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Auckland Regional Plastic Reconstructive and Hand Surgery

Public Service, Plastic Surgery, Cancer Network Group, Orthopaedics

Malignant (Cancerous) Skin Lesions

Basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended.
Surgery to remove skin lesions usually involves an outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.
Actinic keratoses (also known as solar keratoses): Skin cancers may be preceded by a pre-cancerous condition known as actinic keratoses.  These are usually pink or red spots, with a rough surface, which appear on skin that is exposed to the sun.  The head and neck, face, backs of the hands, and forearms are most often affected.  As they are rough to the touch, Actinic keratoses may be easier to feel than they are to see.  Most actinic keratoses will never become cancerous and early treatment may prevent them changing into skin cancer.
Basal cell carcinoma (rodent ulcer): Most basal cell carcinomas are painless.  People often first become aware of them as a scab that bleeds occasionally and does not heal completely.  Some basal cell carcinomas are very superficial and look like a scaly flat red mark; others show white pearly rim surrounding a central crater.  If left for years, the latter type can erode the skin, eventually causing an ulcer - hence the name "rodent ulcer".  Other basal cell carcinomas are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels.
Squamous cell carcinoma:  A squamous cell carcinoma usually appears  as scaly or crusty area of skin, with a red, inflamed base.  It may look like an irritated wart, or break down to form a bleeding ulcer.  Most small squamous cell carcinomas are not painful, but pain in a growing lump is a suspicious sign for squamous cell carcinoma.  They occur most often on the head, neck, ears, lips, back of the hands and forearms.  Organ transplant patients are most at risk from this form of cancer.
Melanoma: melanomas are much rarer, but are the most serious type of skin cancer that can quickly spread to other parts of the body.  It is important they are diagnoses and treated as early as possible.  Melanoma usually appears as an irregular brown or black spot, which may start in a pre-existing mole or appear on previously normal skin.  Any change in a mole, or any new mole occurring for the first time after the age of thirty, should be shown to your doctor.  Cutaneous malignant melanoma is a cancer of the pigment cells of the skin.  If it is treated early, the outlook is usually good.  It is not contagious.

See and Treat Service

Patients will be asked to make contact with their GP prior to arriving so that their GP can advise them on the management of their anticoagulants prior to their appointment.

As patients may require a biopsy or surgical procedure in the See and Treat Facility, please let us know if the patient is taking any medication to thin their blood such as warfarin, aspirin, clopidogrel, dabigatran or dipyridamole.

Clinical photographs accompanying the referral will assist prioritisation.

Additional referral requirements for Skin Cancer Service:

  • Good clinical photo
  • Histopathology
  • If the skin lesion is not biopsied, please give information as to location, size and duration, and if the patient is on immunosuppression
  • Molecular pathology (BRAF, CKIT, and NRAS) to be included if performed
  • X-rays  - radiology and nuclear medicine images (if completed)
  • Operative reports (if carried out)
  • Please advise if there has been any previous treatment of this lesion
  • Would you consider this patient suitable for excision on the same day as initial treatment?
  • Please state if the patient is on immunosuppression

Guidelines for anticoagulant management prior to surgery for the See and Treat patients will be made available soon.

If you have any questions please feel free to email GP Liaison Officer, Russell Smart (CMDHB)  or Skin Cancer Clinical Nurse Specialist, Trish Leathem (CMDHB)

This page was last updated at 1:18PM on December 21, 2021.