What are the different types of skin cancer?
Basal cell carcinoma – there are different forms. This one has the characteristic “pearly nodule” appearance
Squamous cell carcinoma – these often present as a sore that does not heal
Malignant melanoma – these are often asymmetrical with blurred edges. Just to complicate matters they are not always pigmented.
Is skin cancer common?
Although there are no reliable national UK figures, studies from overseas suggest the incidence of skin cancer is rising. In the United States there are over 500 000 new cases each year, with 80% occurring in the head and neck. The overwhelming majority involve the nose and ear.
To reduce your risk of cancer:
- stop smoking
- avoid sunburn especially in childhood
- wear a broad rimmed hat in the sun and use a sunscreen
How are skin cancers treated?
Local anaesthetic day-surgical excision is the mainstay of treatment although basal cell and squamous cell carcinomas are also responsive to radiotherapy. If caught early the majority will be cured. Patients with malignant melanoma may require additional treatment. It is important that your surgeon should have excellent working relationships with colleagues who will be involved in this care (dermatologists, radiotherapists and oncologists, radiologists and histopathologists) I participate in the regional MDT (multi-disciplinary team) in dermatopathology where the management of individual cases is reviewed.
Are there any special considerations with skin cancer involving the nose?
Excision of skin lesions on the nose with adequate margins to prevent recurrence will leave defects which cannot be simply ‘primarily’ closed without distorting the nose itself or adjacent areas such as the eyelids. There are a multitude of local flaps which can be used to transfer skin to fill the ‘gap’. These should be carefully planned and executed to achieve the optimum cosmetic result. Super specialisation and a familiarity with a range of alternative options to close any defect created will avoid compromise on the excision margins to facilitate surgical repair.
Where a full thickness defect is created it is important that that the underlying bony and cartilaginous framework of the nose and internal mucosal lining are reconstructed by the sinus surgeon. Simply filling the defect with a mass of skin will lead to a poor cosmetic and functional result. Without cartilaginous support and an internal lining the skin flap will simply contract.
It is vitally important that any extension of cutaneous malignancy into the nasal cavity and sinuses is adequately resected. This is dependent on adequate pre-operative radiological and endoscopic assessment from the sinus specialist.
…and other lesions?
Similar techniques can be used by the sinus surgeon to remove disfiguring non-malignant lesions from the nose. Surgical and laser techniques also exist to address scarring.
