Simple excision is the most appropriate treatment for many skin cancers. This achieves a cure rate in excess of 95% in properly selected cases.
Dr Sheridan will carefully mark out your skin cancer, together with a ‘safety margin’ of surrounding skin. The safety margin varies with what is being treated. Aggressive skin cancers such as melanomas may require a 1 – 2 cm margin of skin to be taken around the cancer. For less aggressive non-melanoma skin cancers (BCC and SCC) 4-5mm will suffice.
It is not uncommon for patients to be surprised by the length of the scar resulting from surgery to remove what initially appeared to be a ‘small’ lesion. This is because it is not possible to close a circular defect without ‘bunching’ at the ends. Such bunching compromises both skin function and cosmesis. To avoid this, the post excisional defect must be converted to an ellipse or a geometrical flap shape . For ellipses, a ratio of at least 3:1 (wound length to wound width) is required to achieve the best scar outcome. Therefore, to anticipate the likely length of your postoperative scar, the width of the lesion margin must be multiplied by at least 3.
All excision specimens are sent to a Pathologist. Occasionaly the excision is deemed inadequate by the Pathologist, and re-excision is recommended to ensure complete clearance of the lesion.
Mohs Micrographic Surgery is the most effective surgical treatment for skin cancer. Mohs Surgery has a proven cure rate approaching 99% for primary tumours. Mohs surgery is indicated in situations where the doctor and patient wish to ensure complete cancer removal, with maximum conservation of normal surrounding skin and underlying tissues. This is especially beneficial in preserving function and deliver an optimal cosmetic result in areas such as the nose, eyelid, ears, digits and genitalia.
Mohs surgery is the treatment of choice for high risk tumours, such as those which have resisted prior treatment and demonstrate aggressive histopathological features under the microscope. For this group of skin cancers, traditional surgery cure rates generally fall to 60%; compared to 92% for Mohs surgery.
Unlike other forms of skin cancer surgery, Mohs surgery ensures complete tumour removal, histopathological analysis, and surgical reconstruction at the one treatment session in most cases. Once the skin cancer has been completely removed by Mohs surgery, a subsequent repair may be confidently undertaken by the surgeon and patient; safe in the knowledge that the risk of repeat surgeries to chase out ‘missed’ or recurrent cancer is markedly reduced. This avoids unnecessary discomfort, anxiety and inconvenience for patients.
Mohs surgery is performed by highly trained specialists who have completed training as both specialist dermatologists with the Australasian College of Dermatologists (ACD); and as Mohs micrographic and reconstructive surgeons through advanced fellowship training with the American College of Mohs Surgery (ACMS). A Mohs Surgeon is specifically trained in surgery, pathology and optimal functional and cosmetic reconstruction. Further information and a list of ACD and ACMS accredited Mohs surgeons can be found at: www.mohscollege.org and www.dermcoll.edu.au.
Dr Sheridan is a respected and trusted Dermatologist specialising in Mohs Micrographic Surgery. He has undertaken training in Mohs surgery in Perth and Sydney, Australia; and Oxford, UK.
Dr Sheridan serves on the Mohs Micrographic Surgery Committee of the Australasian College of Dermatology. He heads the Mohs Surgery and Pathology Quality Assurance Programme which sets and enforces standards for Australian Mohs Surgeons.
Dr Sheridan believes in a multidisciplinary approach and works in close association with a network of highly skilled Oculoplastic Surgeons; Plastic and Reconstructive Surgeons; Radiation Oncologists; ENT Surgeons; GPs and Skin Cancer Clinic doctors. Our staff actively liaise with other team members in accordance with the needs of each individual case, to ensure that every patient receives the very best of care.
How does Mohs Micrographic Surgery work?
A microscope will be used to allow your specialist to ensure complete removal of your skin cancer.
There are two significant advantages with this technique:
1. Complete eradication of the skin cancer, ensuring a very high cure rate, including for difficult and aggressive forms of skin cancer.
2. Preservation of as much normal tissue as possible, without compromising the high cure rate.
There are 5 key steps to Mohs Micrographic Surgery:
1. Removal of the clinically apparent/visible skin cancer.
2. Precise marking and mapping of the excised tissue layer and preparation for microscopic analysis.
3. Microscope guided detection of all tumour extensions.
4. Precise removal of any residual tumour – unnecessary tissue sacrifice is carefully avoided.
5. Expert reconstruction of the microscopically controlled tumour free defect; ensuring an optimal
functional and cosmetic outcome.
For more information about Mohs Surgery, please explore the ACMS patient education link: www.skincancermohssurgery.org
Scar types vary according to causation – ie post traumatic vs post surgical vs post acne etc. Common types are atrophic, pigmented, erythematous and vascular, ice pick, hypertrophic (raised and prominent) and keloid (symptomatic and extend beyond the site of causative trauma) scars.
Accurate diagnosis and sub-classification is essential for effective treatment, as this determines correct treatment selection. Combination treatments are often required and choices include:
1. Elimination and prevention of causative factors
2. Supportive skin care and taping
3. Prescribed topical and intralesional medications
4. Radiofrequency (RF)
5. Laser: Vascular, pigment, non ablative fractional and ablative lasers
6. Light therapies
Your specialist Dermatologist will determine and discuss the most appropriate treatment(s) for your particular scars, in your particular skin.
Cryosurgery is the treatment of skin lesions with liquid nitrogen and other cryogens.
Cryosurgery is employed by Dermatologists to treat a range of benign skin lesions such as warts, seborrhoeic keratoses, solar lentigines and actinic keratoses.
It may also be used to treat carefully selected malignant skin cancers such as superficial BCC.
If a lesion is treated by your doctor and fails to completely clear within four weeks, always seek a further opinion to be sure the lesion does not require further treatment.
Curettage and electrodesiccation (C&ED) is an excellent treatment for appropriately selected superficial skin cancers.
A spoon-like surgical curette is used to scrape away friable cancerous tissue. Electrosurgery is then applied to destroy any residual tumour cells and to achieve haemostasis. No sutures are required. A dressing is applied and the area allowed to heal.
Dr Sheridan and the Specialists at SDSL will help you determine whether this treatment is appropriate for you.
Many of us wish to address cosmetic concerns, but this can be a daunting and confusing process. Where to start and how to filter the information overload and marketing noise?
Dr Sheridan and the highly qualified nurses at SDSL can help you to identify those issues which are of most concern to you; and then plan the careful and safe treatment of these.
At SDSL we are strong believers in a multidisciplinary approach, as this ensures the best outcomes for our patients. There may therefore be instances where Dr Sheridan and the nursing team call upon a carefully selected network of skilled and ethical Plastic Surgeons, Oculoplastic Surgeons and Cosmetic Physicians to further assist in your care.