Skin malignancies are the commonest cancers in Australia, and there are two broad types. The vast majority are tumours arising from the non-pigmented cells of the skin, the keratinocytes. These are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Basal cell carcinomas do not spread to distant sites in the body(metastasise), but can be locally destructive. Squamous cell carcinomas can also cause problems by invading local tissues but also have the potential to metastasise.
The other most common form of skin cancer is melanoma, arising from the melanocytes, or pigmented cells of the skin. Melanoma is much less common than other forms of skin cancer and has higher rate of metastasis.
The diagnosis of skin cancer is usually confirmed by biopsy. Depending on the type, size and location of the tumour this can often be done under local anaesthetic in the office. If the tumour is small the biopsy will often involve removal of the entire lesion. Formal excision of skin cancers requires removal of a margin of normal skin from around the edge to ensure the cancer is completely removed. Depending on the size and position of the tumour, this wide excision can sometimes require procedures like skin grafts or skin flap surgery to allow healing and achieve a good cosmetic result.
Usually no other investigations are required prior to surgery, unless the surgeon suspects the tumour is more advanced. It may be necessary to image or biopsy the lymph nodes (glands) where the skin cancer may have spread. In the case of melanoma this is often done at the time of wide excision (sentinel node biopsy).