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Skin Cancer

Dr McGovern has performed literally thousands of skin cancer removals since starting practice in 1994. We treat skin cancer seriously at Vie Institute and guarantee to see you within 3 weeks of your GP’s skin cancer diagnosis. If your GP would like you seen more quickly, we will see you within a week.

All melanomas are seen within the week and surgery is scheduled for the next available operating list, which is generally the same week, or the following week.

Each and every person that presents with a skin cancer is different and the surgery required to repair the defect left by the removal of the cancer, is markedly different – particularly when the cancer is on your face.

Any doctor can cut out your skin cancer, but if you want to not look like you have had surgery, ask for a referral to Dr McGovern. As a Specialist Plastic Surgeon with over 25 years of experience, Dr McGovern will choose a method of reconstructing the defect left from removing the skin cancer so you do NOT look like you have had surgery.

Dr McGovern is renowned for the amazing results he achieves with facial skin cancer reconstruction. Within a couple of weeks scars have faded remarkably and within a couple of months most people cannot see where the surgery has been!

A FEW FACTS ABOUT SKIN CANCER

  • The Sunshine Coast has the highest rate of skin cancer in the world.
  • Once you have been diagnosed with a skin cancer you have a 50% increased risk of further skin cancers within 2 years.
  • Skin cancer occurs when skin cells are damaged by cumulative exposure to ultraviolet (UV) radiation from the sun and solarium tanning beds and usually manifests itself many years after sustained exposure.
  • The two types of UV radiation that causes skin cancers are UVA rays which cause the skin to age and are much the same strength at all times of the day and UVA rays which cause skin cancer and are strongest between 10am and 3pm.
  • Non-melanoma skin cancers are the most common in Australia.
  • The two main types include basal cell carcinoma and squamous cell carcinoma with a third group of lesions called keratinocyte dysplasia’s.
  • Skin cancers can grow quickly, while others are very slow.
  • The larger the skin cancer, the more surgery is required, the more scaring involved and the more cost to you. Medicare costs these according to their size!
  • It is best to get your skin cancer attended to as soon as possible.
  • Most skin cancers treated appropriately and in a suitable time frame by an experienced plastic surgeon will not recur or be apparent to others.

TYPES OF SKIN CANCER

Basal Cell Carcinoma (BCC)

The most common form of skin cancer, comprising about 80% of all skin cancers. BCC’s are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells (the outermost layer of the skin). They typically grow over a period of weeks to months and if left untreated often look like open sores, red patches, pink growths or shiny bumps that involve the surrounding tissue.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma comprise the remaining 20% of skin cancer. They are an uncontrolled growth of abnormal cells arising in the squamous cells (the most upper layer of the skin) and are more rapidly growing than the BCC’s. They often appear like open sores, scaly red patches, elevated growths with a central depression, or warts which may crust or bleed. If left untreated they can become disfiguring and can spread to other parts of the body. SCC’s may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs. Often the skin in these areas reveals tell tale signs of sun damage, including wrinkles, pigment changes, freckles, “age spots”, loss of elasticity, and broken blood vessels.

Keratinocyte Dysplasias Keratinocyte dysplasia’s are a group of non-invasive cancers that require treatment to reduce the risk of development into non-melanoma skin cancers. These lesions include solar keratosis, Bowenoid keratosis and Squamous cell carcinoma in-situ (Bowen’s disease).

Melanoma

Melanoma is a form of cancer that develops in skin’s pigment cells called melanocytes. It is the most dangerous form of skin cancer and grows very rapidly if left untreated. It can spread to other parts of the body including the lymphatic system, liver, lungs, brain and bone. Often melanoma has no symptoms, however it can be associated with changes in a mole that relate to asymmetry, irregular border, uneven colour, diameter usually greater than 6mm or an evolving (changing and growing) lesions. Diagnosis is by biopsy to remove the whole lesion.

TYPES OF SURGICAL PROCEDURES USED TO TREAT SKIN CANCER

  • All skin cancers need to be removed.
  • The earlier the diagnosis, the less surgery will be required to remove it.
  • Some common skin cancers can be treated with Efudix or Aldara ointments or radiation therapy, however in most cases surgical removal is required.
  • If a skin cancer is very small it may be able to be removed with a direct excision.
  • Skin cancers on the lower leg generally require a split skin graft for best results, as there is very little spare tissue on the lower leg.
  • Skin cancers on the face, particularly around the nose, are best treated with a flap repair (see below)
  • Skin cancers on the lips may require a wedge excision or stair-plasty to avoid distorting the lip shape and size.
  • Excessive sun damage and skin cancers on the lips may require a vermilionectomy.
  • Skin cancers on the ear many doctors simply cut out leaving a deformity. Dr McGovern will do a wedge if the cancer is small and close to the edge of the ear. Otherwise he will do flap repair including reshaping the cartilage so the ear looks normal as a result

Simple Excision The skin cancer is excised as an ellipse with a margin of normal tissue. The incisions length is generally 2 to 3 times the diameter of the skin cancer.

Wedge Excision A technique used if the skin cancer involves the edge of a lip, nose and ear. It involves a full thickness wedge of tissue being removed and provides the most aesthetically pleasing result.

Local Flap Flap repair surgery involves moving the skin and tissue that has its own blood supply in a variety of directions to minimise redundant skin removal and maximise the cosmetic outcome for the patient.

Rotation Flaps Rotation flap surgery involves removing the skin cancer in a wedge shape and then rotating adjacent skin in an arc to close the defect left from the cancers removal.

Skin Graft A skin graft involves removing skin from one part of your body and transplanting it to a different part.

Split Skin Graft Split skin graft involves removing the top two levels of the skin (epidermis and dermis) from a donor site. Split skin grafts are used to cover larger areas of defect.

Full Thickness Skin Graft A full thickness graft involves removing the epidermis and the entire thickness of the dermis from a donor site. Full-thickness grafts are generally used for reconstructing smaller defects where optimal aesthetic result is necessary, such as the face.

Stair-plasty Is used for very large skin cancers on the lower lip in particular. To avoid shortening one side of the lip significantly a series of Z-shaped incisions are made to reconstruct the area to allow for maximal movement and an optimal long-term result .

Vermilionectomy is used when you have diffuse sun damage and skin cancers over the lip. Generally the lower lip as this gets more sun exposure. Basically the entire sun-damaged area is removed in an ellipse the length of the lip. The lip is thinner as a result, but the scars are impossible to see. A good reason to ensure you wear sun protection on your lips!

MAKING AN APPOINTMENT TO SEE DR McGOVERN

  • As mentioned, when you call to make an appointment for a skin cancer removal, we will want to see you quickly, as skin cancers can grow quickly.
  • Your initial consultation with Dr McGovern to discuss treatment options will cost $150, with your GP’s referral you will receive a Medicare rebate of $73.85 (2019).

YOUR APPOINTMENT WITH DR McGOVERN

  • Please arrive 10 minutes early for your appointment so that all relevant paper-work can be completed.
  • We are very happy if you bring someone with you to the appointment. A lot of the information you will be given will be unfamiliar and it is always good to have an extra set of ears.
  • Your appointment with Dr McGovern is 15 minutes.
  • He will examine you, and explain the type of skin cancer he believes you have, if this has not already been biopsy proven by your GP.
  • He will explain what surgery he has to perform.
  • He will answer all your questions.
  • Dr McGovern will then take you to our theatre booking staff who will discuss surgical costs and available dates with you.
  • This entire process should take about an hour.

COSTS OF REMOVING SKIN CANCER

  • The cost of your procedure will depend on a few variables(explained below)
  • Our theatre booking staff will give you quote according to the procedure (and item numbers) Dr McGovern is planning on performing.
  • These costs may change, but generally only if you decide not to proceed with surgery for a while – as your skin cancer can grow in size and require more extensive surgery.
  • We will explain all of your out-of-pocket costs in detail at this appointment.

The cost of removing skin cancer if you are insured

  • If you have top hospital cover, your hospital costs should be covered, except for any co-payments or excess you may have agreed upon with your health insurer.
  • Private health insurance will cover your surgery under twilight sedation at the Sunshine Coast Day Surgery or the Buderim Privae Hospital.
  • Dr McGovern’s fee and your anaesthetic fee will be partly covered by Medicare and your private health fund.

The cost of removing skin cancer if you are not insured

  • If you are uninsured and your skin cancer we your skin cancer is small, we can perform the procedure under local anaesthetic in our rooms to reduce your costs.
  • Local anaesthetic is like going to the dentist.
  • If your skin cancer is too large to be operated on under local anaesthetic, you will have to have this done under twilight sedation at one of the local hospitals.
  • You will incur hospital fees and anaesthetic fees.
  • Our staff can help you find out these costs.

WHAT TYPE OF ANAESTHETIC IS USED FOR SKIN CANCER SURGERY?

  • For smaller procedures, we will choose local anaesthetic only and this can be done in our rooms.
  • In most cases a combination of sedation with a light anaesthetic is used. This is performed by an anaesthetist (we don’t use GP’s for our anaesthetics) in a day hospital facility.

DO I HAVE TO STAY IN HOSPTAL AFTER SKIN CANCER SURGERY?

  • Generally skin cancer surgery is scheduled as a day procedure.
  • If done in a hospital day surgery unit, You will spend 2-3 hours in recovery following your procedure
  • Please note, you are unable to drive yourself as you have had anaesthetic.
  • If your skin cancer/s are on your lower legs, you may find it easier to stay in hospital for a few days as keeping your legs elevated as much as possible aids the healing process immensely.

WILL I HAVE ANY DRESSINGS OR GARMENTS AFTER SKIN CANCER SURGERY?

  • If your surgery is on the face, we ask that you keep dry for 48 hours and apply an antibiotic ointment to the surgical incision twice per day until we see you the Tuesday following your surgery
  • If you have a dressing over the wound, we ask that you keep this day and intact until your first post-operative visit.
  • We try to keep things simple for you every step of the way.

WHAT LIMITATIONS TO MY NORMAL ACTIVITIES ARE REQUIRED AFTER SKIN CANCER SURGERY?

  • It is important to avoid any activity which will increase your blood pressure after surgery, as this can cause unwanted bleeding.
  • Therefore no strenuous activities following surgery. No heavy lifting, sporting activities or strenuous workouts for two weeks following your procedure.
  • You can generally return to work the day following surgery. If you are in a position in the public eye, you may want to take a week off work.

HOW OFTEN WILL I NEED TO SEE DR MCGOVERN AFTER SKIN CANCER SURGERY?

  • Surgery is scheduled for either a Wednesday or a Thursday and your first postoperative appointment will be the following Tuesday in Dr McGovern’s rooms.
  • If dressings are in place they will be taken down, the surgical site cleaned and often sutures will be removed on that appointment.
  • You may need a follow-up appointment in two days, then the following week and a final three month appointment with Dr McGovern.

HOW DO I PREPARE FOR SKIN CANCER SURGERY?

  • It is important to stop smoking prior to surgery as it greatly increases your risks of complications.
  • Cease any medications and vitamins that will interfere with your surgery. Please discuss these with our staff.
  • It is advisable to be as fit and healthy as possible prior to surgery.
  • We recommend boosting your immune system with anti-oxidants, vitamins and supplements which greatly reduce the risks of surgery and help with recovery.
  • Ours staff can help you with any queries you may have about medications etc

RECOVERY AFTER SKIN CANCER SURGERY

  • If you are having surgery at Buderim Private Hospital or Sunshine Coast Day Surgery you will be admitted 1 ½ hours prior to surgery and recover for approximately 2 hours post procedure.
  • If your surgery is a Vie Institute you will be required to present to reception 15 minutes prior to your procedure time. Dr McGovern will discuss the length of your surgery at your consultation.
  • Once we have removed your skin cancer and you’ve healed, we will talk to you about effective means of skin cancer prevention.
  • It is important that you make a habit of checking your own skin. If you find any new lump, bump, or even an area of scaly skin, you should make an appointment with your GP to check your skin.
  • If your GP is concerned about the lump, ask for a referral to Dr McGovern.

HOW LONG BEFORE I WILL SEE THE FINAL RESULTS OF SKIN CANCER SURGERY?

  • It can take three months for the swelling to completely resolve, whilst scars can take 18 months to fully mature.

 

HOW TO AVOID GETTING SKIN CANCER

Your skin is not only your largest organ, but also the most obvious, demonstration of your health and youthfulness, and the organ most likely to develop cancer in your lifetime.

Look after it well, and it will look after you…

  • Firstly, avoid extrinsic damage. Smoking and air pollution damage skin.
    In particular, UV light causes free radical damage to collagen and elastin, as well as cellular DNA. This causes both photo-ageing and skin cancer.
  • Applying sunscreens liberally and frequently when in the sun is important. If you have already developed skin cancer, use a sunscreen with an SPF of at least 50.
  • Avoid sun exposures between 10am and 4pm, where possible.
  • Once you have developed your first skin cancer, you are very likely indeed to have many more, unless a pro-active approach is adopted
  • About 50% of people develop a second skin cancer within two years, and almost all then develop skin cancers with ever increasing frequency. After all, much of your skin will have had similar levels of ultraviolet ray induced sun damage.
  • Sun protection alone is not sufficient, but is important to prevent further damage Sun protection done correctly, will predictably result in vitamin D deficiency as your body only makes vitamin D in response to UV light.
  • Vitamin D deficiency is terrifically bad for your general health, and roughly doubles or triples rates of death from all causes. It is easy to boost vitamin D levels with oral supplementation.
  • There is excellent evidence in the anti-ageing medical literature that the optimal dosage of oral vitamin D supplementation is about 8,000 to 9,000IU (International Units), and not the 1,000IU frequently prescribed.
  • The Life Extension Foundation, a non-profit organisation running out of the USA since 1978, makes arguably the worlds best multi-vitamins. Their “Two per Day” multivitamin contains 2,000IU Vitamin D and is accompanied by their “Vitamin D 7,000IU”tablet for a total dosage of the optimal 9,000IU. No over dosage or toxicity has ever been reported at this dose.
  • There is some evidence that high vitamin D levels may be independently protective against skin cancer.
  • There is also limited evidence suggesting that low-dose aspirin, the diurnal rhythm hormone melatonin, and the diabetes drug metformin may all be protective against skin cancer, also.
  • Fish oil supplementation may also be beneficial.
  • In terms of skin cancer prevention, there is a very high level of scientific validation that three interventions progressively reverse accumulated sun damage and progressively lower skin cancer risk. These are:
  1. Tretinoin creams – this prescription form of vitamin A is applied topically to sun-damaged skin at night. It cures most solar keratosis (or sunspots) over a 12 month period, and is shown to significantly reduce skin cancer risk after that period of use. It is also widely used to improve the lines and wrinkles of photo-ageing, with this effect noticeable within a few months.
  2. Niacinamide creams – this non-prescription vitamin B3 cream is used each morning, and has exactly the same effects as Tretinoin creams.
  3. Niacinamide supplements – taken in a daily dose of 1,000mg per day, vitamin B3 prevents skin cancer throughout the body, with reduced risk evident within a few months. The Life Extension Foundations “Shade factor” supplements includes this dose of vitamin B3, and two other ingredients. Extracts of the South American firm, Polypodiumleucotomos, and also a blood orange extract, are both shown to reduce UV damage and associated inflammation. They appear to cause the skin to behave as if an SPF4 sunscreen were present, which is to say, they reduce UV damage by perhaps 80%.

Of course prevention is where the money’s at.
Starting these good skin habits early is the key.
We would recommend starting the vitamin creams in your late twenties, as this is when the first signs of photo-ageing (sun damage) start to appear.

The Sunshine Coast has the world’s highest incidence of skin cancer. If you are now part of that statistic, avail yourself of these scientifically proven means of reversing the carcinogenic and cosmetic adverse effects of sun damage.

Please ask our friendly staff for a complimentary skin consultation…