Skin Cancer

Skin cancer is common in NZ and is related to the fact that many New Zealanders have inherited a fair complexion from ancestors who came from a northern climate at high latitude. Celtic skin is much thinner and less pigmented in order to gather light at lower levels in northern climes to make Vitamin D in the skin. It is this that makes white skinned people prone to develop skin cancer as the life span progresses.

Nature’s evolutionary process thickens and darkens the skin as humans live further towards the equator.

Maori skin is nature’s solution for this latitude being medium pigment and medium thickness. Maori however are not exempt from skin cancer risk with many having some European ancestors. The genetic expression of skin type can be very variable with thin skin combining with some pigment. It is the skin thickness that provides most of the protection from UV radiation.

Skin cancer arises  due to the fact that the UV light damages the genetic structures of  Stem cell population in the skin whose job it is to turn the skin over once a month in order to replace the aged skin cells. Additionally the immune cells whose job it is to remove damaged cells are also impaired by UV light. The prevention regimen is based on this understanding and is an essential part of treatment.

If your doctor has referred you with a suspected skin cancer then the first step is to have a good look and enquire about past and family history.  An early step is to perform a biopsy under local anaesthesia to determine the tumour type and characteristics.  Once this step has been done a treatment plan is discussed with you.

If it is possible we always do the simplest thing, which may be removal under local anaesthesia.

If the tumour has previously been excised but unsuccessfully or is more aggressive then we may arrange to remove it and repair the defect under a general anaesthetic usually as a day case.

We often also perform an examination at the time of removal with the help of our Pathologists called Frozen Section whilst you are still asleep. This entails removing 4 mm of tissue around the tumour, which gives a 97% chance of complete removal. An extra 1 mm of tissue is removed from all margins and sent to the laboratory snap frozen, stained and examined to confirm clearance before reconstruction is done.

This gives a 99% chance that all is clear.

The careful use of frozen sections on all margins of excision is the same technology used in Mohs micrographic surgery, which is a precise surgical technique where thin layers of cancer-containing tissue is progressively removed and examined until only cancer-free tissue remains.

We are fortunate in having good pathologists to support us in this endeavour with constant improvement in the process and accuracy, recognised in recent Health Quality Awards (2017).

For very complex and advanced cases more than one round of frozen section is performed to achieve a complete clearance. Less commonly this may be divided into two separate theatres.

The form of reconstruction is the simplest that will achieve a good cosmetic outcome and will be discussed in detail at the time of consultation prior to operation booking.

Complex reconstructions may sometimes but not always require more than one stage.

Prevention and ongoing management to reduce the risk of further lesions is an important part of treatment.

This will be discussed in detail and you will be trained in the use of preventative and early treatment creams. This approach is highly effective at reducing frequent flyer status as without it there is a very high risk of further lesions needing to be removed.

An annual skin check is usually part of this regimen and is supported by your insurance company.

If you are an affiliated member of SX then coverage is automatic subject to your insurance policy and treatment can be arranged without any further paperwork at your convenience.