Dermatologists are the best healthcare professionals to assess and treat skin cancer. Dr Michael Rich has been assessing and treating skin cancers for over 30 years, and his expertise in the area is highly regarded. Dr Rich is the president of the Skin Health Institute, a true skin expert.
Why choosing a dermatologist over a skin cancer clinic is advised - Melbourne
Because dermatologists are so busy, it may take a while to get an appointment, resulting in a proliferation of so-called ‘skin cancer clinics’. Many of these clinics are run by inadequately trained staff, who carry out unnecessary biopsies and surgeries because they have not undergone the rigorous and extensive training required to be a dermatologist. Skin cancer clinics are therefore not necessarily your first best option in the fight against skin cancer.
ENRICH is first and foremost a dermatology clinic. Dr Rich and his associate dermatologists are all Fellows of the Australian College of Dermatology (FRACD). Skin cancers are more likely to be correctly diagnosed and treated at our clinic, and unnecessary tests, treatments and costs are minimised.
We assess and treat all skin conditions. If you have a suspicious lesion, contact us to make an appointment today with one of our specialist dermatologists to discuss your concerns with a skin cancer specialist.
What is skin cancer?
Skin cancer develops when the skin cells see an abnormal spurt of growth, with DNA damage (usually caused by UV light/sun) causes genetic defects. The cells replicate with this DNA damage, perpetuating the problem and causing a cancerous growth.
There are three major categories of skin cancer:
- Basal cell carcinoma
- Squamous cell carcinoma
- Keratinocyte dysplasias (solar keratosis, Bowenoid keratosis and squamous cell carcinoma in-situ (Bowen’s disease))
Basal cell and squamous cell carcinomas are known as non-melanoma cancers, and are the most common skin cancers in Australia, though they do not pose a great risk of death like melanomas do. Over 750,000 Australians will be treated for non-melanoma skin cancers every year, but the survival rate is very good. Early detection is key.
Basal cell carcinoma (BCC) skin cancer
BCC cancers are the majority of non-melanomas (about 70 per cent), with BCC appearing on the topmost outer layer of skin (the epidermis). BCC skin cancers appear almost anywhere on the body but are most common in areas of high sun exposure like the head, neck, face, shoulders and back.
There are usually no symptoms and BCCs are slow to grow. You might see a pearl-like lump or a shiny, scaly area that is pink or pale in colour.
Squamous cell carcinoma (SCC) skin cancer
SCC make up about a third of all skin cancers in Australia that are not melanomas, and SCC occur in the upper layer of the epidermis, typically in sun-exposed areas (head, neck, arms, legs). Compared to the BCC, SCC is fast-growing over weeks or months.
Symptoms of an SCC are a thick, scaly area, a fast-growing lump, the appearance of a sore that won’t heal, and/or tenderness of this area.
Cause of non-melanoma skin cancers
The cause of all skin cancers it generally the same: UV-damaged ‘dud’ skin cells replicating themselves. You have a greater propensity to develop skin cancer if you have a lot of moles, have fair skin that burns easily, lots of freckles, light eye colour, light/red hair, and if you have had previous skin cancer.
Any visible changes should be reported to your dermatologist, along with getting regular checks.
Melanoma skin cancers
Melanomas are a serious form of skin cancer whereby melanocytes – the pigment-producing cells in your skin – overgrow.
Melanocytes are found in the outer layers, and their job is to produce melanin – the dark pigment that causes tanning and dark skin tones. The variation in human skin tone we see is due to differing levels of production of melanin, despite everyone having the same amount of melanocytes – the darkest and the lightest skin are all equal in melanocytes – but those melanocytes in dark complexions produce a lot more melanin than those with light.
Albinos lack properly-functioning melanocytes, leaving them without melanin – pigment – at all.
Melanin is protective because it absorbs UV light, thus preventing it from entering our bodies further, causing deeper cell damage. Dark-skinned people are much less likely to be UV-damaged than those with lighter complexions.
Growths of melanocytes can be non-cancerous, and appear as the very common mole or as freckles. Cancerous growths of melanocytes is a melanoma.
Melanomas are classified by how far they have spread, for example ‘in situ’ means just on the skin, ‘invasive’ means the tumour has spread into other layers of skin, and ‘metastatic’ means cancer has spread to other tissue.
Who gets melanoma?
The highest rates of melanomas in the world are found in Australia and New Zealand, with a rate of about one in every 15 New Zealanders and 7.5 in every 15 Australians developing a melanoma in their lifetime. Men are affected more than women, though this is thought to be due to women being better informed about skin-cancer prevention than men.
Melanoma usually affects adults only and is rare in children. Those in the 45 – 65 age bracket are the most likely to be diagnosed.
What does melanoma look like?
A melanoma may appear from within an already-existing freckle or mole, or may appear on otherwise normal-looking skin as a new growth. Three-quarters of the time a melanoma appears from normal-looking skin. A melanoma from within a mole or freckle is characterised by changes in shape, size, and texture – typically a freckle will become odd-looking or misshapen.
Melanomas may be tan, black, dark brown, blue, red, or grey. A melanoma without pigment can also occur, and the skin may appear scarred, normal, or white.
Melanomas have different growth phases, with the first horizontal phase appearing flat. Once the vertical phase commences, melanoma thickens and rises.
Where are skin cancers most likely to appear?
Cancers can appear anywhere on the body, including areas that never see the light of day. The most common site is the back in men and legs in women.
The lips, eyes, brain and genitals aren’t very good growth areas for melanoma cancers, but from time to time this does occur.
Preventing and detecting skin cancer early
You need to get regular checks from your health professional or a trusted ‘mole-spotting’ partner who is trained in proper examination. You can get a buddy and do mole checks on each other regularly.
After skin cancer is detected and removed, checks should be conducted six-monthly for five years, but this drops down to ever four months for more advanced disease. Skin cancers can develop quickly, so catching it early is key.
New treatments being developed for treating malignant skin cancers
There are trials going on all the time for new treatments. These include:
- Interferons – some promising results, though side-effects can be intolerable
- Ipilimumab – promising results for metastatic melanoma
- BRAF inhibitors – vemurafenib (Zelboraf) – trametinib (Mekinist), dabrafenib (Tafinlar), and pembrolizumab (Keytruda)
- Talimogene laherparepvec (Imlygic) – genetically-modified live herpes simplex virus that is designed to replicate within tumours causing an immune reaction
- Tumour-cell vaccines
Contact us to make an appointment today with one of our skin cancer specialist dermatologists.
*Results may vary from person to person
SKIN CANCER FAQ
We should all be having regular, annual check-ups to have our skin, moles and freckles examined. We keep a record of your skin and visually record our findings. These checks mean we can keep an eye on any suspicious moles or lesions, and move forward with early detection and treatment as necessary.
We can feel that if we go for checks regularly, then there’ll ‘always be something’. We may feel afraid of what we might discover, but remember, early detection and treatment is key for positive outcomes. If your skin looks good upon examination, then nothing more needs to happen and you can rest assured that you’ve had the best eyes on your body and can continue to care for your skin
by protecting it from the sun.
When we take a biopsy, we are taking a small amount of tissue as a sample. By its very nature, this sample-taking requires us to break the skin, which causes minor discomfort. We use an anaesthetic cream to make your biopsy as comfortable as possible. Most people find the process very tolerable and thankfully it’s very quick. We only take a very small amount of tissue.
A biopsy breaks the skin to take a sample, so it does require healing over with scar tissue. The biopsied area is very small, however, so the scar will fade quickly and naturally over time. We do not expect a lasting visible scar from a biopsy and will offer you our healing tips to ensure a seamless mend.
If you have keloid scarring develop from any break in the skin, a very red or purple raised scar, then make sure you tell us beforehand so we can take precautions.
Assessments and tests will determine the treatment most appropriate for you. Each type of cancer has specific ‘best’ treatments, but the grade of cancer will be of the most importance in terms of treatment.
The most common treatment is first to remove the lesion. More extensive treatments may be required, such as chemotherapy or radiation therapy, especially if the cancer has spread. Most cancers are easily removed with no more treatment required, but frequent check-ups are important.
Your best next step is to see your GP who can refer you to our specialist clinic, or you can simply call and make an appointment with us directly. There is no need to get a referral in most cases; however, it can pay to take advantage of Medicare rebates in certain situations.
Getting regular checks, especially if you see a mole changing its appearance, is critical for catching any issues quickly and dealing with them promptly. Unchecked lesions can continue to develop without treatment, leading to potentially worse outcomes.
Skin cancer is not transmissible. You can’t give it to someone else, or get it from someone else. Cancer is a proliferation of abnormal skin cells, which develops within your own body.
Viruses are responsible for some forms of cancer and are thus in some ways deemed contagious. One of the best examples of this is the human papillomavirus (HPV) that causes cervical and other types of cancer. The HPV virus is transmissible via skin contact. There is no evidence that viruses or microbes cause skin cancers (at this stage – future research may prove otherwise!).
Certain predisposing factors can run in families, for example, having very fair skin or many moles. These factors don’t mean you will develop skin cancers, but if you are in a high-risk group, regular check-ups are essential.
Check around in your family to get an idea of what your familial risk factors are. See your specialist dermatologist for regular checks and receive a further analysis of your risk factors.
Usually, skin cancer provides us with no clues, making it hard to detect in yourself without a visual guide and proper analysis of lesions. Skin cancer doesn’t usually hurt, but the lesion may weep, bleed or crust over. Advanced cancers may cause pain.
If you are feeling pain around any lesion on your skin, see your dermatologist immediately for assessment and treatment. Skin conditions take many forms and show a variety of symptoms in each of us, so take your skin seriously and get checked if you are suspicious or at-risk.
The first treatment of removal of the lesion doesn’t come with any side-effects besides regular healing, but chemotherapy and radiation therapy come with a whole host of side-effects that range from tolerable/merely unpleasant to downright awful.
Your side-effects are related to the chosen treatment since there are many kinds of chemotherapy and dosing. Talk to your doctor about what to expect from treatments.
We develop cancerous tumours throughout the body constantly, but our immune system kicks into gear and eradicates them. It’s only when a tumour gets out of control that the body can’t hit CTRL+Z.
It is therefore unusual for skin cancer to resolve on its own once it reaches a certain point, which is way beyond what the body can cope with on its own. It is best to get immediate, thorough treatment, especially for melanomas, which can be deadly.
We do not recommend home remedies for skin lesions. Accurate diagnosis and treatment with scientific evidence behind it is the most reliable treatment. Treating yourself at home with unproven remedies could be dangerous to your health, especially if you have a melanoma that has spread to other tissue in your body.
While home remedies may be cheap and seem like a good idea, we recommend you visit the clinic for an accurate diagnosis and treatment options. Waiting for longer while you try to cure a lesion at home on your own may result in precious time wasted.
Each treatment comes with a unique risk profile, so speak to your doctor about what to expect. We’ll fully inform you of what to look out for, in the case that something unusual occurs.
A lesion going undiagnosed and untreated is the greatest risk. It may turn out to be nothing, but it’s better to know.
The main cause of skin cancer is skin cells damaged by UV rays emitted by the sun. With our dissipating ozone, more damaging rays are making it to the earth, where they are absorbed by our skin cells and damage DNA.
Skin cancer prevention is, therefore, a matter of protecting your skin from these damaging UV rays by wearing protective clothing, hats and sunscreen when outside or near reflective surfaces like windows or water.
Some skin cancers couldn’t have been prevented, but sun damage is the most common, preventable reason. Your best UV protection methods include:
- Proper, regular application of a high-SPF sunscreen
- Wearing long, loose sleeves and long pants or dresses
- Wearing a wide-brimmed hat
- Making sure you are getting plenty of vitamin D through supplementation or other means (no sun exposure means no vitamin D production)
You do not need a referral to visit our clinic for a mole check; however, in some cases, it’s smart to get a referral from your doctor to make the most of Medicare benefits.
We will take a biopsy and may remove the lesion in your appointment. If the biopsy comes back clear, then we do nothing. If the biopsy seems suspicious, we will offer treatment.
Once the lab has your biopsy sample, they will process it. We expect 1-2 weeks usually, but we will advise you of how quickly the lab will process your test and give us the results. We’ll call you to schedule another appointment unless you’ve already made one, to discuss your results.
It’s never too early to start caring about your skin and keeping tabs on moles. When we’re young, we don’t have as many moles, but as we get older, mole numbers increase. Start now!
When you come into the clinic for a full skin check, we need to be able to see your bare skin to get an accurate visual check. You may need to fully or partially undress; however, we’ll work with you if you are shy, to make sure you are very comfortable. If you want a doctor of a specific gender, we will make sure that happens. You keep your underwear and bra on.
You can expect a full skin check to take about an hour, but a spot check for a = specific lesion will be shorter depending on your situation.
No, mole mapping is a fully external visual examination with nothing to cause any pain.
If you have a suspicious lesion, you will need to come back for your results. If you are having treatment, we will need regular check-up appointments. We recommend annual check-ups for everyone.
Sometimes skin cancers can return at the same site or a different place. Regular checks can help keep tabs on your skin.
How a melanoma is diagnosed
There is a checklist – change in size and/or colour, irregular shape, bigger than 6mm, inflamed, oozing, change in sensation, border irregularity, and it evolves and changes.
You may visit your specialist dermatologist at our clinic to be checked and if necessary, have a biopsy. A suspicious lesion may be taken out completely and sent for testing; partial biopsies are typically avoided.
Once your test results are back, your specialist will explain the results to you and your treatment options.
Skin cancer treatment – clinic
Your treatment at our clinic will depend entirely on the results of the tests: Is it cancer? How deep is the cancer? Usually, the immediate treatment is to remove the lesion using a wide cut, so making sure skin around the lesion is also removed. There are margins generally recommended, with an incision ranging from 5-10mm margin to up to 20mm margin.
The stage of the melanoma will also make a difference to your treatment, and further treatments may be required. Lymph node removal may be necessary to help stop the spread of cancer cells throughout the body.
You will be checked regularly for recurrences, and new lesions should be detected and removed early because a second cancer can occur, at the same site or a new area.
Melanomas are known to be resistant to chemotherapy and radiotherapy agents, but in non-melanoma skin cancers, topical chemotherapy treatment may be applied. In some areas that are hard to treat surgically (like around the eyes and nose) radiotherapy may be performed.
For non-melanoma skin cancers, your specialist may use liquid nitrogen (cryotherapy) to freeze the cancer off, or use heat or scrape the cancer off.
How does a melanoma feel?
A melanoma may itch or feel tender, but as the cancer progresses, the lesion may bleed and crust.