Skin cancer treatment

Bristol Plastic Surgery aims to ensure the best treatment for all types of skin cancer, using what ever modality is most appropriate, in the most timely manner. To meet this objective we work in close association with Dermatologists and Oncologists to provide a coordinated and comprehensive treatment program that is effective, efficient and aesthetic. We have been treating NHS patients under contract with North Bristol Trust (NBT) and University Hospitals Bristol NHS Foundation Trust (UHBT) for several years, as well as self-paying patients and patients covered by insurance.

We provide a full consultant lead skin cancer service which includes:

  • Extensive experience in the visual diagnosis and the use of technical diagnostic aids.
  • Accurate pathological diagnosis and evidence of clearance.
  • Highly skilled surgery without overtreatment.
  • A high level of reconstructive outcomes, minimising the need for secondary treatment.
  • Complex more extensive surgery, such as sentinel node biopsy, lymph node dissection and complex reconstruction if this is required.

Unconstrained by limitations of the surgical technique, the healing art of plastic surgery can be tailored, without compromise, to obtain an accurate diagnosis, provide adequate treatment and restore function.

We benefit from a close association with the Skin Cancer Service in the NHS where Mr Antonio Orlando is the chair of the specialist skin cancer Multi-Disciplinary Treatment Committee in North Bristol Trust. He is also the North Bristol Trust lead clinician for skin oncology.

Our aim at Bristol Plastic Surgery is to provide the most effective and cost efficient treatment of skin cancer.

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Diagnosis

At Bristol Plastic Surgery, we hold a weekly skin cancer clinic, RASCAL (Rapid Access Skin Cancer & Lesion).  This gives you the opportunity to have any areas of concern quickly examined by a qualified consultant plastic surgeon with expertise in the diagnosis and treatment of skin cancers.

Those lesions thought to be small skin cancers can usually be removed the same day, but certainly no later than one week after diagnosis. Non-urgent moles and lesions can be removed at a time to suit you. All the moles and lesions we remove are sent for full histological examination, and you will be informed of the results. This service provides rapid diagnosis, reassurance and treatment.

Treatment options

The majority of suspicious lesions can be removed and the wound simply sutured under local anaesthetic as an outpatient. This provides both the diagnosis and treatment at the one procedure. If the lesion is in a challenging anatomical area, the surgery may need to be a little more complex and require either a small local flap or a full thickness skin graft. Even then the surgery can usually be carried out under local anaesthetic as an outpatient.

If the findings in the pathologist’s report indicate the need for more extensive surgery then this will be explained to you in full detail and arrangements then made to perform this either under local anaesthetic or under general anaesthetic. This could be a simple wider excision and direct suture or in some instances, a split skin graft may be required.

In a small number of cases, certain types of skin cancer can spread to the local lymph nodes. If there is a risk of this happening, you will be kept under close and regular surveillance. Lymph node dissection is performed when the spread has been detected and confirmed either by removing the suspicious node or by needle biopsy where a sample will be extracted using a syringe. Detailed protocols are followed and you will receive a full explanation at each stage. If removal of all the local lymph nodes is advised, the procedure will be done under general anaesthetic. The local lymph nodes are the second line of defence functioning as part of your immune defence and as a filter trapping the wayward cells. Their removal provides a second opportunity to cure the condition.

Skin cancer information

It should be emphasised that many skin cancers which include basal cell carcinoma (BCC) and squamous cell cancer (SCC) can be treated simply and cured without major surgery. Melanoma can be a more serious form of skin cancer but provided diagnosis is made early, this too can be effectively cured by simple surgery. The following information is a brief summary of skin cancer. If you are at all concerned see your doctor or make an appointment with Bristol Plastic Surgery.

There are three main types of skin cancer – basal cell carcinoma, squamous cell carcinoma and malignant melanoma. The key sign is the development of a new lump, a scaly or crusty lump or change in an existing mole.

Sun exposure is implicated as a cause in all types of skin cancer as they often occur on exposed parts of the body such as head and neck. They are also more common in sunnier climates and certain skin types.  It is not a simple relationship however as the distribution on the body of the different types and the age of developing them varies greatly. It would seem wise to avoid overexposure and sun burning but moderate sun exposure is vital for the synthesis of vitamin D which itself is an anti-cancer vitamin.

Basal Cell Carcinoma is sometimes called a rodent ulcer. It does not spread elsewhere in the body and remains localised. It can infiltrate deeply if neglected. It may appear as a raised, scaly lump but it can be flat and it can ulcerate. You may experience itching. Curative surgical treatment can be by excision with quite a small margin of healthy skin. The wound can usually be sutured. Occasionally a small local flap or small skin graft is required.

Squamous Cell Carcinoma is also relatively easy to treat and while most don’t, there is more chance of them spreading. Signs include a firm red lump or a flat, scaly and crusted scab like area. These can appear on the face, neck, ears and the backs of hands. There is often a stronger correlation with sun exposure, skin type and time spent in the tropics. Bowen’s Disease is a form of in-situ squamous cell carcinoma which means it is localised and does not spread beyond the local lesion.

Malignant Melanoma can appear almost anywhere on the body but usually appears on the back, legs, arms and face. The first signs are the appearance of a new mole or a change in the appearance of an existing one. They tend to have an irregular shape, consist of more than one colour and are larger than 6mm (1/4”) in diameter. Sometimes they may also itch or bleed.

Malignant melanoma is the most serious type of skin cancer because it can spread to other areas of the body. With early detection and diagnosis, it can be quickly cured but it must be treated with some respect as it accounts for more than 1,500 deaths in England and Wales each year.

If you are at all concerned contact us immediately and book an appointment at our RASCAL clinic. You may not need surgery and we would be happy to offer reassurance.

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There are a number of other much rarer forms of skin cancer such as Merkel’s Cell Skin Cancer which are primarily treated through plastic surgery.