Skin cancer

Skin cancer

While your skin may not seem to change day to day, month to month, it is actually very “busy”, continually replacing itself. This requires millions of cell divisions every day, each cell dividing into two exact replicas. The miracle is that there are so few mistakes! But mistakes are made and the number of mistakes tends to increase in number and severity with age. When these abnormal cells themselves replicate, skin lesions are formed. They may be benign or malignant. The malignant ones will grow in an unrestrained way.

Some lesions appear but then over a period of one or two months disappear by themselves, evidence that your body’s immune response has dealt with them.

If a lesion appears and persists and especially if it is getting larger you should seek advice from your GP. There are also clinics that offer whole body surveillance.

Your GP will often remove small skin lesions, particularly if they are not on the face.

I see and treat a large number of skin lesions, especially facial ones. I do not normally do whole-of-skin examinations.

There are a large number of benign skin lesions and a few uncommon skin cancers. However there are three common skin cancers. Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Malignant Melanoma (MM).

BCC, the commonest, always remains a local condition but will grow remorselessly if ignored.

SCC has a spectrum of severity. The vast majority are local like BCC but a few are aggressive locally and can send cells elsewhere in the body (metastasise) and be life threatening.

MM is less common than BCC and SCC but more risky, with a higher tendency to metastasise.

It is important with all skin lesions that, if there is suspicion that they are malignant, they be removed when they are small, for then their excision is straightforward.

If the lesion is large or in a difficult site and the naked eye diagnosis is not clear it may be necessary to take a small sample first (biopsy).

The specimen is sent to the pathologist who makes the definitive diagnosis and, in the case of the skin cancers,  provides a lot of information about the degree of severity and whether there is a clear margin of normal tissue beyond and beneath the lesion.

The surgeon needs to remove enough “extra” tissue to achieve these clear margins without taking more than necessary.  This is particularly important on the face which is why plastic surgeons most often do these facial excisions.  The procedure can often be excision and direct closure but size of lesion and tricky anatomical sites may necessitate skin graft or skin flap closure.

*Sometimes what appeared to be an adequate margin proves not to be the case when the specimen is subject to microscopic examination.  In this situation a further excision is required.

Post-Operative Care

Risks

Scarring:
Since the nipple always has to be re-sited higher up, all breast reductions methods result in a scar right around the areola and a scar vertically down from there to the inframammary fold (groove beneath the breast). Usually there is also a curved transverse scar running the length of the inframammary fold. There are “vertical scar” techniques which seek to avoid this transverse scar and this is sometimes appropriate.

Loss of nipple sensation is not uncommon. Numbness of some skin beneath the nipple is usual.
You may not be able to breastfeed should you have a pregnancy after breast reduction.
The nipple has to move up and retain its blood supply. it is possible for this blood supply to be inadequate and to lose part or all of a nipple but this is an exceedingly rare complication.
Symmetry should be very good but may not be perfect.

Coming from
out of town?

Ideally a consultation should be face to face but is certainly possible to arrange a telephone consultation. If you can email the photos first so much the better. If it is clear what procedure is required then the in-person consultation can be the day before or the morning of the surgery.