Skin cancer is the most common cancer in Ireland. Its prevalence is rising each year.
The common and relevant skin cancers in the Caucasian population are:
Unfortunately, not all skin cancers can be diagnosed clinically as some of the skin cancers can appear normal-looking with no specific signs.
Similarly, some benign-looking lesions could be a skin cancer or in the phase of developing into a cancerous lesion (in-situ lesion). As such, patients are strongly encouraged to perform regular self-examination of skin lesion or moles. If in doubt, a visit to the GP is strongly encouraged as the first access to the cancer treatment pathways.
Early skin cancer detection can dramatically improve patient outcome and reduce the risk of permanent disfigurement and potential requirement for complex reconstructive surgery. As such, a close working relationship with General Practitioners (GPs) with a special interest in early skin cancer detection is vital for early detection and treatment. In my practice I work closely with Dr Steve Karagiannis, a very skilled GP with a special interest in early skin cancer detection, diagnosis and treatments. He runs various Skin Check Clinics in Dublin. Further information can be found at www.skincheck.ie.
The following links are a good introduction to Skin Cancer in Ireland and UK
The plastic surgeon works closely with the GP, the dermatologist, histopathologist and oncologist in the management of patients with skin cancer. Biopsy (sample of tissue taken from the lesion for laboratory examination) is sometimes indicated in cases of uncertain clinical diagnosis. The management of skin cancer is guided by clinical guidelines, which is based on the evidence-based medicine to facilitate the delivery of optimum clinical care.
Surgery remains the most effective way of removing skin cancer in most patients. Skin lesions are commonly found in the head and neck regions. Sensitive cosmetic areas such as the face require careful excision to ensure optimum outcome. In some patients, a defect will not be able to close directly following excision of a lesion. Thus, various plastic and reconstructive surgery techniques, including the design of specific local flaps and skin grafts, are used to reconstruct the defect with as little disruption to the facial aesthetics as possible.
The goal in skin cancer was initially, and still is, to focus on the complete removal of the skin cancer, but with increasing emphasis on achieving optimum form and function following excision of the skin cancer.
The skin cancer situated around the eye, the nose and the lip areas can be very disfiguring, which can be caused by the skin cancer itself or following skin cancer excision. A methodical approach and individualised approach to reconstructing the defect can achieve good outcomes, both in form and function, as more robust plastic and reconstructive surgical techniques are discovered and applied in skin cancer surgery.
In summary, a multidisciplinary team approach to the care of patients with skin cancer is the way forward for optimum patient care. Of note, in certain patients, sentinel lymph node biopsy (surgical excision and examination of some lymph nodes under microscope) followed by formal excision and reconstructive surgery is indicated, especially in patients with melanoma and also in some patients with squamous cell carcinoma. Additionally, some patients may be eligible for inclusion in some clinical trials, especially patients with melanoma. The majority of patients should achieve good outcomes with skin cancer, including patients with melanoma, if diagnosis is made at an early stage of the disease.