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Some forms of skin cancer, including superficial basal cell cancers and Bowens Disease, or very thin SCCs can be treated with creams. Solar keratosis, or sunspots respond well to various types of creams. The use of skin cancer creams has advantages over surgery in that there is less scarring, and no tissue is removed. This means quicker recovery times, and less limitations on activities. Using specialised creams in the correct setting is essential for the best results with the lowest recurrence rates. Our skin cancer doctors will guide you in regards to the application of creams, and the safety profile of treating various forms of skin cancers.
Important fact on treating skin cancers with creams
Skin cancers can look like innocent lesions such as warts, flat moles, or persistent red spots. The biggest clue to a clinical diagnosis of a skin cancer is a changing lesion or a new persistent lesion. Remember, skin cancers are not just black moles, they can resemble warts, or even flat red patches. Your skin cancer doctor can give you a diagnosis, or if in doubt, conduct a biopsy.
At My Skin Cancer Clinics we make professional skin care and skin checks affordable for everyone. Our initial appointments are 15 minutes long for a standard skin check, but if your skin needs it, we will take longer to ensure a full and thorough examination. Fees may apply, and medicare rebate is claimable for at least half of the fee. Most eligible surgical and non surgical treaments and procedures are bulk billed. DVA eligible patients are bulk billed for all services including standard skin checks, as are pensioners and valid Health Care Card holders.
More than ever, patients are given a choice of effective treatment methods for sunspots. Efudix is an excellent method of sun spot removal, however the redness and downtime following Efudix therapy is significant- upto 6 weeks. Newer treatments have a much shorter 'downtime' and work as well as Efudix in the removal of pre cancerous spots.
Cryotherapy or liquid nitrogen is an excellent method to treat or remove a few sunspots, especially on the hands and forearms, however can be an unpleasant experience if spots on face are treated. Treating the 'field' with Photodynamic Therapy, Fraxel Laser or creams can reduce the need for liquid nitrogen. Your skin cancer doctor or dermatologist can guide you as to the best 'field treatment' for your needs.
Sun damage can be treated by a variety of methods including spray nitrogen, creams such as Efudix, Alara, Picato, or one off laser- light methods such as Fraxel Laser or Photodynamic Therapy. The type of procedure will depend on your available downtime, extent of damage and budget. Creams such as Efudix cost $70, whilst laser treatment and PDT can cost several thousand dollars.
All treatments are individualised according to your downtime, severity of sun spots and costs. As a guide- Efudix is the cheapest option, but associated with a downtime of 4-6 weeks. PDT or photodynamic therapy has the shortest downtime, but is also the most costly. Fraxel Laser and Picato sits in the middle.
Fraxel laser is the newest laser in the fight against sunspots. Using special patented Micro Fractional Technology, laser energy destroys sunspots, pre cancerous cells, and excessive pigmentation, replacing damaged skin with fresh, younger and clear skin. Fraxel laser can remove over 80% of sun damage in one sitting. In severe cases of sun damage and solar keratosis, 2-3 treatments are required.
Brisbane has one of the highest Skin Cancer rates in the World. The hard facts are- one in 16 residents will develop a melanoma in their life, and one in three Queenslanders will develop a skin cancer.
Brisbane's high UV exposure and our outdoor lifestyle are the major contributors to the development of skin cancer and sundamage.
Skin cancers can be diagnosed clinically (examination), however a firm diagnosis is made on histology. This means the lesion, or a sample of skin is sent away for testing under the microscope.
My Skin Cancer Centre doctors employ thorough Dermatoscopic examination to assist in the diagnosis of skin cancers, including Melanomas.
These 3 forms of skin cancers account for the majority of skin cancers seen in Queensland.
BCCs or basal cell cancers are 'good cancers'. Mortality rate is virtually nil, however these cancers are locally invasive and can cause destruction of local tissue.
Melanomas are bad skin cancers with a very high mortality rate IF left untreated. If a melanoma is discovered, you will need to be followed up every 3 months for 2 years following the diagnosis of melanoma. Melanomas are graded according to the thickness of the cancer.
SCCs are 'in between' skin cancers. They can have a significant mortality rate if they are not treated, especially on areas such as the ears, lips, head and neck area. Excision is usually curative.
Very. 1 in 16 Queenslanders will develop a Melanoma; one in three residents will develop non-melanoma skin cancer. One in two Caucasian patients over the age of 40 will exhibit solar keratosis- an early marker for sun damage and pre cancer. The Sunshine State of Queensland enjoys brilliant weather for most of the year, but also predisposes their residents to skin cancer.
Did you know only one episode of sunburn in childhood doubles your risk of melanoma? Sun exposure will also increase the likelihood of developing non-melanoma skin cancers, including basal cell cancers, squamous cell cancers, dysplastic moles, and solar keratotis and sun spots. If you work in an out door occupation- you should consider getting a regular skin check.
Our doctors are all highly trained in the field of dermatoscopy- a specialised technique to identify potential skin cancers. We also have a mole mapping service, using state of the art computerised imaging and photography. This process is designed to image your moles and keep track of any potential changes.
Our clinic also has access to Fraxel Lasers and several photodynamic therapy light sources.
BCC occur most often on areas of the body that are frequently exposed to the sun such as the face, head/scalp, neck and hands.They often grow slowly over time and range in size from millimeters to 1-2 centimeters in diameter and have varied appearances. Frequently BCCs present as a pinkish nodule with a crater like indentation in the center.
Other features of BCCs can include the following:
Doctors at My Skin Clinics will treat all cases of BCC. Treatment options often depend on the type, size, location, and number of tumors. Possible treatments include:
Non-Surgical Options:
Freezing the tumor with liquid nitrogen can be used for treat small superficial BCCs. A permanent white scarcan result from this treatment.Cure rates are lower than those seen with surgical treatments–approximately 85-90%.
Photodynamic Therapy (PDT)
A chemical cream is applied to the skin several hours prior toexposing the treated skinto light in order to activate the chemical. This is ideal for smaller more superficial BCCs.
Topical Chemical Treatments
Imiquimod cream (Aldara) is used mostly for small superficial BCCs and induces a localised inflammatory response. The skin is generally treated once a day for 5 days per week, for a total of 6-12 weeks.
5-Fluorouracil cream (Efudex)can be used for very superficial small BCCs usually requiring 12 weeks of application twice a day.
Involves the use of x-rays and generally requires several treatments per week for a few weeks for complete removal. Radiation may be most appropriate for the elderly or for tumors that are difficult to manage surgically. Cure rates are around 90%, however this treatment can result in long-term cosmetic problems and involves radiation risks.
Use of local anesthesia is required before surgical treatments.
Curettage and Electrodessication
The BCC is scraped off using a curette (a sharp, ring-shaped instrument). Curettage is often followed by the use of an electro-cautery needle to remove residual tumor and control bleeding. Although cure rates are similar to those of surgical excision this treatment may not be as useful for aggressive BCCs or when the BCC is in a high-risk or difficult site. Healing is usually complete within several weeks.
Surgical Excision
For larger BCCs a scalpel may be used to remove both the BCC as well as a surrounding border of normal skin as a safety margin. The skin is then closed with stitches, and the excised tissue is sent to a pathology lab for examination to confirm that all cancer cells have been removed. This method produces cure rates around 90%.
For large BCCs or those on specific areas of the body skin grafts may be necessary.
Mohs surgery. This is a procedure performed by a specialized skin doctor (dermatologist or Mohs surgeon). The cancerous cells are removed layer by layer. This technique is used frequently for tumors on delicate areas such as eyelids, temples and ears. This treatment has a high cure rate.
PDT is a highly effective method of treating superficial BCCs on virtually any area, including the face, scalp, hands and chest. It is a minimally invasive treatment that leaves little to no scarring with a relatively rapid recovery. The treatment makes use of photosensitizing agents such as Aminolevulinic acid hydrochloride (ALA) cream that is applied topically and becomes concentrated within cancer cells over 3-6 hours. When activated by light, the photosensitizing agents selectively destroy cancer cells, leaving normal cells largely unaffected.The resultant reaction usually appears much like sunburn and usually heals within 4-8 weeks with good cosmetic results. Cure rates are variable ranging from 70 to 90%.
Benefits of PDT include shorter treatment time compared with Imiquimod (Aldara) or Flurouracil (Efudex) creams.
Read more about Photodynamic Therapy
No single treatment method is ideal for all BCCs. Factors influencing treatment include the lesion's size, site, and histologic type, as well as your age and functional status.
Superficial and nodular BCCs respond especially well to non-surgical treatments whereas larger lesions may require surgical excision. PDT can be used where multiple BCCs are present.
Despite most BCCs being cured by treatment, recurrence is always a possibility. Furthermore, those individuals affected by BCCs have an increased risk of developing other forms of skin cancer such as melanoma. For these reasons it is recommended the following steps are undertaken to manage your risks:
Invasive SCCs are usually slowly-growing, tender, scaly or crusted lumps. The tumour may be soft and freely movable and may have a red, inflamed base.The lesions may develop sores or ulcers that fail to heal. SCC'soccurmost often on sun exposed sites such as the scalp in balding men, forehead, ears, lips, lower legs, forearms and backs of the hands.Tumors on the scalp, forehead, ears, nose, and lips are at higher risk of spreading (metastases).
SCCs typically grow slowly over months to years however can also develop rapidly. They vary in size from a few millimetres to several centimetres in diameter.
Most SCCs develop as a result of exposure to ultraviolet radiation, which damages the DNA of cells. Those with fair complexions, blue eyes and light hair are most at risk although SCC's may develop in anyone.
Actinickeratosis (also known as sunspots) is the most common precursors of SCC. These lesions begin as pink, brown, rough patches that are more easily felt than seen. Another precursor to developing SCC isIntraepidermal Carcinoma (IEC) also known as Bowen's disease, which presents as irregular, well defined, red, scaly patches on sun-exposed areas.
Other factors that may increase the likelihood of developing SCCsinclude a family history of SCC, smoking, prior burn injury, persistent ulcers, long-term use of immunosuppressant's, and infection with a strain of human papillomavirus (which causes most genital SCCs). Any person previously diagnosed with or treated for SCC is at increased risk of recurrent disease.
SCC isusually diagnosed based on the appearance of the lesion. To confirm the diagnosis and rule out other conditions, your doctor or dermatologist will perform a biopsy of the lesion. In certain circumstances, when SCCs are invasive or have spread to other sites, additional tests such as ultrasound, CT or MRI may be performed.
SCC isa potentially invasive cancer and may be treated best by surgical removal of the lesion under local anaesthetic. The doctor will usually cut out the lesion along with an appropriate margin of normal skin surrounding the tumor.
Mohs micrographic surgery, a specialized form of surgery performed by a trained specialist, may be necessary for large, poorly defined, deep or recurrent tumours or those on delicate areas.
Where large excisions are necessary, a skin graft may be required.
Radiation treatment utilizes x-rays to destroy cancer cells. It is sometimes used for high risk primary skin cancers on the face and for metastatic disease (where the cancer has spread beyond the skin).
The larger these tumors grow, the more extensive the treatment needed.
Following diagnosis of SCC, treatment is usually curative. It is possible however, for an SCC to recur at the same site or for a new SCC to develop elsewhere. Should this occur, additional treatment with surgery or radiotherapy will be required.
If you have had an SCC you are at increased risk of developing further SCC as well as other skin cancers, particularly basal cell carcinoma and melanoma.
It is recommended that those who have had SCC undergo regular skin checks with a GP or My Skin Clinic doctor or dermatologist. The earlier a new lesion is detected, allows for easier and more effective treatment to be undertaken.
SCCs in general have an increased likelihood for recurrence and metastasis than BCCs and hence require more regular follow up. It is suggested that you see your doctor at regular intervals (every 3–6 months) for the first several years, depending on the location, size, aggressiveness, and spread of the initial cancer.
Lentigo maligna is a type of melanoma "in situ" which means that the cancer cells are confined to the top layer of the skin (the epidermis) and have not yet had the opportunity to spread anywhere else in the body.Lentigo maligna is a slow growing lesion that develops in areas of skin that are exposed to sun such as the face or upper body. Because it grows slowly it can take years to develop. Because lentigo maligna is confined to the top layer of skin it is cured with surgery. If treatment for lentigo maligna is not undertaken,it may go on to develop into lentigo maligna melanoma which is a more serious disease.
Lentigo maligna like many other skin cancers is associated with exposure to ultraviolet (UV) radiation. Brisbane has a particularly high UV index and therefore placesmany Queenslanders at greater risk of developing lentigo maligna.
Lentigo maligna is more common in males than females and tends to occur in people over the age of 40. Having a fair complexion places you at increased risk;however, even those individuals with darker skin may still develop lentigo maligna, although the risk is less. Other important risk factors include a family history of melanoma and/or a personal history of non-melanoma skin cancer.
Lentigo maligna is associated with exposure to the sun. Research indicates that episodes of sunburn as a child under the age of 15 may increase the risk of developing lentigo maligna as an adult. Furthermore, intermittent episodes of sunburn as an adult may play a significant role in your risk for developing lentigo maligna. Those individuals who are exposed to the sun on a regular basis, such as outdoor workers,are also at increased risk.
If you're my Skin Clinic doctor or dermatologist suspects that an abnormalpatch or mole may be a type of melanoma or a lentigo maligna, a biopsywill be necessary to allow a pathologist to confirm the diagnosis. Usually, when a lesion is suspected of being a melanoma, or has the potential to become a melanoma, a complete excision of the lesion at the time of biopsy is undertaken. When this happens your doctor will often remove a 2-3mm margin of surrounding normal skin along with the lesion to reduce the likelihood of leaving cancer cells behind. The biopsy is normally performed using a local anaesthetic.
The treatment that offers the best cure rate is surgical excision. A border of healthy skinsurrounding the lentigo maligna melanoma is taken in hopes of removing any residualabnormal cells. Depending on the size of the lesion, simple stiches may be adequate or a skin graft may be necessary.
A skin graft uses skin from another part of the body to cover the area from which the lesion has been removed. The area on which the skin is grafted may look unattractive after the operation however, with time it will heal and the redness will fade. As this is a surgical procedure, there is a risk of infection and scarring. Occasionally skin grafts may fail and will necessitate further treatment.
Lentigo maligna may be treated with other treatments if surgery is not a feasible option. Such treatments may include the following:
Lentigo Maligna(melanoma in situ)has a good prognosis when detected and treated. It is rare for these lesions to recur because they are 'in situ', therefore have not been able to spread to other regions of the body.
Regular skin checks are advisable despite successful treatment to monitor for any new lesions.
Keratoacanthomas are wart like lesions that occur on UV exposed sites, such as the ears, nose, face and limbs. They are most commonly seen in elderly patients, especially those who have a background of sun-damage. They are thought to be related to a more sinister skin cancer called a Squamous Cell Cancer.
Read more about Squamous Cell Cancers
The high UV index of Brisbane contributes to the formation of Keratoacanthomas. The incidence of KAs per capita is higher in northern cities and towns compared to Melbourne or Sydney.
This lesion typically looks like a volcano, with a crater in the middle. KAs are very fast growing skin cancers, typically doubling in size every few weeks.
In England we use to call this a 6-6-6 tumour, 6 weeks to reach maximum size, 6 weeks to stay, and if it resolves it will take 6 weeks. It is advisable not to have the 'wait and see' approach as KAs may resemble more sinister cancers such as SCCs.
Major causes of KAs include-
1. Genetics
2. UV radiation
3. Immune suppression
4. Trauma
5. Some cases related to HPV infection
6. Rare genetic conditions
Skin Cancer Doctors at My Skin Clinics always treat KAs. Observation is NOT an option. This is because KAs can resemble a nasty skin cancer called an SCC.
Treatment options for KAs include-
1. Surgery: most common treatment with highest cure rate
2. Curette: Great treatment for KAs and frequently used by dermatologists
3. Radiotherapy- great for marginal KAs and in the elderly
Excellent. Once removed by surgery, KAs very seldom recur. (Exceptions are centrifugum varieties, genetic KAs seen in England, and immune suppressed patients).
What is important is that patients who have had KAs ensure that they have their skin checked at least once every 4-6 months for other forms of skin cancers. KAs often occur in sun-damaged skin, associated with solar keratosis, BCCS and even melanomas. Your skin cancer doctor will guide you in regards to follow up intervals.
Keratoacanthomas are very common skin cancers seen in Queensland. The high UV index of Brisbane and other northern cities predisposes to KAs. Fortunately this form of skin cancer is less aggressive than melanomas and SCCs. In fact, death is very, very, very rare following a KA.
Skin cancer doctors at My Skin Clinics are trained to diagnose, manage and follow up patients with this common, but relatively harmless tumour. Early management is the key.
Dysplastic naevi are also known as atypical naevi or Clark's naevi. These names all refer to moles that have unusual features when examined both on a clinical level as well as under a microscope following a biopsy. Atypical naevi while generally considered benign and not of concern, may in certain cases be precursors to the dangerous skin cancer, melanoma. Often these moles can look similar to a melanoma in that they may be asymmetrical with irregular borders and may have a dark orvariegated appearance.
When examined under a microscope these moles have features that are different to those seen in "typical" moles.
While having one atypical naevus is not of great concern, those who have a lot of these moles (greater than 5) are at increased risk for developing a melanoma at some point in the future.
Read more about melanoma skin cancer
YES, Familial Atypical Mole and Melanoma syndrome (FAMM) previously referred to as dysplastic naevus syndrome refers to a genetic condition in which family members exhibit atypical naevi. For a diagnosis of FAMM, all of the following criteria must be present:
Any atypical naevus should be examined by your doctor or dermatologist, such that a decision may be made as to whether or not the mole should be removed. Often, most patients will undergo a comprehensive baseline skin examination. Based on the findings from the examination your doctor will determine the ideal management plan.
As a basic guide, dysplastic nevi with mildly atypical features can be carefully watched with regular examinations for changes in appearance. A routine skin checkshould be carried out at least every 12 months and patients should perform monthly self skin examinations. More frequent examinations may be indicated if additional risk factors exist. Dysplastic nevi with a moderately atypical appearance are often completely removed by a biopsy and no further treatment is required. Dysplastic naevi with severely atypical features are best treated by complete removal along with a surrounding margin of normal skin.
As a general rule, any mole that does not "behave" in the expected manner or changes over time is likely to be removed under local anaesthetic.
Things to look for on self examination:
– Any new moles
– Any changes to existing moles (size, shape, colour, bleeding, itch or pain)
Solar keratosis or sun-spots is due to an abnormal development of skin cells, and is secondary to Ultraviolet light exposure. Sun-damage most frequently occur in areas exposed to the environment, including the face, neck and back of hands. Other areas affected include the top of the ears, nose, upper lip and temples. Solar keratosis present as red, often scaly, rough and persistent spots.
Solar keratosis can also present on the lips, a condition known as actinic chelitis.
The principle case of solar keratosis or sun-damage is UV exposure and genetics. Brisbane receives more UV radiation than other cities such as Sydney, and Melbourne. Up to a quarter of middle aged Brisbane population will exhibit early changes of solar keratosis.
Efudix – time tested, this is a chemotherapy cream for sunspots. The downside about Efudix is the prolonged recovery time – up to 4 weeks.
Picato Gel – Picato gel (Ingenol Mebutate) is a Brisbane invention, and is now used all over the world to treat sunspots. Picato is derived from a common plant known as Milkweed and is now used to treat actinic keratosis (sunspots) and precancerous lesions.
Aldara Treatment – can be used for sunspots; however the disadvantage is the long application regime, often extending months.
PDT or Photodynamic therapy – is an excellent method to treat sunspots. The recovery is within a week, however costing is an issue. PDT is a very effective treatment for sunspots, especially on the scalp and face.
Fraxel Laser – is the very latest in the fight against sunspots and is extremely effective in removing sun spots, solar keratosis, skin pigmentation and overall sun-damage. Recovery is within 5-7 days, and the results can be outstanding.
Liquid nitrogen or freezing – is a time tested method of treating sunspots, however if performed incorrectly, can lead to blistering, and scarring. This method can only be used to treat a few spots at a time.
No. No treatment will clear up ALL sun-damage; however the aim is to decrease the amount of solar keratosis and sun damage. As a guide, treatments such as Fraxel Laser, PDT, Efudix, and Picato will clear up 80-85% of sunspots with one treatment cycle.
Most people will need to repeat treatment every 4-10 years, depending on the severity of sun damage.
Yes, laser is the newest method of treating sunspots. This procedure is conducted by specialist dermatologists at Westside Laser Dermatology. Laser treatment can be tailored according to the level of sun-damage. Lasers include erbium, CO2, or Fraxel Laser.
This procedure is conducted at a Specialist Level by Laser Dermatologists, Dr. Davin S. Lim and Dr. Shobhan Manoharan.
Laser treatments start from $990 for Fraxel Laser, using the latest in Fractional Laser technology.
Read more about Fraxel Laser
Your skin cancer specialist will discuss treatment options with you based upon factors such as your downtime, cost, and expected cosmetic results.
Efudix is the cheapest method of removing sunspots, but has a downtime of nearly one month. Fraxel laser on the other hand, has a downtime of less than a week, but costing can be an issue. Our aim is to give patients options to treat their sun damage.
|Efficacy of treatment
|Duration of treatment
|Cosmetic outcome
|Down time of treatment
|Price of treatment
|3 hours
|Fraxel 1927 laser
|30 min
|6 days
|3-4 weeks
|25 days
|$60-$80 per tube
|Picato Gel
|3-4 days
|$ 145 per tube
|Glycolic / AHA peels
|15 min, series of peels needed
|1 hour(Recommended for mild photo-damage)
There are two outstanding treatments for sunspots and solar keratosis. These treatments are highly effective, with the quickest recovery. Like creams, the clearance rate from PDT and Fraxel laser is around 80%- depending on the level of sun-damage.
PDT: downtime of 7 days, conducted by Specialists at Westside Laser Dermatology. This treatment is ideal for DVA patients – Veteran Affairs patients as there is no out of pocket cost.
Fraxel Laser: downtime of 5-7 days, performed by laser specialists. Rejuvenates skin as well as removing sun spots.
Read more aboutFraxel laser
More on Westside Dermatology
Sun damage on the lips can present in several forms, including a blurred or ill-defined lip edge. They can also present as rough, dry scaly patches on the lips, or areas of whiteness called leukoplakia.
Sun damaged lips can cause symptoms such as burning, stinging or even bleeding.
In some cases, sun damage lips may present as a lump or ulcer- in this situation a biopsy is need to exclude skin cancers within the sun damage areas.
Sun damage lips should always be treated, however not all forms need aggressive treatment such as lip laser. The reason why we should treat or prevent actinic chelitis is to reduce the chances of skin cancer within these areas.
Skin cancers such as IECs or Squamous Cell Cancers can result from sun-damage on the lips.
Read more about Mole Map – by Dermatologist
There are two reasons for which you should consider treatment for sun damage on your lips.
Firstly, if you suffer symptoms such as stinging, burning, bleeding, or just annoyed in regards to peeling, crusty skin on the lips. Cosmetically, sun-damage lips can either cause lipstick to run, or give the lip border a blurred edge. Young lips have a sharp well defined border, whilst sun-damaged lips have blunt edges.
Secondly, if your Specialist Skin Cancer Doctor or Dermatologist recommends treatment. This is important, as if left untreated moderate to severe sun-damage on the lips can lead to skin cancer. You will be guided in regards to the severity, timeline and treatment options available during your skin cancer screening consultation.
Yes. In some cases actinic chelitis, or sun damage to your lips can be dangerous. Sun spots, known as solar keratosis can occur on your lips. This may lead to IEC or intra epidermal Squamous cell skin cancers. These can transform to Squamous Cell Skin Cancers. SCCs on the lip are serious forms of skin cancers.
High risk patients for developing SCC skin cancers on the lips include-
Due to the intense amount of UV radiation, especially in Brisbane and other Queensland cities, lip balm with a high factor SPF should be worn on a daily basis.
Some tips to minimize sun damage to your lips include-
For mildly sun-damaged lips: Skin cancer doctors advise the use of high factor SPF 50+ applied 3-4 times a day, coupled with Vaseline at night. A prescription Vitamin A can help reverse mild sun damage and actinic keratosis on lips.
For moderately sun-damaged lips: Photodynamic therapy or laser resurfacing of the lower lip
More severely sun-damaged lips: PDT (2 treatments) or CO2 – Erbium Laser Resurfacing or lip surgery by a plastic surgeon.
My Skin Cancer Clinics doctors work closely with Specialist Laser Dermatologist in the treatment of moderate to severe sun-damage lips. The use of CO2 and Erbium lasers are conducted by Laser Specialists at Westside Laser Dermatology.
This procedure is conducted in a laser operating theater by a Laser Dermatologist under partial sedation. It involves resurfacing your lip with either a CO2 Laser or an Erbium laser. Laser destroys the abnormal cells and sun-damage on your lips, and allows health, new cells to develop over weeks. This procedure is partially covered under Medicare.
Recovery following lip laser can take up to 2-3 weeks.
The majority of treatments are covered under the Department of Veteran Affairs Act providing your hold the correct card. This entitles you to services such as skin cancer screening, cryotherapy, skin cancer surgery and state of the art treatments such as PDT or Photodynamic Therapy and newer topical treatment.
You are also entitled to services provided by BOTH Skin Cancer Doctors AND Specialist Dermatologists.
Some treatments are not covered under DVA, even if you hold the correct Card for skin related issues.
Treatments NOT covered under the Department of Veteran Affairs include-
*Note however, that PDT or Photodynamic Therapy is covered under DVA.
If you have served with the Department of Defence, you maybe entitled to a White or Gold Card. You will need to speak to DVA to arrange for an assessment by an Advocate. Based upon your service history, occupational history and service dates, you maybe granted a card that entitles you to treatment under the Department of Veteran affairs act.
This process may take a few months to process.
As a WHITE or GOLD Card holder, you are also entitled to see a Specialist Dermatologist for your skin. Our Skin Cancer doctors can arrange an appointment to visit a Dermatologist, as we work closely with Specialist to provide you with the best possible team orientated service.
UVB is a shorter wavelength radiation, and generally, is at its highest during the middle of the day and summer months. When the skin is exposed to UVB radiationsunburn and underlying cell damage can occur.
UVA is a longer wavelength and penetrates a little deeper into the layers of the skin. UVA is a little trickier to detect ashigh exposure can occur anytime during the day, including winter and on cloudy days. Surprisingly UVA can also penetrate through glass. UVA causes damage to the collagen and elastin in the skin and is responsible for premature skin aging characterised by wrinkles, sagging, yellowing and pigmentation.
Both forms of ultraviolet radiation cause cellular DNA damage. This puts the skin at risk of developing skin cancer. There are a number of types of skin cancers including melanoma, basal cell carcinoma and squamous cell carcinoma. Melanoma is the most serious and can be deadly. Every year in Australia over 12,000 people are diagnosed with melanoma and over 1500 people die from this cancer. Melanomas have been directly linked to sun exposure. Other risk factors include fair skin and number of moles.
As well as seeking other methods of protection, such as clothing, hats and shade, it is important to wear a sunscreen when exposed to UV radiation. Since UVA can penetrate through glass and clouds – that is pretty much all the time! No sunscreen can last all day and hence a sunscreen should be re-applied every few hours to ensure maximum protection is maintained.
The ideal sunscreen should have a high level of UVB and UVA protection. In other words it should be 'broad spectrum'. The UVB protections level of a sunscreen is shown as SPF. UVA protection is not stated on the label so it is important that you ask what level of protection it offers. A sunscreen should also have a sophisticated formula allowing a high UVA/UVB protection but with a light non-greasy texture. It should also be free from irritants. This means it will be more cosmetically appealing and more likely to be used correctly and re-applied.
Anthelios XL Extreme Fluid 50+, by La Roche-Posay, is a high UVB and UVA protection sunscreen. It is light and non-comedogenic. It is free from irritants such as fragrance and is suitable for sensitive skin.
The best sunscreen to use will depend on factors such as your skin sensitivities, and the activity you are doing.
Every day sunscreens should be light but also protect against skin cancer producing UVA and UVB rays. If you are going to the beach, we recommend a UV sunscreen with waterproof qualities.
My Skin Cancer Clinics recommend the use of La Roche Posay.
Dermatoscopy (also known as dermoscopy or epiluminescence microscopy) is the examination of skin with a special magnifier using non-polarised light. Traditionally we use a transparent plate and a liquid medium between the dermatoscope and the lesion examined.
This allows inspection of skin lesions unobstructed by skin surface reflections. Modern dermatoscopes dispense with the use of liquid medium and instead use polarised light. With suspicious or changing lesions we capture the image on a camera and store this on a computer for future comparisons.
Doctors who are trained in the specific field of dermoscopy, the diagnostic accuracy for melanoma is significantly better than for skin cancer doctors who do not have any specialized training in dermatoscopy.Thus, with specialists trained in dermoscopy, there is considerable improvement in the pick up rate of melanomas.
Compared with naked eye examination the accuracy by dermatoscopy increases melanoma pick up by 20%.
Absolutely not! Dermatoscopy adds an accurate tool in the management and diagnosis of skin cancers and melanomas, however is NOT 100% accurate. In skilled hands this procedure can add to the diagnosis or exclude non cancerous lesions during the skin examination.
Choose the type of sunscreen that suits the situation. For children, Skin Cancer Doctors recommend 2 types.
Daily sunscreen: This should be used twice a day. A non- greasy formulation is essential or your kids will hate using it! La Roche Posay is an excellent formulation.
Activity sunscreen: This is greasy, but waterproof, and is ideal for the beach or outdoor activities. Apply every 2-4 hours, especially in the Queensland sun.
This is a hard one to call. Children will develop moles as they grow up, in fact most people will 'collect' more moles till the age of 30. There after there is a slow decline in the number of moles.
If your child is 'moley' or if you or your GP is unsure in regards to the safety of moles, a mole check by either a skin cancer doctor or Dermatologist is needed. Both skin cancer doctors and Dermatologists manage moles in children in very similar ways- in the vast majority of times we professionally measure
Reducing risks factors in adult life starts off in childhood. It takes just one episode of blistering sun burn in early life to DOUBLE the chances of developing melanoma in adult life. Start educating your children young- slip, slop, and slap.
Developing good habits of twice daily sunscreen use, as well as hats and rashies, will protect your children, and reduce their chances of developing melanoma and non-melanoma skin cancers.
Skin cancer, especially melanomas are exceedingly rare in children, however we never take risks! Moles are carefully examined by a process called dermatoscopy. We look for subtle changes within the mole, and will measure, document and photography the mole. Children are then reviewed every 3 -12 months, and comparison photographs are taken.
Moles in children should grow at the same rate as the child, and not quicker.
Skin flaps are commonly used to close wounds from excisions of skin cancers. Most skin defects can be closed with normal elliptical excisions, however if the defect is large or if important cosmetic issues arise, we may elect to use a skin flap.
Skin flaps are geometric movements of skin from adjacent areas designed to close a defect. The type of skin flap used will depend on many factors including the size of skin cancer, and how much skin needs to be mobilised.
Common areas for skin flap skin cancer surgery include – the temples, nose, ears, forehead, and sometimes the lower legs.
Flaps can be described according to the geometry or shape of the flap. Some flaps are complex, some are simple.
Flap types include-
The type of flap used will depend on many factors including the location of the skin cancer defect, the movement of skin, and important cosmetic structures.
Skin grafts can either be split thickness or full thickness grafts.
Full thickness skin grafts are often used to repair defects on the nose and ears.
Spilt thickness skin grafts are used to repair larger defects on the scalp, and lower limbs.
Donor sites are areas where the skin graft is harvested. Most common donor sites for the full thickness skin grafts include the front part of the ear, the collar bone area, and the back of the ear.
Split thickness grafts are usually taken from the upper thigh, or the back of the upper arm.
Healing times range from 9-21 days, depending on the type of skin graft, the location of the graft and other factors, including your general health and circulation.
Full thickness grafts on the nose and ears heal the fastest.
Split thickness grafts on the lower legs in elderly patients take the longest to heal.
Donor sites (from where the graft is harvested) take between 5 days (full thickness donor site) to 3 weeks (split thickness graft) to heal up.
Yes. Most scars will improve with time, however skin cancer doctors, Plastic Surgeons and Dermatologists will often work in with Laser Dermatologist to help improve scars even further.
Laser surgery can help improve the colour and texture of skin grafts and flaps. Red areas can be treated with the V Beam Vascular laser, whilst scar lines and contours can be evened out with several types of lasers, including the Erbium ProFractional Sciton laser, the CO2 CORE laser, or Fraxel lasers.
Most scars can be improved by 30-90% with a combination of laser techniques. Your doctor will refer you to a laser dermatologist if scar revision is needed.
Read more about scar revision following surgery
Only certain types of skin cancers and skin lesions can be treated with laser. Examples of skin lesions amendable to laser surgery include-
Skin cancers such as SCCs, solid BCCs, invasive BCCs or Melanomas cannot be treated with laser therapy.
Read more about basal cell cancers
If performed by a Specialist, laser therapy is very successful. The cure rate for the treatment of BCCs and IECs (Bowen's disease) is over 95%.
Laser resurfacing of the lower lip for actinic chelitis (sun-damage lips), is extremely effective, removing between 80-95% of sun-damage with one treatment.
FRAXEL 1927 for sun spots and solar keratosis is also very successful. Most patients will require only one treatment, however if sun damage is heavy, two treatments will be needed. As a guide line between 60-80% of sun damage can be shifted with Fractional Laser.
Read more about Fraxel for sun spots
No. Laser surgery is not an option for removal of moles. My Skin Cancer Centre doctors will always submit moles for testing, and 'blind treatment' of moles is not recommended. The treatment of choice for changing or suspicious moles is surgery.
Laser therapy can be used to remove sun-damage, sunspots, or pre-cancerous solar keratosis. Laser can also remove unwanted skin pigmentation, freckles, and age warts.
You Skin Cancer doctor will guide you in regards to the safety of lasers.
Our doctors will work in with our team of Laser Dermatologists to choose a particular laser for your condition.
Superficial BCCs (Basal cell cancers), and thin SCCs as well as sundamage and age spots respond well to CO2 or Erbium laser. These types of lasers are termed 'ablative' and remove very precise layers of the skin- destroying the skin cancer cells, as well as rejuvenating the surrounding skin.
Areas of precancerous sun damage, sun spots and skin pigmentation can be effectively treated with a laser called FRAXEL 1927. This laser treats 'fractions' of the skin, producing areas called MTZ or microscopic treatment zones. This treatment has a downtime of only 5-7 days, compared to other methods of removing solar keratosis.
Read more about Fraxel laser for sunspots
Lasers are more precise tools than surgical scalpels, and in the right hands, do less damage to the surrounding tissue. For areas such as the lips, nose, and face, the use of lasers can result in minimal scarring. Not all skin cancers can be treated this way, and your skin cancer expert will advise you of what cancers respond best to laser therapy.
The other huge advantage of laser therapy is that of rejuvenation. After laser treatment your skin will look younger, fresher and cleaner. Laser removes unwanted skin pigmentation, age warts, spots and stimulates collagen formation. All this results in tighter younger skin. This is the best positive side effect of laser treatment.
Laser can only be utilized to treat certain forms of skin cancers, including IECs or Bowen's Disease, Basal cell cancers of the superficial type, and sun spots or solar keratosis. Other forms of skin cancers can not be treated with laser.
Surgeons must have specialised training before they can perform laser therapy, and hence patients are referred to Laser Dermatologists to perform this procedure.
Laser therapy is more expensive than surgery, or creams for sun-damage due to the cost of running a laser theatre, assistants, and laser machines.
Laser Specialist Dermatologists perform this type of work. Your skin cancer doctor will refer you toDr Davin Lim, Dr Shobhan Manoharan, Dr Scott Weber, or Dr Brad Jones to under take laser surgery.
Laser Dermatologist have an additional 4 years training in managing skin conditions, and additional training in the use of lasers for skin cancers.
Read more about Westside Laser Dermatology
Laser surgery costing will depend on the type of skin cancers treated, the number of sessions and the location of the problem.
As a guide-
Some treatments such as lip resurfacing partially covered under Medicare, however Fraxel Laser is not covered under Medicare- Health insurance.
Medicare does provide some rebate for laser surgery for skin cancers and sun-damage, however an out of pocket cost will apply.
Examples include- treatment of basal cell cancer with laser, Medicare Rebate of approximately $170
Fraxel 1927 for sunspots are not covered by Medicare, and an out of pocket expense of $990 applies.
Private Health insurance does not cover laser surgery for sunspots unless conducted in Hospital
Only certain types of skin cancers can be safely treated with creams. Your skin cancer specialist will guide you as to your treatment options for a particular form of skin cancer.
Type of skin cancer and pre- cancerous lesions that can be treated with creams include-
Basal cell cancers: Superficial subtype. This means that the skin cancer is very thin, and does not invade into the underlying skin. Superficial BCCs can be identified clinically as flat red scaly areas, or by histology- testing a tiny piece of skin under the microscope.
SCCs – of the thin type, also known as IECs or intraepidermal cancers, or Bowen's disease. If SCCs are very thin, and do NOT invade the deeper layers of skin, they can be safely and effectively treated with creams.
Solar Keratosis, or Sun Spots are precancerous lesions, and may lead to thin SCCs or Bowen's disease. These should always be treated, as prevention is better than cure.
Types of skin cancers that can NOT be treated with creams include- melanomas, moles, dysplastic naevi, invasive BCCs including solid BCCs, Morpheic BCCs, micronodular BCCs, infiltrating BCCs, BCCs with nerve spread, and all forms of invasive SCCs.
Your Skin Cancer Specialist at My Skin Clinic will guide you as to what is the best method to treat your form of skin cancer.
More than ever, patients now have a good selection of creams for skin cancer treatment. The most frequently used creams at My Skin Cancer Clinics include –
Remember, only some forms of skin cancer can be treated with creams. Our experienced skin cancer doctors will guide you as to what is the best treatment for your type of skin cancer…
Your skin cancer doctor will guide you as to the duration of cream treatment. As a guide you will need to apply creams for a duration of 2 weeks – 6weeks, depending on the type of cream you use and the type of skin cancer treated.
Photodynamic Therapy or PDT uses a cream called METVIX, this from of skin cancer treatment is the most convenient, as cream treatment is applied 3 hours before a laser light is used. Most patients will require 2 treatment sessions, spaced a few weeks apart.
Other forms of creams (such as Imiquimod, or 5FU) will need to be applied by yourself for several weeks.
Read more about Photodynamic Therapy
If used correctly, skin cancer creams have a very high success rate in removing sun spots as well as treating superficial skin cancers such as superficial basal cell cancers, and superficial squamous cell cancers such as Bowen's disease or Intraepidermal Cancers.
As with all skin cancer treatments, follow up by your skin cancer doctor is required to ensure that your sun damage or skin cancer has been cleared.
Follow up follow skin cancer treatment is always needed. By careful examination of your treated areas, your skin cancer professional can tell if skin cancer treatment has been successful. In some situations, a biopsy, or sample of the skin can be helpful, as we send the sample away for testing under the microscope.
If you have had treatment for skin cancer, lifetime follow up is advisable as you are at risk for developing another skin cancer.
The main advantage of using cream over surgery is that skin tissue is preserved with creams- no cuts, not stitches, no blood, no needles.
Cream treatment may also result in less scarring, and also less limitation on activities compared to surgery.
Remember, only certain types of skin cancer can be treated with creams. Specialists at My Skin Clinics will advise you in regards to what is the best treatment for YOU.
Read more about Photodynamic Therapy
Creams provide patients with an additional option for the removal of certain forms of skin cancer, and may NOT be the solution for your type of skin cancer.
In summary surgery is-
Your skin cancer specialist will guide you as to what is the BEST method of skin cancer removal.
All creams will have expected and controllable reactions if applied correctly. Skin cancers are expected to be inflamed or aggravated following skin cancer treatment. Additionally pre skin cancerous areas, such as sun damage, solar keratosis and sun spots will react the same way.
Side effect of cream treatment for skin cancers include-
Creams such as imiquimod or ALDARA and EFUDIX will have skin reactions that may last for up to 6-8 weeks, however photochemical creams such as PHOTODYNAMIC THERAPY or PDT reactions typically last a few days.
Read more about photodynamic therapy
Creams for skin cancer vary in price according to the amount used, the number of treatments and the type of chemical.
As a guide, Efudix for sunspots cost $60-75 dollars, whist Aldara and Picato Gel is more expensive. Photodynamic Therapy cost several hundred dollars for treatment. The exact amount will be dependent on the size of your skin cancer and the NUMBER of treatments required.
Skin cancer treatment is always tailored according to the skin cancer type, location, and individual factors. Specialists at My Skin Clinic will guide you in regards to the BEST treatment but also provide you with options for treating skin cancers and pre cancer cells. Other options include-
Surgery for skin cancer: This is the best option for solid cancers, invasive BCCs, SCCs, moles, melanomas and keratoacanthomas. Surgery provides a very high cure rate, but a longer recovery time. In cosmetically sensitive areas, scarring maybe an issue.
Curette and Diathermy: can be used to treat BCCs or Bowens, however can result in scarring or changes in skin colour.
Liquid Nitrogen: this can be used to treat very thin Basal Cell Cancers, and early sun-damage.
Laser surgery: This is a very specialised procedure performed by Specialist Laser Dermatologist, and is ideal for treating precancerous areas on the lips, and face. Scarring is reduced, and cosmetic benefits such as improved skin texture and skin tone can be seen.
Combination PDT and Laser: Again a very specialised treatment for skin cancers of the Superficial BCC subtype and IEC. Dermatologists combine PDT with V Beam laser, followed by FRAXEL laser all in one session. This combination address both skin cancer, pre cancerous cells and provides cosmetic rejuvenation to the treated areas and surrounding skin.
Yes. Creams can be used to help REDUCE the incidence of skin cancers by treating sun damage, sun spots and solar keratosis. Solar keratosis can be classed as pre-cancerous lesions and should be treated.
Here are some ways Skin Cancer Doctors and Dermatologists use creams to reduce the amount of sun damage-
Mild sun damage- Vitamin A creams can be applied nightly to affected areas. Vitamin A can only reduce very mild sun damage, and should always be used as a prevention cream after any treatment.
Moderate to severe sun damage- Creams such as PICATO, EFUDIX, ALDARA or PDT can be used to treat sun spots. Your skin cancer doctor will discuss what is the best treatment for your type of sun-damage.
"My Skin Clinics"
Skin cancer creams have come along way since the use of Efudix or 5 FU over two decades ago. Now patients have a selection of creams to effectively treat both skin cancer and pre cancerous areas. We individualize treatments according to the type of skin cancer, the location of skin cancer, as well as the downtime of the patient. Most importantly we take into consideration the potential for scarring, and take steps to minimise scars following skin cancer treatment.
Photodynamic therapy is an excellent method to treat superficial BCCs anywhere on the body, but is especially useful on facial areas, as well as on the lower limbs. This treatment is performed by the clinic, and provides superior convenience compared to creams applied by the patient.
Other creams we commonly use include ALDARA, EFUDIX and PICATO; each has their own merits and drawbacks.
Radiation therapy can be an excellent method to treat certain types of skin cancers because cancerous cells are sensitive to radiation -induced damage. The most frequently treated skin cancers in Australia are Basal Cell Cancers, and SCC or Squamous Cell Cancers.
Ideal skin cancers are-
Your skin cancer specialist will guide you as to the suitability of RADIATION therapy.
The most common situation for radiotherapy of skin cancer arises when the skin cancer is either very large or if there is spread to surround areas, including nerves. Skin cancer doctors may refer you to a radiation oncologist in the following situations-
Remember, the doctors at My Skin Cancer Clinic work as a TEAM and will work in with Dermatologists, Plastic Surgeons, and Radiation Oncologists to provide you with the best possible solution for your type of skin cancer.
In Australia, radiation therapy is administered and supervised by Specialists Radiation oncologist. Radiotherapy is administered in clinical centers on an outpatient basis. This requires several visits to the Specialist, over a period of weeks or months.
The initial visit involves planning how many sessions and the type of therapy needed. Subsequent visits are very quick and involve radiation of the treated area and surrounding skin. Each session takes approximately 15 minutes to complete.
Side effects from radiotherapy can be early, also known as acute, or late, or chronic.
Acute side effects can occur during early treatment of your skin cancer. The side effects developed in the treatment area will depend on the location of your skin cancer, the type of skin cancer treated (ulcerated cancer versus nerve involvement of cancer such as a Basal Cell Tumour), the dose of radiotherapy, your medical condition and how the dose is delivered. Acute side effects include hair loss in the treated area, or decreased salivary flow. This may occur if a skin cancer is treated around the mouth or lip area.
Chronic side effects following radiotherapy for skin cancer may or may not occur. Most common chronic side effects from skin cancer radiotherapy include discolouration of the skin, blood vessels, and changes in the texture of the skin. Rarely a second cancer may occur many years after radiotherapy of the area.
Your radiation oncologist will discuss the prognosis of this therapy for YOUR SKIN CANCER. Success will depend on many factors including the location of your skin cancer, and the type of skin cancer.
Most commonly Skin Cancer doctors refer patients who have extensive basal cell cancers or BCCs with perineural or nerve spread. In this group, the use of adjunctive radiotherapy can be extremely successful.
Following radiotherapy, a regular skin check by your skin cancer doctor is recommended.
Medicare covers radiotherapy treatment for skin cancers, in some situations an out of pocket cost may apply.
Costing will depend on the number of treatments, and the number of skin cancers treated. Your oncologist will discuss this with you during your initial consultation.
No, radiotherapy is a very specialized field, and special equipment and safety requirements are needed. All radiotherapy procedures for skin cancers are performed in centres at the Wesley, Greenslopes or Mater Hospitals in an outpatient setting.
In cases where by sun-damage is thin (superficial) we may elect to use PDT, rather than radiation therapy.
Read more about PDT for Skin Cancers
Scarring following all forms of surgery, including skin cancer surgery is universal. Correct surgical technique can reduce, but not eliminate scars. Scars following surgery or trauma to the skin occur in the deeper layers of the skin, known as the dermal layer.
Scars occur as a result of inflammation and altered arrangement of collagen in the deep layers of the skin. Red scars are due to a process called 'neovascularisation', a process in which new blood vessels form after surgery.
Keloid or hypertrophic scars are as a result of an exaggerated healing process in your skin.
Read more about scars and scar revision
4 simples steps can help give you the best possible scar results following skin cancer surgery-
Scars following skin cancer surgery can be classified in to 4 types, each type of scarring will have a 'best treatment' approach.
Hypertrophic scars- these scars are raised scars, and due to overproduction of collagen. Examples include keloid scars and also raised full thickness skin grafts. This form of scarring responds well to steroid injections or laser resurfacing.
Atrophic scars– this form of skin scars are opposite to hypertrophic scars, and result from loss of tissue, especially following cancer surgery and grafting. Atrophic scars respond well to dermal fillers, such as Juvaderm.
Pattered scars– as the name suggests, this type of scar takes the form of a pattern, such as a line, or in the case of a skin flap, a geometric shape. Patterns include 'train-tracks' or spread scars. This form of scarring responds well to ablative and fractional lasers including Fraxel.
Pigmented scars – this type of scarring from skin cancer surgery can occur if a flap is performed, or if surgery is conducted in darker skin patients. Red scars can often be faded with vascular laser. Darker scars respond best to conservative treatment, rather than laser therapy.
All scars can be improved, no matter how severe.
Raised scars on the face respond best to a series or laser treatments, or a combination of anti-inflammatory injections and laser. The extent of scar improvement will depend on many factors including the type of scar, the scar location and most importantly – how your immune system responds to treatment.
Read more about scars and scar revision
Keloid and hypertrophic scars are lumpy, and often itchy scars that extend beyond the border of a surgical wound. They occur because you body's immunity is too strong, and results in overproduction of collagen and scar tissue. Keloid scars usually occur a few weeks or months after skin cancer surgery.
The most common location for keloid and raised scars are on the chest, back, and shoulders. These types of scarring are more commonly seen in the younger age group.
Keloid scars can be treated by Specialist Dermatologists using a combination of vascular V BEAM laser and Corticosteroid injections.
No. Scars will occur following any form of surgery on the skin. What your scar eventually looks like will depend on many factors, some beyond the control of your skin cancer surgeon, dermatologist, or even plastic surgeon.
Factors that may affect scar formation include the following-
Dr Davin S. Lim, laser dermatologist explains laser treatment of scars secondary to skin cancer surgery:
"Essentially 3 types of laser can be used to treat scars secondary to skin cancer surgery. Each type of laser has a specific function and represents a method of treatment."
Ablative lasers- This is the most common laser I use to treat surgical scars. As the name suggests this totally removes the upper and middle layers of the skin, enabling me to remove excess tissue, especially with over corrected skin grafts. This also helps reduce the appearance of old suture lines and 'cuts'. Usually only one treatment is needed, however the recovery time approaches 8-10 days. All ablative laser procedures are conducted in a laser theatre, often under very mild sedation.
Fractional lasers- including ProFractional, PEARL, and FRAXEL laser. This form of laser resurfacing treats 'fractions' of skin, and not the entire surface
Specialist laser and cosmetic dermatologists perform scar revision. Dermatologists are specialist physicians and surgeons who work with skin cancer doctors. They have extensive training in the use of highly skilled techniques, including the use of lasers to resurface, and revise all forms of scarring, including surgical scars and acne scars.
My Skin Cancer Centre refers to Westside Laser Dermatology for all scar revision work.
Read more about scars and scar revision
Heal times following revision of skin cancer surgery scars will depend on the procedure. As a guide-
Once again this depends on the surgical scar type and location. If scars are raised follow flap or graft surgery, as few as one laser scar removal session will give the desired outcome.
If scars are hypertrophic or keloid, then several sessions are needed to flatten surgical scars.
Red scars will require 2-3 sessions of vascular laser before lightening.
Scar revision can occur immediately after suture removal. If you have the tendency to have red lumpy and raised scars, V Beam laser immediately after surgery can reduce likelihood of scar formation.
Lumpy raised scars from grafts, flaps and skin cancer excisions can be treated with either erbium or CO2 – Fraxel laser within weeks of the procedure.
Skin grafts and flap scars can be improved by laser methods. Your GP or skin cancer doctor will refer you to a Specialist Laser Dermatologist for this procedure.
Laser can improve a surgical scar by several methods-
Almost all scars, no matter how severe can be improved. Scars secondary to skin cancer surgery, burns, trauma, acne, chick pox and accidents can all be improved with a combination of laser and physical modalities.
Each scar type will have an optimal method of scar revision. Note that 2 forms of scars respond very poorly to any form of treatment –
Scar revision is a highly specialized field, conduced by Consultant Laser Dermatologists and Plastic surgeons. Most cases will be partially claimable by Medicare, however an out of pocket fee is applicable.
As a guide, out of pocket expenses for scar revision ranges from $190 to $2900.
Fees are dependent on –
My Skin Clinics work in conjunction with Specialist Dermatologists at Westside Laser Dermatology and Plastic Surgeons for scar revision procedures.
Read more about Westside Laser Dermatology
A consultation with a Specialist is the very first step in scar revision. During the initial consultation, your Specialist will discuss the type of scar you have, and methods to visibly reduce scarring. We also undertake a full medical history, as well as photographic documentation of the scars.
Specialists will discuss issues such as –
For more information on booking an appointment to see Dr Davin S. Lim or Dr Shobhan Manoharan, call Westside Laser Dermatology on 07 3871 34 37.
Laser Dermatologist
Westside Laser Dermatology
"Scars following skin cancer surgery are universally seen, and can be improved. Scarring will depend on many factors, including genetic, but also dependent on site of skin cancer or mole, and the techniques used to close the defect."
"Raised scars are the easiest to treat, especially following skin grafts. I use a combination of methods to help improve scars, including steroid injections to flatten the scar, as well as lasers. For keloid scars, most patients will require a series of 2-3 injections spaced 4-8 weeks apart. Laser ablation of raised scars will often only require one treatment. Red scars do particularly well with vascular lasers."
"No matter how old the scar is, improvement can always be achieved."
Picato gel is one of only a few pharmaceuticals to have been developed and produced in Australia. The initial work on Picato began in 1997 following the discovery by Australian scientists of a group of compounds isolated from the Euphorbia peplus plant.
The active ingredient in Picato gel, ingenol mebutate,is produced in Australia with both Queensland and New South Wales being the only places in the world where the plant is produced for commercial use.
For treatment of the face or scalp Picato gel 0.015% shouldbe used once daily for 3 consecutive days.
For treatment of the trunk or extremities Picato gel 0.05% should be used once daily for 2 consecutive days.
If you have missed the second or third application of Picato gel within 3 days of the last application, apply the second or third tube when you remember. If it has been more than 3 days since the last application, do not apply the remaining tube(s) and contact your doctor for advice.
Following application:
One treatment of Picato costsapproximately $140.00 AUD
The most common side effects are expected to occur and indicate that the treatment is working.
Such effects can include:
Other effects may include:
The skin reactions are transient and usually occur within one day of commencing treatment and peak in intensity up to one week following completion of treatment. Healing should be complete within about 15 days. If the effects continue for longer you should contactyour my Skin Cancer Doctor.
Contact your doctor should you notice the following side effects:
Actinic keratosis (or sunspots) are very common precancerous lesions. They are also referred to as solar keratosis. Sunspots ought to be treated due to the potential of cancer arising within these lesions. Even though Picato gel has been shown to be an excellent method of clearing sunspots, your doctor or dermatologist will discuss other options with you.
The ideal treatment will depend on tolerated downtime, the severity of your sunspots, any pre-existing skin condition and costs.
Alternatives to Picato gel include the following:
Efudix: This cream is applied twice a day to sunspots for up to 3 weeks, you will be red and spotty for up to 4-5 weeks, and you must limit your exercise and UV exposure during this time. Complete healing of the treated area may not be evident for 1 to 2 months following completion of Efudix therapy.This is a time tested and cost effective (prescription cost of $60 AUD)method of treating sunspots
More on Efudix Treatment for sunspots
The active ingredient of Efudix is 5-Fluorouracil which is a form of chemotherapy drug. Abnormal (pre-cancerous or cancer) cells will selectively absorb Efudix allowing the drug to kill the abnormal cells. The treatment will produce a skin reaction that typically develops over the first week of treatment with redness and slight scaling. Over the second week the reaction intensifies with increasing redness and crusting with resolution of the reaction occurring several weeks following cessation of treatment. A stronger reaction will be observed in those who have a greater number of abnormal cells in the skin. It is important not to stop the treatment because of the reaction. Efudix is highly effective in treating AKs, particularly when large areas of skin are affected. Repeated treatments may be required and this is perfectly safe.
Aldara (Imiquimod): This cream is used to treat a variety of skin conditions including warts, sunspots, skin cancers such as superficial basal cell carcinomas and even intra-epidermal carcinomas. Application time will vary according to clearance and side effects. Aldara has a very high clearance rate for solar keratosis, however this treatment is hampered by a long treatment course.
More on Aldara for the treatment of sunspots
Aldara works by stimulating the immune system causing the release a number of chemicals called cytokines that are necessary to fight viruses and destroy cancer cells. Aldara treatment usually requires application of the cream 2 times a week for 6 weeks to a defined area of skin that should be no larger than 5cm x 5cm.
Common side effects of Aldara include:
Less Common effects:
PDT: Is also known as photodynamic therapy. This is a once off treatment applied in rooms. Treatment is over within hours, and your skin starts to heal by day 3. Downtime following PDT is only 5-7 days at most.
TGA is currently reviewing recommendations of home use of PDT- known as daylight PDT. Studies are promising.
The advantage of PDT is its ability to treat large areas of skin at one time making it asuitable treatment for patients with large "fields" of affected skin. Usually only one treatment is required for AKs with costs ranging from $1500 – $2500 AUD depending on the area treated. Although generally well tolerated, common side effects may include slight burning or stingingduring treatment and mild swelling and redness similar to sunburn afterward. Peeling and redness subside after about week. Overall PDT results are usually very good with excellent cosmetic outcomes.
More on PDT for sun damage
Cryotherapy: This is also called liquid nitrogen or freezing. This is an excellent method to treat individual sunspots, however if sun-damage is extensive, field cryotherapy cannot be used, and topical creams come into play.
More on Cryotherapy for Sunspots
Fraxel 1927 laser: This is the most promising and exciting method of treating AKs. Recent studies have shown that one treatment can clear up to 85% of sunspots. Downtime is only 5-7 days. The other benefit of using a laser is that it also clears up skin pigmentation, fine wrinkles and age spots. The only downside of laser is the cost. Patients require 1-2 treatments, each treatment cost $990, and is supervised by a Dermatologist.
More on Fraxel 1927 for sunspots
Photodynamic therapy is a non-surgical and well tolerated treatment that combines the use of a special photosensitizing agent (ALA). This chemical is activated with a specific wavelength and intensity of light. It is a two-part treatment. First, the drug is administered to the skin via cream. An incubation period (wait time) of 90-180 minutes is need for absorption of the cream. This is followed by exposure under a specific light source for several minutes. Once the skin is exposed to the light treatment, the photosensitive drug starts to react by destroying damaged and cancerous cells leaving normal skin tissue unaffected.
PDT can only treat superficial or thin skin cancers, including superficial BCCs or Basal Cell cancers and IECs or Bowen's disease.
PDT is also an excellent method of treating pre-cancerous areas or solar keratosis.
Read more about treating sun-damage
In general PDT is well tolerated and in many cases an anaesthetic is not required.
For treating skin cancers, a slight stinging or burning is commonly felt in the treated area when the laser light activates the cream.
For large areas of PDT, such as the face, or scalp we often provide pain relief with either a cooler or analgesia. The larger the area treated, the more the pain. Your skin cancer specialist and nursing staff will ensure that you are comfortable throughout the treatment process.
Due to the sunsensitivity of photodynamic therapy, many patients have a sunburn feeling for several days following treatment. This can be alleviated with the use of cool compresses, and of course, sun protection.
Large treatment areas such as the face or scalp usually heal within 4-6 days.
If you have PDT to the lower limbs, you may need to restrict your activities for a few extra days to ensure that your skin heals.
Preparation of the area for PDT typically takes 10 to 15 minutes.
Step one: Cleaning skin, degreasing with applicator and microdermabrasion if needed. Areas to be treated marked out. Skin cancer location photographed and documented.
Step two: Application of cream. Cover with light proof dressing.
Step three: Incubation for three hours. The wait time allows for the chemical to be concentrated in the area of sun damage and cancerous skin cells.
Step four: illumination with specific low-level laser light. This takes 7 to 8 minutes to perform
Step five: Application of healing balm post PDT.
Cream PDT METVIX is then placed on the targeted areas
Chemical of METVIX is activated with light
This is what you look like at day 3. Skin heals up by day 6-7.
How much time off work will depends on the site and extent of treatment.
Full face PDT takes approximately 6-7 days to recover from, which compares favorably with Efudix treatment (downtime of 3-4 weeks). Smaller treated areas such as the nose or upper lip heal within four to five days after the procedure.
Your skin cancer specialist will inform you of the downtime prior to treatment.
In general Photodynamic Therapy treatment has-
Note that not all lesions are suitable for PHOTODYNAMIC THERAPY, your skin cancer doctor or Specialist Dermatologist will guide you accordingly.
Sunspots or solar keratosis is a common pre-cancerous lesion seen in the Queensland population. Sun-spots are rough, dry, red and scaly lesions on areas of the face, ears, scalp, and hands. They should be treated because they can transform over time into skin cancer.
Efudix treatment involves application of a cream twice a day for a period of 3-6 weeks. It is highly effective, however downtime is significant- approaching 4-6 weeks. Additionally, with high humidity and UV index seen in Brisbane, Efudix treatment is limited to Autumn and Winter.
In contrast to Efudix, PHOTODYNAMIC THERAPY can be performed all year round and involves a single treatment. The procedure is over within a few hours and you skin heals up within a week of therapy. The major advantage of PDT over Efudix, Aldara and Picato is the convenience of treatment.
Read more about Efudix for sunspots
|Efficacy of treatment
|Duration of treatment
|Cosmetic outcome
|Down time of treatment
|Price of treatment
|3 hours
|Fraxel laser
|1 hour
|990 for one treatment
|3-4 weeks
|4 weeks
|Upto 6 weeks
|Upto 6 weeks
|140-360 dollars
|Picato Gel
|3-4 days
|7 days
|260- 990 dollars
Cost of photodynamic therapy will depend on the area treated and the number of sessions you will require.
Sunspots will require only one treatment session, whilst skin cancers such as BCCs and IECs will require two sessions. Your skin cancer specialist will assess the severity and area at the time of consultation.
As a guide
Prices include all aspects of treatment including-
Note: PDT is NOT covered under Medicare. Some health insurance companies do provide a partial rebate for this procedure. We advise patients to check with their cover prior to undertaking this procedure.
An assessment by our Skin Cancer Specialist is need prior to PDT treatment. This ensures that your skin cancer or sunspot can be safely and effectively treated by this method.
Once an assessment has been conducted, your Skin Cancer Doctor will refer you to an appropriate centre for treatment
PDT or photodynamic therapy has been a time tested treatment method for sun spots, actinic keratosis and superficial or thin skin cancers of the basal cell and squamous cell subtype (Bowens Disease). If performed in the correct setting, PDT has a very high cure rate, with a low incidence of scarring.
In the setting of sun spot treatments, it has a shorter downtime compared to traditional treatments such as EFUDIX, however newer methods of sun spot treatments such as FRAXEL 1927 Laser is slowly replacing large area PDT treatments. Laser treatment of sun spots has a very promising future- treatments are more cost effective compared to PDT, and is associated with better comfort levels for the patient, as well as a decreased downtime. Clearance rates following Fraxel Laser varies from 60-85%.
Read more about Fraxel for sunspots
Aldara or Imiquimod can be used to treat some superficial and less aggressive forms of skin cancer, including superficial basal cell cancers, and SCC in situ. It can also be a good method of treating sun damage, and solar keratosis or sun spots.
REad more about basal cell cancers
Wash your hands before and after applying Aldara.
Cut the top off the packet or pierce the sachet with a needle and squeeze out a small amount of cream onto your fingertip. Apply this to the affected areas as directed by your skin cancer doctor.
Although the information on the packet states that the sachet is for single use, you could seal it using a bulldog clip and place it in the fridge. Aldara now comes in a pump pack for convenience.
Imiquimod may be used at any time of year, as it is not photosensitizing, unlike Efudix
Aldara treatment is one of the most variable treatments we use. This is because it stimulates your own immune system to fight cancer. Some patients have a very good immune system and reactions are short, and brisk. Other patients have a mild reaction to Aldara, and may need a longer application regime.
As a guide-
Your skin cancer specialist will advise you accordingly.
Specialists and leading skin cancer doctors can give you treatment options for removing sunspots, apart from Aldara. Treatments such as Fraxel Laser or Photodynamic Therapy can be an excellent method of sunspot removal, without the inconvenience of weeks to months of Aldara use.
A suitable treatment will depend on downtime, convenience, and costing for each patient. This table will give you a guide line as to what leading skin cancer doctors use-
|Fraxel 1927
|5-7 days
|From $990
|Cost; may need two procedures if severe sun damage
|One off treatment, very quick recovery time – less than 7 d.
|Helps with skin rejuvenation
|21-28 days
|$160+ including follow up
|Downtime, follow up visit mid treatment
|Cost effective, works very well
|*Best option if downtime is not an issue and tolerable skin type
|PDT –photodynamic therapy
|7-8 days
|$2500- $3500Face and scalp
|Short downtime, very effective, one off application
|Good treatment for smaller areas of sun-damage. Eg: upper lip
|Picato Gel
|5-7 days
|$150 for 5 cm by 5 cm
|Cost; variable levels of inflammation.
|Shorter downtime
|Variable inflammation; needs physician monitoring.
|4-8 weeks
|$300-$700 including follow ups
|Long treatment regime
|Limited use
Aldara is a good treatment for sunspots, however the protracted daily use for weeks or months may not suit busy patients. There are other treatments that are very effective for the treatment of sunspots and skin cancers with a much shorter 'downtime' compared to Aldara.
Shorter treatments for sunspots include –
Fraxel 1927 laser
Read more about Fraxel laser for sunspots
PDT or photodynamic therapy
Read more about photodynamic therapy
Aldara cost will depend on several factors including the area you are treating, the number of treatment cycles, and the types of skin cancers or sun damage.
As a guide, treatment for superficial BCCs are subsidised, however treating sun spots and solar keratosis are not.
Aldara for solar keratosis costs between $130-$300 – depending on the area used.
Aldara is subsidized under DVA, however PDT or photodynamic therapy is a better option.
Read more about photodynamic therapy
Sun damage can manifest as sun spots (solar keratoses) – rough, dry, red, often scaly areas on the face, hands and chest. These areas are pre-cancerous and may not resolve over time. The natural history of sunspots is to potentially worsen over time. Skin cancers can arise from solar keratoses. The risk of developing certain skin cancers can be proportional to the amount of solar keratoses.
The latest studies have shown that clearance rate of up to 85% can be expected after one Fraxel laser treatment, similar to the use of Efudix or PDT (photodynamic therapy).
Your skin cancer doctor will guide you as to what is the most effective treatment for YOUR type of sun damage.
One treatment with Fraxel can be extremely successful in decreasing the number of sunspots. Treatment is very well tolerated, and on average takes only 30 minutes to perform. It is relatively painless. Healing occurs within days of treatment. Another positive effect is skin rejuvenation (decrease in pigmentation, liver spots, and fine wrinkles).
No, not all sunspots will go following one treatment; however there will be a noticeable improvement.
For mild to moderate sundamage- one treatment to improve solar damage by 60-85%
For moderate to severe sundamage- two treatments to improve solar damage by 60-85%
*Your dermatologist will guide you as to the number of treatments you may require.
5-7 days. Your skin will be swollen from day 2-3, and then peeling from day 3-6. Most patients are comfortable to perform daily duties from day 3. You must refrain from exercise for 5 days after Fraxel 1927
Fraxel 1927 treatment will give you excellent improvement of sunspots, with the minimal downtime; further benefit includes skin rejuvenation. Patients should take note of other treatments available, and their pros and cons:
|Fraxel 1927
|5-7 days
|From $990
|Cost; may need two procedures if severe sun damage
|One off treatment, very quick recovery time – less than 7 d.
|Helps with skin rejuvenation
|21-28 days
|$160+ including follow up
|Downtime, follow up visit mid treatment
|Cost effective, works very well
|*Best option if downtime is not an issue and tolerable skin type
|PDT –photodynamic therapy
|7-8 days
|$2500- $3500Face and scalp
|Short downtime, very effective, one off application
|Good treatment for smaller areas of sun-damage. Eg upper lip
|5-7 days
|$150 for 5 cm by 5 cm
|Cost; variable levels of inflammation.
|Shorter downtime
|Variable inflammation; needs physician monitoring.
|4-8 weeks
|$300-$700 including follow ups
|Long treatment regime
|Limited use
The ideal treatment will depend on your down-time, severity of your sunspots, desire for skin rejuvenation, convenience and budget constraints. We do not suggest Fraxel as the ONLY treatment for solar keratoses; however it has significant advantages over other treatments. A discussion with your skin cancer specialist will provide a solution for your situation.
Cryotherapy is a useful treatment for solar keratosis (sunspots), viral warts, small seborrhoeic keratosis and superficial basal cell carcinomas (BCC).
Read more about treating sunspots and solar keratosis
There are variations of this treatment. The commonest method uses liquid nitrogen. This drops the temperature of skin extremely quickly to a temperature below freezing point. The nitrogen is applied through a "gun" that sprays the liquid nitrogen onto the skin or alternatively, it is applied with a cotton bud or similar.
The treated area will become red and swollen and a blister may develop. Blisters are best left alone, but can be burst with a sterile needle if they are uncomfortable.
Days 2 and 3 following treatment:
At this stage the skin becomes weepy. If the weeping is mild, leave it open to the air and you can safely wash the area with mild soap and water. If the weeping is excessive, cover the area with a dressing.
Days 3 to 4 following treatment:
At this stage a scab will form. The scab will remain in place for up to a week and then the area should heal without a mark. Do not pick at the scab as this can result in scarring. Occasionally following healing, the skin may be discoloured. More often than not this is temporary however it can be permanent.
Most treatment options have potential side effects and cryotherapy is no exception. The most common complication of cryotherapy is "hypopigmentation". This refers to the skin that is treated ending upbeing pale when compared withsurrounding skin. Hypopigmentation occurs due to the destruction of the pigment producing cells (melanocytes) within the skin that are not regenerated. The effects of hypopigmentation are more evident in those with darker complexions.
Uncommon side effects can include infection, damage to tissues beneath the skin and blood blisters. Most of these will resolve in time.
Sunspots, also known as solar keratosis or actinic keratosis are commonly seen on exposed areas of the hands, face, chest, and in balding men the scalp. Due to the high UV exposure and index in Brisbane, sunspots are very common. Most Queenslanders will have at least one solar keratosis before the age of 50.
Sunspots should be treated due to the precancerous potential of these lesions. Liquid nitrogen is very effective for treatment of a few lesions or sunspots, however if damage is extensive, you may require other forms of treatment.
Your Skin Cancer Doctor will discuss treatment options for you and tailor a program for your lifestyle and extent of sundamage.
Some creams and lasers we use include the following:
Picato Cream: This cream is a Brisbane invention and is now used all over the World for the treatment of sunspots and solar keratosis. Unlike Efudix treatment, the downtime following Picato is only 4-7 days.
Read more about Picato treatment for sunspots
Efudix: This cream is also called 5 FU and has been used to treat sunspots for well over 2 decades. It is cheap, effective but associated with a downtime of 4 weeks plus.
The active ingredient of Efudix is 5-Fluorouracil which is a form of chemotherapy drug. Abnormal (pre-cancer or cancer) cells will selectively absorb Efudix allowing the drug to kill the abnormal cells. The treatment will produce a skin reaction that typically develops over the first week of treatment with redness and slight scaling. Over the second week the reaction intensifies with increasing redness and crusting with resolution of the reaction occurring several weeks following cessation of treatment. A stronger reaction will be observed in those who have a greater number of abnormal cells in the skin. It is important not to stop the treatment because of the reaction. Efudix is highly effective in treating AKs, particularly when large areas of skin are affected. Repeated treatments may be required and this is perfectly safe.
Read more about Efudix Treatment for sunspots
Aldara: This cream is called Imiquimod, and stimulates your immune system. It is very effective in clearing sunspots, but treatment times can be prolonged.
Aldara works by stimulating the immune system causing the release a number of chemicals called cytokines that are necessary tofight viruses and destroy cancer cells. Aldara treatment usually requires application of the cream 2 times a week for 6 weeks to a defined area of skin that should be no larger than 5cm x 5cm.
Common side effects of Aldara include:
Less Common effects:
Read more about Aldara for the treatment of sun spots
PDT: Is also known as photodynamic therapy. This treatment is covered under DVA for Specialist treatment of sunspots. PDT is a once off application with downtime of less than a week.
The advantage of PDT is its ability to treat large areas of skin at one time making it a suitable treatment for patients with large "fields" of affected skin. Usually only one treatment is required for AKs with costs ranging from $1500 – $2500 AUD depending on the area treated. Although generally well tolerated, common side effects may include slight burning or stinging during treatment and mild swelling and redness similar to sunburn afterward. Peeling and redness subside after about week. Overall PDT results are usually very good with excellent cosmetic outcomes.
Read more about PDT for sun-damage
Fraxel 1927 laser: This is treatment not only clears sunspots but rejuvenates the skin. One treatment can clear the majority of sun-damage; however patients with extensive sun damage and sun spots may require additional treatments. Costing is an issue with laser, each treatment cost $990, and is NOT COVERED BY MEDICARE. Treatments are supervised by specialist laser dermatologist.
Fraxel is a fractional laser treatment that works on both the epidermis (top surface of the skin) as well as the dermis (middle layer of the skin) to produce a reaction beneath the skin's surface that eliminates old, damaged skin cells. Prior to treatment a topical anaesthetic cream is applied to prevent pain. Fraxel usually takes 20-40 minutes to perform depending on the area treated. Following treatment, mild swelling and a pinkish tone may be evident for about 3 days. Fraxel may be used on any area of the body with predictable results for all skin types and minimal disruption to a client's daily routine.
Read more about Fraxel 1927 for sunspots
Remember a mole doesn't always have to be brown and raised to be skin cancer – some skin cancers may be flat, pink, scaly or pearly.
Keep an eye out for the appearance of a new spot or mole, a mole that looks different to those around it, a mole or spot that has changed in appearance. Look for any skin sore that shows no signs of healing within 3-4 weeks.
Basal Cell Carcinoma (BCC)
These are the most common type of skin cancer, and they may look like an ulcerated sore that does not heal.
A nodular BCC looks pearly, and is a well-defined, pink or brown lump that is less than 1cm in size
Superficial BCC present as a dry, red, raised patch.
Squamous Cell Carcinoma (SCC)
Are usually scaly, crusty, red lesions that feel tender or sore. They might bleed and look like an ulcer.
Look for the ABCDE criteria of melanoma
A – Asymmetry, one side of the mole looks different from the other
B – Border, ragged or irregular outlines
C – Colour uneven colour with varying shades of brown or, sometimes, areas of white, grey, red, pink or blue
D – Diameter, Melanomas usually are larger in diameter than the size of the eraser on your pencil (about 6 mm), but they may sometimes be smaller when first detected.
E – Evolution, change in appearance over time.
Additional hints:
It is really important that you have good lightning
Examine carefully your face, particularly the nose, lips, mouth and the front and back of your ears.
If it is possible ask a family member or a friend to help you to examine those hard-to-see areas, such as your back, back of the neck, scalp and back of your thighs.
If you are female, lift your breasts to view the underside.
These recommendations are based upon the US Skin Cancer Foundation, and follow the general consensus of Skin Cancer Specialists.
0- Six Months (INFANTS)
Six Months to One Year old (BABIES)
Toddlers and Pre-school age
While anyone may develop melanoma, those with fair complexions and those who have a past history of frequent sunburns particularly as a child have anincreased risk. Other factors that increase your risk include a past history of non-melanoma skin cancer, a family history of melanoma, having many moles on your skin (>10 on your arms OR > 200 o your body), being immunosuppressed (eg: chemotherapy) and increasing age.
Melanoma develops when pigment containing cells (melanocytes) in the skin are transformed into cancer cells. Although melanoma development is complex and not completely understood, it is thought to involve interactions between environmental factors, genetic changes, and an impairment of DNA repair allowing cells to grow at an uncontrolled rate.
The growth of melanomas is thought to occur in three distinct steps. In the earliest stage, the melanoma may be confined to the most superficial layer of the skin (epidermis) and displays only horizontal growth where it is referred to as melanoma in-situ. As melanoma progresses, it can extend into deeper layers of the skin (the papillary dermis) where it becomes known as microinvasive melanoma. In the more advanced cases, melanoma continues to grow vertically and spread even deeper where itinvades the dermis of the skin where it then has the ability to spread to other areas of the body (metastasize), and is referred to as invasive melanoma.
Melamona may initially present itself as a new or unusual looking mole, freckle or patch on the skin. Melanoma can vary in appearance ranging from brown, tan, pink, red black or even blue. Despite being derived from pigment cells, not all melanomas have a colour, these melanomas are referred to as amelanotic melanoma. Melanomas are often asymmetric and may have an irregular border. In the early stage of growth where they remain on the superficial layer of the skin they are often flat. With further growth or as the melanoma invades deeper layers of the skin it may become thicker and become raised. Melanomas may be itchy or tender and with further growth of the lesions they may become crusted over and bleed.
Because melanomas can present in a variety of ways and have features that vary, it is advisable to get you're my skin clinic doctor or dermatologist to assess any new moles or any lesions of concern to you.
There are four main subtypes of melanoma: superficial spreading melanoma, nodular melanoma, lentigomaligna melanoma, and acrallentiginous melanoma. Rarer subtypes of melanoma include nevoid melanoma, desmoplastic melanoma, clear cell sarcoma, and solitary dermal melanoma.
Superficial spreading melanoma
Superficial spreading melanoma accounts for the majority of melanomas comprising 50-80% of all melanoma diagnoses. As its name suggests, it is a form of melanoma in which only the superficial layer of the skin is affected and the melanoma has only grown horizontally along the skin surface and vertical (deeper) growth has not yet occurred. It is most frequently seen on those areas of skin exposed to the sun such as the back in men and the lower limbs in women, however it may occur on any region of the body. These melanomas arise de novo yet can also occur within a pre existing mole.
When examined, a superficial spreading melanoma appears multicolored with a well definedand often irregular border. Typical presentations include lesions that have multiple shades of tan, brown, black, grey, purple, pink, and, rarely, blue areas and may possibly have small or localised whitish areas (hypopigmentation).
20 – 30% of diagnosed melanomas are of the Nodular melanoma type. This type of melanoma is characterized by the early onset of growth in a vertical direction, meaning cancer cells are seen in the deeper layers of the skin at an earlier time frame. Nodular melanoma is more common in men, and usually found on the trunk in men and legs in women.On examination, they appear as a uniformly dark brown, black, or blue-black pigmented lesions.
Lentigomaligna melanoma is seen most often in the elderly population, particularly those with a history of sun-damaged skin. This melanoma has a predilection for those areas of the skin regularly exposed to the sun such as the temples, nose, forehead, neck, and forearms.
On examination, lentigomaligna melanoma commonly presents as a slowly enlarging patch that is flat with variable pigment that may be tan, brown, and black in appearance. Additionally, the tumor is stereotypically asymmetrical with irregular borders. Lentigomaligna, while often small initially, can reach several inches in diameter if left untreated. This melanoma may take many years to reach the invasive stage of growth, however, immediate treatment is required if this melanoma is diagnosed.
Acrallentiginous melanoma is not a common melanoma seen in Brisbane and is most often reported in African American populations and those with darker complexions. It is the rarest subtype of melanoma, accounting for less than 5% of all melanomas.These melanomas are characteristically found on hairless areas of the body such as the nail bed, the palms and the underside of the feet.
On examination, an acrallentiginous melanoma regularly develops as a unevenly colored patch, usually brown or black, that has an irregular border and increases in size with time.The surface may feel raised to touch particularly when the tumor grows deeper into the skin and becomes invasive.
When this melanoma occurs in the nail bed it often appears as a brown or black longitudinal line extending from the cuticle to the tip of the nail.
When your doctor or dermatologists suspect melanoma they may use a dermatoscope to assess the lesion. Dermoscopy is a specialized technique that aids in the diagnosis of melanoma.
Should a lesion be suspected of being a melanoma is should be surgically excised along with a 2 to 3mm margin of normal skin surrounding the lesion. Following excision, this skin sample will be sent to a pathology laboratory where it can be examined under a microscope to confirm or rule out the diagnosis of melanoma. Smaller biopsies are avoided to improve diagnostic ability and also to attempt to remove the cancer before it has a chance to spread any further.
Following a confirmatory biopsy, the pathologist will provide a description of the melanoma based on specific features that will help guide further management. Further excision of surrounding tissue may be necessary to achieve appropriate clearance and to reduce risk of recurrence either at the site or of metastatic spread.
The cornerstone of melanoma treatment is surgical excision. For those melanomas that are small and more superficial, extensive surgery is often not necessary. Usually these lesions will be removed along with a margin of normal skin under local anaesthetic. In some cases a second surgery may be required when the pathologist is not satisfied that the margin of normal skin is cancer free.
A wider area of excision is necessary for those melanomas that are thicker (those over 1 mm). In some instances where a large portion of skin has to be removed, a skin graft may be required.
Mohs micrographic surgery is a specialized surgical technique that may be recommended when the melanoma occurs on delicate areas, such as the head and neck.
Radiotherapy has a very limited role in the treatment of melanoma because melanoma is known to be resistant to this form of therapy when compared with other forms of cancer. Radiotherapy may be used as an accessory therapy when obtaining adequate surgical margins has not been possible.
A biopsy of the lymph node that is the first in the chain of lymph nodes associated with the melanoma (Sentinel lymph node) is usually recommended for those melanomas that are more than 1 mm deep. The usefulness of a lymph node biopsy is in its ability to provide important prognostic information. Whether or not removing multiple lymph nodes (regional lymphadenectomy) provides any benefit to the patients survival is still not well known.
Superficial melanomas usually have a good prognosis.
Following the diagnosis and treatment of a melanoma there will be a life long risk of developing a second melanoma in the future. For this reason it is imperative that regular skin checks are carried out to ensure the early detection and management of new/recurrent tumors.
Self skin examinations are recommended along with regular follow up with your doctor or dermatologist. Suggested intervals of follow up with your doctor are six-monthly for five years for patients with stage 1 disease and every three months for five years for patients with stage 2 or 3 disease with yearly visits thereafter.
Sunscreen use is the cornerstone skin care regime in the lives of everyday Australians due to the high risk of skin cancer and other damage to the skin caused by the sun's rays.
UVA and UVB are forms of radiation emitted by the sun. These two forms of ultraviolet radiation are significant due to two main reasons: 1) they reach the skin 2) they have damaging effects on the skin. Choosing a correct sunscreen for your skin type and use is the key factor to effective photoprotection. Sunscreen use has been shown to decrease both sun damage, and reduce the incidence of non-melanoma skin cancers.
Apply sunscreen twice a day, 15-20 minutes before sun-exposure. Skin Cancer doctors endorse the use of La Roche Posay sunscreens.
Yes. Studies have shown that vitamin A, retinol, retinoic acid and various forms of 'retinoids' can reduce or even reverse sun damage. Active vitamin A creams have to be compounded or prescribed by your skin cancer doctor or dermatologist. Each patient should have a tailored mix of vitamin A cream, as putting too much cream can result in skin irritation
AHA or alpha hydroxy acids are best for sun damage skin, especially mild to moderate sun damage. They are best conducted by Specialist Dermatologists. AHA peels are also known as lunch time peels- no downtime peels. Patients will need a series of 5-7 peels over weeks to months for best results.
If your sun damage is very severe, you may benefit from a highly specialised peel called a medium depth TCA peel. This is conducted by Dr Davin S. Lim, Laser Dermatologist.
With the invention of Fraxel 1927 laser, most 'peel cases' are now treated with laser. Laser is less painful, equally as effective, and has less downtime compared to old fashioned TCA peels.
Read more about Fraxel for sunspots
Yes, new forms of laser therapy know was FRACTIONAL lasers can reduce sun damage and solar keratosis.
Laser treatment with Fraxel can be extremely successful in reducing sunspots. Treatments are very well tolerated, and on average takes only 30 minutes to perform. Healing occurs within days of treatment. Another positive effect is skin rejuvenation (decrease in pigmentation, liver spots, and fine wrinkles).
Depending on the amount of sun damage, patients will require between 1- 3 Fraxel laser sessions
Read more about Fraxel for sun-damage
If you are at high risk, picking up skin cancer early can be life saving!
High risk patients should see a skin cancer doctor every 3-6 months, especially if you have a personal or family history of melanoma.
High risk patients include-
Australia has one of the highest rates of skin cancer in the world. One in two Australians will develop skin cancer each year. The answer to this is to be sun smart, see a doctor regularly and undertake routine self skin checks.
It is strongly recommended that you examine your own skin every two to three months to get into a routine along with your yearly skin check by your GP, skin cancer specialist or Dermatologist. Examination is recommended monthly if you have a known history of skin cancer.
A self check exam can be an excellent method of early detection of skin cancer.
Read more about self skin examination
Skin surgery is the Gold Standard of treatment for –
In this group of skin cancers, surgery provides the highest cure rate.
Read more about SCC
Read more about BCCs
Read more about Melanomas
Surgery is performed in our operating theatres under very strict Queensland Health Guidelines. You will be given specific instructions prior to skin cancer surgery this includes-
The first step is the use of local anaesthetic to the area, prior to any surgery. All surgical cases at My Skin Clinics are conducted under 'local' and not 'general' anaesthetic. (I.e.you are fully awake for the procedure.) For patients who are anxious, we can provide mild sedation to make the procedure a more pleasant one!
Depending on the number of skin lesions removed, and the complexity of closure, you will be given an appropriate time slot ranging from 30 minutes to 90 minutes.
After surgery, dressings will be applied, and you will be given instructions on wound care. We will arrange a time for you to return for sutures or stitches to be removed.
All moles and lesions we remove are 'tested under the microscope' for final results.
Yes, providing the skin cancer CAN be safely treated with other methods. Only some forms of superficial skin cancers can be safely treated by methods such as Photodynamic Therapy, Aldara, Double Freezing, or cautery.
Examples of skin cancers that can be treated with non- surgical methods include-
Photodynamic Therapy is the most convenient method for treating thin cancers. This involves the use of a special cream concentrated in cancer cells. Following application of the cream, as laser- light source activates the chemical several hours later. Most skin cancers will require 2 treatments spaced a week or two apart.
Read more about Photodynamic Therapy for skin cancers
The number of stitches you will have depends on the location of the skin cancer and the size of the wound. More stitches are required if your wound is large, and if internal sutures are used.
Flaps and grafts will require more stitches compared to a normal or simple surgical wound. Your skin cancer specialist will tell you the number of sutures after surgery.
Suture removal timings will depend on several factors including the location of the wound the complexity of wound closure.
As a guide-
Suture removal and wound checks are conducted by our Specialist Nurses.
Yes. In some situations we use special self-dissolving sutures- this provides maximal wound strength.
Self-dissolving sutures are used in wounds on the lower limbs and in some operations on the face and scalp.
We consider many other factors such as skin mobility, tension of the wound, wound size and contour, and location of the skin cancer as to whether or not dissolving sutures are used.
Scars will be visible after skin cancer surgery; however with proper care and time, they will improve.
Following suture removal, scars are at their weakest, and extra care need to be taken not to over-exert the wound. Scars are often red and inflamed, however with proper taping, cleaning and time, will start to fade.
Complete scar remodelling does not occur for up to 6-12 months following skin surgery.
Looking after you wound is essential after surgery. Our skin cancer doctors will give you helpful instructions to minimise scars after surgery, including-
Proper wound care= Best scar results.
Scarring often fades with time, however if scarring is still significant after a few months, specialist laser dermatologists can fade the scar. Specialists use a variety of scar removal techniques including surgery, steroid injections, ablative and Fractional – Fraxel laser.
Read more about scar revision following surgery
Moh's surgery is a special form of skin cancer surgery, pioneered in the United States. This type of skin cancer surgery is performed in hospital, under the guidance of a team of Specialist including Dermatologists and Plastic Surgeons.
The vast majority of skin cancers will NOT require Moh's surgery, however if you skin cancer exhibits very aggressive histology and margins involvement, your skin cancer doctor will work in with a Dermatologist- Plastic Surgeon for consideration of 'margin control.'
This may involve Moh's with a Dermatologist, or 'Frozen section control' under a plastic surgeon such as Dr Eddie Cheng, Dr Andrew Jenkins, Dr Phil Richardson, or Dr James Emmett.
Dr Davin S. Lim
Laser Dermatologist
Westside Laser Dermatology
Skin cancer surgery forms the basis of our cancer cure at My Skin Cancer Centre. Surgery is the only option, however in many cases maybe the very best option for a particular type of skin cancer. Skin cancers that are suited to surgery include solid and invasive BCCs, as well as SCCs, moles and melanomas.
Planning your excision with carefully placed incision lines, as well as correct surgical technique, and closures will provide optimal cure rates, whilst minimising scarring.
Most skin cancers require 'simple surgery', whilst larger or aggressive skin cancers in areas such as the nose, eyelids, and ears may require more complex closures such as flaps or skin grafts.
Solar keratosis or sunspots are very common pre cancerous lesions, seen in over 25% of Brisbane's population over the age of 40. The high UV radiation in Queensland predisposes their residents to sun-damage and solar keratosis.
Solar keratosis, also known as sunspots, present as red, scaly, rough, dry and sometimes stingy persistent patches on the face, neck and hands. Sun spots should be treated due to their pre cancerous potential. Treatment depends on your age, location of sunspots, and your lifestyle.
Read more about treating solar keratosis – sunspots
Efudix is also known as 5FU or FLUROURACIL topical. This is chemotherapy for sun spots, solar keratosis, and some forms of skin cancer including intraepidermal cancers (Bowen's disease or SCC insitu). It does not work well for the treatment of BCC or Basal Cell Cancers.
Efudix is a chemotherapy and works by destroying abnormal skin cells, cancerous cells and pre cancer. The more sun-damage you have, the bigger the reaction.
Patients need to apply the cream twice a day for a specified time frame (on average 3 weeks to allocated areas.
All patients should receive some form of reaction after applying Efudix to sunspots. The more sunspots your have, the larger the reaction, or inflammation you will receive.
Day 1-4: Mild reaction, not much may happen during the first few days of treatment, persist as per application guide.
Day 4-8: Efudix starts kicking in, and the skin will be red, slightly at first, increasing as the days go by.
Day 8-14: This is when things really start to cook. The skin may have a mild, moderate or severe stinging or burning sensation, and you may start to itch. Dry crusty areas will form. Your skin is now looking angry and irritated. These are all normal reactions following Efudix application. As the treatment continues, sores and crust may appear.
Day 14-21: You will need to see your Specialist or skin cancer doctor during this period. During this appointment, we will check your progress, and determine how much longer you should be on the cream. We may prescribe an anti-inflammatory cream to help you recover from Efudix once the treatment stops.
Day 21-28: Your skin will start to heal. Slowly at first, then more rapidly after 3 days of stopping Efudix. Redness may take a few weeks or months to settle.
Efudix can be used to treat either sun-spots, also known as solar keratosis or for the treatment of Bowen's Disease. Treatment protocols will vary, however as a guide, Efudix is used-
Your skin cancer doctor- specialist will give you an extensive and comprehensive treatment guide before you commence on Efudix treatment.
As a guide, you will need to be on Efudix for 2- 8 weeks. Treatment intervals depends on –
Most treatment regimes are tailored according to your skin condition and lifestyle factors.
Efudix has a great safety record spanning over two decades, however this treatment should not be used if-
Efudix treatment, after 20 years, is still an excellent method for the management of sun spots and sun damage; however you will need to limit your lifestyle during the treatment. This includes-
Time limits will vary between 2-8 weeks, depending on your treatment regime for sun spot clearance.
No. The treated areas should NOT be covered with makeup or sunscreen. You may start using cosmetics and skin care 3-5 days after stopping Efudix Cream.
Redness will ensure for the course of treatment, and will take upto 3-4 weeks to settle down. In patients who are red to begin with (rosacea type skin), Efudix is not the first choice treatment. Treatment with either 1927 Fraxel Laser or with PDT is considered a better choice in this patient subgroup.
In most patients, redness following Efudix treatment will start to settle within 3-5 days of stopping the treatment.
Specialists and leading skin cancer doctors can give you treatment options for removing sunspots, apart from Efudix. Treatments such as Fraxel Laser or PDT can be an excellent method of sunspot removal, without the 4 week downtime of Efudix. A suitable treatment will depend on downtime, convenience, and costing for each patient.
|Fraxel 1927
|5-7 days
|From $990
|Cost; may need two procedures if severe sun damage
|One off treatment, very quick recovery time – less than 7 d.
|Helps with skin rejuvenation
|21-28 days
|$160+ including follow up
|Downtime, follow up visit mid treatment
|Cost effective, works very well
|*Best option if downtime is not an issue and tolerable skin type
|PDT –photodynamic therapy
|7-8 days
|$2500- $3500Face and scalp
|Short downtime, very effective, one off application
|Good treatment for smaller areas of sun-damage. Eg upper lip
|5-7 days
|$150 for 5 cm by 5 cm
|Cost; variable levels of inflammation.
|Shorter downtime
|Variable inflammation; needs physician monitoring.
|4-8 weeks
|$300-$700 including follow ups
|Long treatment regime
|Limited use
Regardless of bad press, Efudix is still considered a very effective and cost effective treatment for sun spots, solar keratosis and sun damage. The downside of this treatment is the prolonged regime of Efudix. Downtime can be up to 8 weeks or longer.
Shorter treatments for sunspots include –
Read more about Fraxel laser for sunspots
Read more about PDT
By far the most common risk factor for IEC is frequent excess sun exposure. Prior radiotherapy to the affected skin is a further risk factor as is previous exposure to the chemical arsenic, however, this remains a rare cause. In those who have to take medications to lower their immunity (for example, people who have had an organ transplant) there exists an increased risk for developing IEC. Occasionally, IEC can develop on the genital area and is usually linked with the human papilloma virus.
IEC can be diagnosed by taking a small sample of the affected skin (biopsy). If you're my Skin Cancer doctor suspects you may have an IEC he/she will use a local anaesthetic to numb the affected skin prior to performing a biopsy. A pathologist will examine the sample of skin under a microscope to provide you with a diagnosis.
Avoid indoor tanning.
IECs can be similar in appearance to several other skin conditions such as:
There are a number of different treatment options available for management of IEC. The type of treatment selected will depend on where the IEC is located, its size, thickness and how many there are.
Liquid nitrogen is sprayed on to the affected area to freeze it. This treatment is suitable for small, flat patches of IEC. After treatment, you will have a scab, which usually falls off within a few weeks. This removes the affected skin.
Creams (topical therapy)
A chemotherapy (anti-cancer treatment) cream called 5-fluorouracil (Efudix), may be used. Clinical studies have shown 5FU to be efficacious in clearing IEC with cure rates of 66-93% reported. Treatment appears to be most successful when Efudix is applied once or twice a day for 6-16 weeks. It can make the skin red and inflamed following treatment. Usually there are no other side effects.
Another cream commonly used is Imiquimod (Aldara), which works by stimulating the immune system to kill the abnormal cells. Treatment takes several weeks and usually causes redness and inflammation to the treated skin
Curettage and Electrocautery
When small patches of IECs are present they may be scraped away (curettage) followed by the use of an electrically heated needle (electrocautery)to stop any bleeding and destroy any remaining abnormal cells. A local anaesthetic is given prior to the procedure to prevent pain and discomfort.
Surgery may be used for isolated or small areas of IEC that can removed under local anaesthetic.
are carrying out research trials to find out how effective this treatment is in the long term.
Photodynamic therapy (PDT)
PDT or Photodynamic therapy can be an excellent method of treating skin cancers such as IECs or thin- superficial BCCs. This is a non-surgical treatment for skin cancer that has a very high cure rate, if performed in the correct setting.
PDT uses a special cream called METVIX, which is applied to the skin cancer. The cancerous cells of IECs and BCCs take up this chemical over a period of 3 hours. A special low level laser light then activates the chemical, and destroys the skin cancer cells. Patients will require two treatments spaced a week or two apart.
The advantages of PDT over surgery include-
PDT is ideal for IECs on cosmetically sensitive areas such as the face, or for IECs that occur on the legs.
Read more about PDT for skin cancers
For those who have larger areas of skin affected by IECs, PDT can be very useful. Clinical trials have shown cure rates from PDT to be to other conventional treatments such as cryotherapy or surgery. The benefit of PDT is that it selectively targets abnormal/cancer cells without affecting the normalhealthy cells therefore cosmetic outcomes are improved.
No. 95% of IECs can be treated with PDT, however IECs on the scalp or in the brow line will need to be treated with surgery. This is because skin cancer cells extend deep into the hair follicle in these areas, out of reach from PDT methods. Your Skin Cancer Doctor will guide you in regards to which skin cancers can benefit from PDT.
People who have had IECs are at greater risk of developing other forms of skin cancer such as squamous cell carcinoma, basal cell carcinoma or melanoma. It is therefore important for people treated for IEC to continue to have regular skin checks performed by their GP, My Skin Cancer doctor or Dermatologist.