Mrs Dalia V Nield FRCS(Ed)   FRCS(Eng)

CONSULTANT PLASTIC AND RECONSTRUCTIVE SURGEON

Formerly Consultant at
St Bartholemew´s and Homerton Hospitals

  5 Devonshire Place   London W1G 6HL   Telephone 020 7616 7693


PROCEDURES: Skin Cancer

Introduction

'Skin Cancer can present as skin lesions that do not go away, grow, have unusual shape or colour or ulcerate. They may affect any part of the body. There seems to be a relationship with history of sunburn and exposure to elements like wind, for example sailors have a higher incidence of certain types of skin cancer.
There are different types of Skin Cancer, some relatively 'benign' and some very dangerous.
The relatively benign ones are curable with treatment and do not represent a risk to life. The very dangerous ones can spread through the body and can cause death. In both these extremes, an accurate early diagnosis and treatment is very successful. Everyday we are learning more about the nature of cancer and education of the public is paramount in the satisfactory outcome of its treatment.

Diagnosis and Treatment

'There are skin lesions known as pre-cancerous ones, like Actinic or Solar Keratosis (damage of the skin by excessive exposure to sun) that look like red patches with a rough surface which do not get better on their own. These are treated with special creams or photo therapy and may not need surgery. (Photo)
It is very important to seek help early from your own Doctor or a Specialist if you have a skin lesion that does not go away or looks strange.
'The most 'benign' type of skin cancer is the BCC or Rodent Ulcer, so-called because it gnaws at all the adjacent structures, including bone and deep structures. It is very slow growing and frequently ulcerates (like a spot that never heals). BCCs do not spread or disseminate and cause death. This type of skin cancer is cured by surgery or radiotherapy. (Photo) Next, is the Squamous Cell Carcinoma or SCC, which grows faster, spreads and can represent a risk to life if not treated in time. (Photo)
'At the other end of the spectrum is the Malignant Melanoma (MM), which can be very aggressive and cause death. (Photo) This type of tumour is pigmented, brown or black, and can arise from an old mole or from a new one. Moles affected by sunburn or sun beds can change into skin cancer. The changes can be in size, colour or shape. If an old mole looks different, either gets larger, thicker, bleeds, itches or changes colour and shape you must consult your Doctor or a Specialist. Or indeed, if a strange new mole appears. Moles in the palm of the hands or the soles of the feet and the nail beds need to be seen.
Malignant Melanomas can be treated successfully if diagnosed early. The treatment is either surgery or a mixture of surgery, chemotherapy and radiotherapy.
'There is a Syndrome, or clinical presentation, known as Dysplastic Mole Syndrome in which the patient has multiple 'strange-looking' moles all over the body. (Photo) The moles can be very dark or larger than usual with irregular borders and pigmentation. This type of mole has a low incidence of MM, but more than a normal looking mole. Therefore, they have to be 'mapped' and followed up for life and some of them will need surgery if changes arise.

Mole Mapping and Computer-aided Dermatoscopy

'Mole mapping (Photographic Survey) consists in photographing all moles (mapping) from head to toe to produce a record (folder) for the use of the specialist and the patient to assess changes in his/her moles. The patient keeps the folder at home and can compare changes that need to be checked by the Specialist as soon as possible. Otherwise the patient is reviewed yearly for life. If the patient moves to a different city or country, he/she carries his/her folder with them to a local Plastic Surgeon as advised.
Looking after Dysplastic moles in this careful way, means that this patient will probably end up with some scars from surgical excision of moles with early changes but rarely with a Malignant Melanoma.
'Computer-aided Dermatoscopy uses a hand-held 'Dermogenius' to magnify 10 to 14 X a photograph of a mole and a computer programme that analyses the characteristics of the mole giving an index DSDP (Digital Standardized Dermatoscopic Point score) that helps the surgeon discover Malignant Melanomas at an early, curable stage. It also avoids unnecessary surgery in pigmented skin lesions.
'Mole Mapping is available at the London Clinic where Mrs. Nield has her rooms and she is able to carry out Dermatoscopy of suspicious moles during your consultation.