New Zealand has one of the highest rates of skin cancer in the world. Squamous cell carcinoma (SCC), Basal cell carcinoma (BCC) and Melanoma are the most common.
In Northland, Mr Patel operates on the majority of patients with a Melanoma skin cancer, and has vast experience in this area. He also discusses most of his cases at the Melanoma multidisciplinary meeting run through Auckland.
Mr Patel operates on all types of skin cancer. He spent 12 months at the Peter MacCullam Cancer Centre in Melbourne gaining further experience in Melanoma cancer surgery and treatment as part of his fellowship in 2015.
Most patients who see Mr Patel would have an SCC, BCC or melanoma diagnosed after either a punch biopsy or an excisional biopsy has been performed under local anaesthetic by their GP.
During your consultation with Mr Patel, he will take a thorough medical history and a thorough history of the skin cancer diagnosis, including a thorough examination of the lesion (or the scar) and the draining lymph nodes. He will then recommend a management plan specific for you. Most of the time, this will be a surgical plan. Some patients only require the skin lesion to be excised, whilst some will also need a sentinel lymph node biopsy. Some may also need cream only.
Types of skin cancer
Squamous Cell Carcinoma (SCC)
Squamous cell cancers are common skin lesions that occur mostly in our older population. They usually start as small rough areas in the skin, sometimes they itch, but mostly they do not cause any symptoms. As they grow they have the potential to spread to other parts of the body. Surgery has been proven to be one of the best ways to remove these lesions. Most surgery can be done as day case under local Anesthetic, however sometimes, a general anesthetic is needed. Mr Patel will spend time talking with you about the preferred method of treatment specific to the type of SCC you have.
Basal Cell Carcinoma (BCC)
Basal cell cancers are slow growing skin lesions that very rarely move to other parts of the body. They often start as a slightly raised skin coloured growth on the skin. As they grow they can become more problematic as they can sometimes bleed and sometimes become infected. There are two general ways in which to treat BCCs. Sometime they can be treated with creams and sometimes they need surgery (similar to SCC). Mr Patel will spend time talking to you about the best option for you.
Melanoma
New Zealand has one of the highest rates of melanoma in the world. Melanoma cancers can start off as pigment mole which slowly grows, can become itchy and can sometimes bleed. Often your GP will take a biopsy of a concerning lesion and if the diagnosis is a melanoma they will refer you to Mr Patel who is a melanoma specialist. Treatment and further investigations depends on the biopsy characteristics- basically the depth (Breslow thickness) and if there us any ulceration. Mr Patel will spend time talking to you about the diagnosis the best way in which to treat this cancer for you.
Types of surgery
Simple Skin lesion Excision
This involves removing a skin lesion is and closing the wound edges using stitches.
The wound will be dressed with a waterproof dressing. This means you can have a shower. Please do not have a bath or go swimming. You may remove this dressing yourself 7 days after the surgery.
Keep the dressing clean at all times.
For skin lesions on the face, there will usually not be a dressing. You will need to apply an antibiotic ointment twice daily until the tube is finished, or for a maximum of 7 days. This will be prescribed to you.
It is important to rest for the first week, and Mr Patel will let you know when you can resume work.
There are two types of stitches. They are either dissolvable stitches or stitches that will need to be removed by your GP/GP nurse. For non-dissolvable stitches, Mr Patel will indicate on this leaflet when you will need to have the stitches removed.
Skin Flap
A skin flap is required when the skin lesion to be excised will leave a space. The skin adjacent to the lesion will be repositioned to fill this space.
The post-excision care instructions are the same as for a simple skin lesion above.
There may also be a bandage around the leg or arm to help protect the healing wound. Please remove the bandage and dressing after 7 days – you can do this yourself at home.
Skin graft
There are two types of skin grafts: split skin and full thickness.
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Split skin graft
- This involves a very thin shaving of the top layer of the skin at the donor site. The area will look like a graze and there will be no stitches in this area.
- The dressing over the donor site will be wrapped tightly with a crepe bandage, and held in place with surgical tape. This is to ensure it does not move and keeps the area clean and dry.
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Full thickness graft
- This is when all layers of the skin are used as the graft
- The donor site will either have dissolvable or non-dissolvable stitches
- The dressing over the donor site will be waterproof. This means you can have a shower. Please do not have a bath or go swimming
- Keep the dressing clean at all times.
If you have had a graft, Mr Patel will inform you of the type of graft used.
The wounds need to be kept clean and dry. If there are wounds on the legs, the leg will need to be elevated until the first dressing change (usually 5-7 days). If the graft site is on the arms, your arm may be in a sling. This is to ensure there is minimal movement of the arm or leg.
The best way to ensure the graft heals well is to rest and minimise movement whilst the graft is healing. This usually takes between 5-7 days. You are advised to rest and limit walking and any physical activity during this time period. This means that if the graft site is on the leg, the only walking you can do is to the bathroom.
Please avoid having a shower, unless you have been specifically told that your dressings are waterproof.
Driving is not recommended whilst the wounds are healing. For most people, this takes around 2 weeks.
The graft site will be reviewed by the district nurses 5-7 days after the surgery. We will organise this. The donor site will be reviewed 10 days after the surgery by the district nurses.
We will send a detailed note to the district nurses.
Sentinal Lymph node biopsy
Sentinal lymph node biopsy (SNB) involves removing a lymph node for testing to see if there is cancer within it. There are usually between 1-3 nodes that are removed from the armpit, groin or neck for testing. The location of the SNB is determined by the location of the skin cancer and also where the scintiscan ‘maps’ to. A scintiscan is a special radiology procedure performed the day before the surgery and this help Mr Patel locate the SNB. The SNB procedure will occur at the same time as the melanoma surgery, during the same general anaesthetic. The main function of these lymph nodes is to help with removing infection. We also know that when skin cancer spreads, the first place it spreads is to the lymph nodes, hence the testing of lymph nodes is important to see if there is cancer in them. The sentinel lymph node is the closest lymph node to the skin cancer, and this is the one that is removed. Sometimes more than one need to be removed. The main risks from an SNB are bleeding and infection. Some patients complain of discomfort that lasts for a few months after the surgery.