Skin Cancer Surgery & Reconstruction Auckland

Skin cancer is the most commonly diagnosed cancer in New Zealand. Early assessment and appropriate treatment are important, particularly when a skin lesion is changing, bleeding, ulcerating or failing to heal.

Plastic surgeons play an important role in the treatment of skin cancer because surgery may involve not only removing the cancer but also reconstructing the resulting defect while preserving appearance and function.

Stanley Loo is a specialist plastic, reconstructive and cosmetic surgeon with experience in skin cancer treatment and reconstruction. His current practice provides assessment and surgical treatment for a range of skin cancers, including basal cell carcinoma, squamous cell carcinoma and melanoma.

What Is Skin Cancer?

Skin cancer develops when abnormal skin cells grow in an uncontrolled way.

The three major types of skin cancer are:

Basal cell carcinoma (BCC)
Squamous cell carcinoma (SCC)
Melanoma

There are also less common forms of skin cancer.

The type, location, size and characteristics of a skin cancer influence how it is treated.

When Should a Skin Lesion Be Assessed?

You should arrange assessment if you notice a skin lesion that:

Does not heal
Bleeds repeatedly
Develops a persistent crust
Changes in size
Changes in colour
Changes in shape
Becomes painful or itchy
Develops an irregular border
Appears as a new or changing mole

A changing lesion should not be assumed to be harmless without appropriate assessment.

Skin Cancer Causes

Ultraviolet radiation from sun exposure is the primary cause of skin cancer. Other factors that play a role include:

Smoking tobacco

HPV infections increase the risk of squamous cell carcinoma.

Some genetic syndromes including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4″) in size are at higher risk for becoming cancerous.

Chronic non-healing wounds. These are called Marjolin’s ulcers based on their appearance, and can develop into squamous cell carcinoma.

Ionizing radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color.

Prevention

Sunscreen is effective and thus recommended to prevent melanoma and squamous cell carcinoma. Other advice to reduce rates of skin cancer includes: avoiding sunburning, wearing protective clothing, sunglasses and hats, and attempting to avoid periods of peak sun exposure.

The risk of developing skin cancer can be reduced through a number of measures including: Decreasing indoor tanning and mid day sun exposure and increasing the use of sunscreen

Avoiding the use of tobacco products

Skin Cancer Diagnosis

Assessment begins with a clinical examination.

Depending on the lesion, a biopsy or excision may be required to establish a definitive diagnosis.

The current practice explains that diagnosis may involve an excisional biopsy and that further investigations can be required once a cancer diagnosis has been established.

Skin Cancer Excision

Surgery is an important treatment for many skin cancers.

The amount of tissue removed depends on factors including:

Type of cancer
Size
Location
Histological characteristics
Whether the lesion is recurrent
Previous treatment
Risk of spread

The objective is to achieve appropriate cancer clearance while considering the functional and aesthetic consequences of the resulting wound.

Skin Cancer Reconstruction

After a skin cancer is removed, the resulting defect may be closed in different ways.

Direct closure

Small defects can sometimes be closed directly by bringing the surrounding skin edges together.

Skin graft

A skin graft uses skin taken from another area of the body to cover the defect.

Local flap

A local flap uses nearby tissue that is moved into the defect while maintaining its blood supply.

More complex reconstruction

Larger or anatomically complex defects may require more advanced reconstructive techniques.

The current practice explains that the size and location of the defect influence reconstructive choice and that facial reconstruction can be particularly challenging because of important functional and aesthetic structures.