Dr. Robert Salmon
25 Osborne Street
WOLLONGONG NSW 2500
Ph 02 4226 3088
Fax 02 4227 1606
mail@idlc.com.au
Skin Cancer
Fully qualified members of the Australasian College of Dermatologists have specialist training in all the following methods of therapy, so are best placed to recommend the most suitable form of treatment for patients with this serious problem. While all the following forms of therapy take considerable skill to perform, even more knowledge and experience is needed to select the most appropriate method of treatment, taking into account the particular patient, the type of skin cancer and the anatomical site of that cancer.
LIQUID NITROGEN CRYOTHERAPY
“Freezing” sunspots and certain early thin forms of skin cancer is a well established therapy. Skill and experience are necessary to select which lesions are suitable. The treated area usually blisters, then forms a crust which can take from 1 to several weeks to lift off, depending on which area of the body has been treated. Because pigment cells in the epidermis are temperature sensitive, cryotherapy may leave white spots following treatment.
5 FLOUROURACIL CREAM
This cream is not generally recommended for treatment of established skin cancers, but rather for premalignant skin lesions (actinic keratoses) commonly called sunspots. It can be very useful for patients with so many sunspots that attempting to treat individual facial spots becomes impractical. It also has a role in treating isolated sunspots in areas where cryotherapy may leave white spots.
The patient usually applies the cream for 3 or so weeks to the effected area. It does cause redness and crusting of the treated area, which can be unsightly. It is important to avoid sun exposure during treatment, as this makes the inflammatory reaction worse. Close supervision before therapy starts, by a skilled doctor, is important, to make sure that all the lesions being treated are suitable for this particular modality.
FULL FACE MEDIUM DEPTH CHEMICAL PEELS
As with fluorouracil cream, medium depth peels are generally used in patients that have so many facial sunspots that cryotherapy becomes impractical. It also has some cosmetic advantages in that it frequently helps clear blotchy pigmentation and some fine wrinkles. These peels penetrate deeper than standard cosmetic peels, and the healing time is generally about 10 days. At ID+LC, this is an office-based procedure, carried out after injections for pain relief and sedation. Its advantages over fluorouracil cream include the shorter treatment and recovery times (10 days v 30 days) and possible cosmetic improvements.
CURETTAGE AND CAUTERY
Certain early skin cancers, particularly those on the trunk or limbs can be treated by this means. The process relies on the skin cancer being softer than the surrounding skin, so it can be curetted (scooped out) and the remaining cells in the base are then destroyed by cautery or diathermy, under a local anaesthetic injection. It is used less frequently on the face because facial skin tumours tend to be biologically more aggressive, so the recurrence rate is higher with this treatment, and it frequently leaves obvious pale scars.
IMIQUIMOD CREAM: At ID+LC we use this preparation on certain actinic keratoses and superficial basal cell carcinomas (BCCs). The cream helps the patient’s own immune system clear away the cancerous cells. For superficial BCCs, the patient applies the cream over a 6 week period. The cancer becomes inflamed and crusted. Healing takes some weeks, depending on the site treated. The success rate is approximately 80%, and the cosmetic results are generally more acceptable than for cryotherapy or curettage & cautery.
PHOTODYNAMIC THERAPY
PDT is a relatively new but proven therapy for actinic keratoses and some superficial skin cancers. The process involves applying a cream that contains an active ingredient that is selectively absorbed by cancerous and precancerous cells. Three hours later the lesion is exposed to a specific wavelength red light that causes a chemical reaction within the targeted cells, killing them. Like imiquimod cream, the PDT success rate is approximately 80%. Its advantages are that it usually takes only 2 treatments for skin cancers, generally one week apart, with healing taking usually about 1 week on the face, longer on other sites, depending on skin healing times. While it is quick, convenient and generally causes little or no scarring or pigment change, the cream is expensive, and it does not attract a Medicare rebate at this stage. It can be particularly useful for superficial cancers on the face where surgery may leave scars, and on the legs of patients with poor circulation where other forms of treatment may cause ulcers that are difficult to heal.
RADIOTHERAPY (XRT)
The principal of ID+LC, Dr. Robert Salmon, has 20 years practical experience in radiotherapy, acting as the main tutor in the subject for the Australasian College of Dermatologists in NSW. We no longer have a radiotherapy unit at ID+LC, but we have an excellent working relationship with the radiation oncologists at Wollongong Hospital. XRT may be the most suitable treatment for some older patients, particularly those with head and neck tumours, and we refer on those cases where we feel that it is in the patient’s best interest.
SURGICAL EXCISION
Surgery remains the gold standard for removal of most advanced skin cancers, and all melanomas. Dr. Salmon and his specially trained staff have a wealth of experience in this field (see Medical Team). ID+LC has a constantly updated office-based operating suite of the highest standard that has served the Illawarra for many years. Both simple and complex skin cancer surgery is carried out here under local anaesthesia. For those privately insured patients requiring reconstruction with skin flaps or grafts, Dr. Salmon has a regular surgery list at Figtree Private Hospital, where operations are carried out under general anaesthesia.
EXCISION UNDER MICROSCOPIC CONTROL (MOH’S SURGERY)
This is a special form of surgery generally reserved for complicated and recurrent skin tumours. Because of the setup costs, the only Mohs units in NSW are in large centres in Sydney. While Dr. Salmon is an accredited Mohs surgeon, we refer all patients requiring this form of specialised surgery to the Skin & Cancer Foundation in Sydney.
SIDE-EFFECTS & COMPLICATIONS OF SKIN CANCER THERAPY
All of the treatments listed above have their own risks, including colour change to the skin, scarring, and most distressing to both the patient and the doctor, failure to cure the cancer. Certain forms of therapy carry their own individual risks, and these should be discussed in detail with the treating doctor.