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 and Cancer Foundation of Victoria and is a skin cancer specialist.
hy 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. This has resulted in a proliferation of so-called ‘skin cancer clinics’. Many of these skin cancer 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 in Melbourne is first and foremost a dermatology clinic. Dr Rich, and his associate dermatologists are all Fellows of the Australian College of Dermatology (FRACD). This means that skin cancers are correctly diagnosed and treated at ENRICH, and unnecessary treatments and costs are minimised.
At ENRICH Clinic, 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 skin cells replicate with this DNA damage, perpetuating the problem and causing a cancerous growth on the skin.
There are three major category 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 skin 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 skin cancers are the majority of non-melanoma skin cancers (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 to speak of and BCC skin cancers 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 on the skin, a fast-growing lump, 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 a previous skin cancer.
Any skin 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 layer of your skin, 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 skin and the lightest skin are all equal in melanocytes – but those melanocytes in dark skin produce a lot more melanin than those with light skin.
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 cell damage deeper in our bodies and skin. Dark-skinned people are much less likely to be UV-damaged than those with lighter skins.
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 as to 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 the cancer has spread to tissue other than the skin.
Who gets melanoma skin cancers?
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 skin cancer 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 skin cancer 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.
Melanoma skin cancers 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, the melanoma skin cancer thickens and rises.
Where are skin cancers most likely to appear?
Skin cancer 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 catching skin cancer early
You need to get regular checks from your health professional or a trusted ‘mole-spotting’ partner who is trained in skin examination. You can get a buddy and do mole checks on each other regularly to help catch skin cancers early.
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 cancer 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 skin cancer treatments. These include:
- Interferons – some promising results, though side-effects can be intolerable
- Ipilimumab – promising results for metastatic melanoma skin cancers
- 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 skin cancer 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
How a melanoma skin cancer 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 skin cancer specialist dermatologist at our Melbourne clinic to have your skin checked and if necessary, biopsies taken. A suspicious lesion may be taken out completely and sent for testing; partial biopsies are typically avoided.
Once your test results are back, your skin cancer specialist will explain the results to you and your treatment options.
Skin cancer treatment – Melbourne clinic
Your skin cancer treatment at our Melbourne clinic will depend entirely on the results of the tests: Is it cancer? How deep is the cancer? Usually the immediate skin cancer 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 skin cancer treatment, and further skin cancer 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 of the cancer, and new cancers should be detected and removed early because a second cancer can occur, at the same site sometimes or a new area.
Melanoma skin cancers are known to be resistant to chemotherapy and radiotherapy agents, but in non-melanoma skin cancers, a 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 skin cancer specialist may use liquid nitrogen (cryotherapy) to freeze the cancer off, or use heat or scrape the cancer off.
How does a melanoma skin cancer feel?
A melanoma skin cancer may itch or feel tender, but as the skin cancer progresses, the lesion may bleed and crust.