skin cancer are Basal Cell Carcinomas (BCC).

These cancers get their name from the cells in which they originate from in the superficial skin; the basal cells of the epidermis.

In general BCCs are more common as you age and have higher rates in the body where there is greater sun exposure for example;  the head, face, hand, forearms and lower legs. 

Classically BCCs tend to grow slowly (months to years) and rarely spread to others parts of the body.

There are many ways to treat BCCs depending on the subtype, however more commonly surgery is offered and reconstruction (if required). 

However if left untreated BCCs (like any other cancer) can spread to the surrounding skin or deeper tissues. 

The second most common type of skin cancer are Squamous Cell Carcinomas (SCC).

These cancers get their name from the cells in which they originate from the squamous cells of the epidermis.

In general SCCs are more common above the age of 50 years and similar to BCCs have higher rates in the body where there is greater sun exposure. 

Importantly SCCs can grow quickly over weeks or months and have a higher rate of spread to surrounding lymph glands or others parts of the body. 

In particular SCCs in some special sites of the face (for example ears and lips) can spread more aggressively or invasively.   

A mention to ‘in-situ’, Bowens disease or intraepidermal squamous cell carcinoma; these are commonly referred to as pre-cancerous SCCs that are not normal cells and yet have not become true invasive SCCs. They are on a spectrum of pre invasive disease and have the potential to become an invasive SCC. 

The majority of invasive SCCs require surgery and / or radiotherapy to treat the surrounding tissues or lymph nodes.  

If detected early and treated with surgery; Melanoma can be cured in the majority (90%) of cases.  

However unlike other skin cancers (such as basal cell carcinomas) Melanoma has the ability to become advanced and spread to deeper layers of the skin, local surrounding lymph nodes or distant parts of the body such as the liver or brain. 

The overall treatment of advanced Melanoma has dramatically changed in the last 10 years and through appropriate care survival has improved five fold, from <10% to >50%. 

Melanoma Facts

• Melanoma is the second most common cancer diagnosed in Queensland.
• Approximately 4000 people receive a diagnosis of melanoma each year in Queensland.
• Melanoma is the most common cancer in young Australians (0 to 39 years)
• Melanoma originates from melanocyte cells in the skin.
• Is associated with higher rates of unprotected sun exposure (UV radiation)
• 
  

Melanoma Myths'

Melanoma only occurs on sun exposed areas’  NOT TRUE

• Less common but importantly melanoma can occur on non-sun exposed sites
• such as the inside of the eye, genital areas, under nails and the soles of feet or palms of hands. 

‘Melanoma only occurs in people with light skin or caucasian origins’  NOT TRUE

• Melanoma can develop in any skin type. 
• It is generally seen more commonly in people with light skin but occurs in Hispanic, Pacific islander, Blacks and Asian origin populations as well – with higher rates of melanoma under the nails. 
• Bob Marley had a melanoma of the great toe which was not diagnosed initially. 

‘Melanoma always presents as a brown mole’  NOT TRUE

• Generally melanomas arise from a mole that has a brown pigment that changes or increases leading to a suspicion of melanoma. 
• However melanomas can also be spots or lesions that are black, pink or have no colour.

Melanoma Subtypes

• Superficial spreading melanoma
• Nodular melanoma
• Lentigo maligna melanoma
• Desmoplastic melanoma
• Acral melanoma
• Subungual melanoma

A mention to ‘in situ’ melanoma which has forms a spectrum of pre-invasive melanoma they can transform into invasive types.

Risk Factors for Melanoma

In addition to high intensity sun exposure melanoma is also associated with genetic conditions, a strong family history and a weakened immune system. 

Melanoma Treatments

Surgery is the mainstay of treatment for melanoma of the skin.
It is important to have a thorough assessment and discuss the appropriate options.

These may include:

• An initial biopsy to provide an accurate diagnosis 
• A wider excision of the melanoma that may require reconstruction
• Sampling of the surrounding lymph nodes or glands (known as sentinel lymph node biopsy)
• Referral to an oncologist for further therapy. 

Follow up for Melanoma 

It is important for patients diagnosed with a melanoma to have regular follow up and care with an appropriate doctor, this can be on a 3, 6 or 12 monthly basis.