Introduction

When completed this website will guide you through the basics of skin cancer surgery concentrating on relevant anatomy and informed selection of surgical excision methods based on the nature of the lesion you are excising and where it is situated on the body. This will be the most difficult of these D----- Made Simple websites to put together. Surgical skill is something that is acquired by experience but you need taught well initially or all that happens is you perpetuate your mistakes. Tissue handling and good suturing is not something that can be taught on a website like this. However we can teach you basic principles of lesion selection, the best surgical method of closure, the best patient preparation for surgery to minimise likely problems etc but then it is up to you to go to reputable training courses or seek a preceptorship watching an experienced doctor carry out these procedures and try to learn from what you see. We will try to scour the web for good videos describing surgical techniques but if you can afford it the book by Paver and Stanford called Dermatologic Surgery has two DVDs with over 100 excellent videos which will go a long way to providing you with experience of good surgical technique and closure selections for various areas of the body. See Dermatologic Surgery

The Lesion

If you are working in Skin Cancer Medicine then the first thing you need to learn is how to recognise a significant skin lesion! You need to know all the variants of the common skin cancers such as BCC, SCC and melanoma but you also need to be able to recognise common benign lesions for what they are and benign lesions that may signify an underlying non skin malignancy associated with various syndromes such as Muir Torre. As well as the triumvirate of BCC, SCC and melanoma you will come across lesions such as Merkel cell carcinoma, Atypical fibroxanthoma, Malignant fibrous histiocytoma, Dermatofibrosarcoma protuberans and other rarer lesions that you also need to know something about. However common things occur commonly so we will start by looking at the various forms of the common skin cancers and then go over the multiple benign lesions that are found on the skin before ending up with the rarities. There is no easy diagnostic algorithm or mnemonic for diagnosing skin tumours. You just have to be exposed to them such that you recognise them and use your dermatoscope! Look at this YouTube video of the images in Module 1A. You should do this before reading through the text and perhaps again after you have finished the text! To view these videos in high definition you should click the arrow to start then hit pause and change the 360 to 1028 and click the outward facing arrows box next to it to make it full screen. Keep the pause on for a minute to allow enough of the video to download first before pressing play to avoid interuptions when running.Press ESC on your computer to go back out of full screen mode . If you have a slow internet connection it might be better just to view it in the small mode and 360 resolution. The video below is an overview of the first Module in the Skin Cancer College Australasia's Advanced Certificate in Skin Cancer Medicine and Surgery. This video is the overview of Modules 1A-D recorded during the first webinar for Module 1

The Site

Skin cancers on the ears, nose, tight sun damaged scalp and fingers are difficult to close without skin flaps or grafts. We will put up videos of suggested repairs in these areas. In most other areas of the body primary excision and direct closure can easily be accomplished if lesions are diagnosed early and are less than 20 mms in diameter.

The Patient

Patient factors are very important in deciding the nature of surgery you will perform or whether to refer the case. Unrealistic patient expectations or unreasonable concerns about scarring are red flags for referral. Patients who are diabetic, on blood thinners or who readily get skin infections from surgery require pre planning with withdrawal of blood thinners if feasible, prophylactic antibiotics and or post op bed rest particularly for diabetics with leg swelling and impaired peripheral circulation.Look at the videos below on these issues.

Preoperative assessment of the patient is important. You need to know the patient's medical history, especially drugs that might interfere with clotting or the normal healing process. You need to know how they heal. Do they suffer from hypertrophic or keloid scarring? Some people unfortunately develop hypertrophic scars and others develop true keloids. There are certain areas of the body where the risk of developing keloids is increased such as the anterior chest, the shoulder, over the breast area in females and sometimes on the upper back. It is also a problem if you are trying to do surgery across joints. Are they bleeders despite not being on blood thinning drugs? (Check clotting times if not sure!) Do they regularly get wound infections after skin surgery? (Check for MRSA carriage and cover with an oral anti staph antibiotic.) Listen to this exhaustive lecture from MD LIVE on the preoperative patient assessment. It covers the topics mentioned above and then some!

The Doctor

Every practitioner carrying out skin cancer surgery should train themselves well before starting in the field and should regularly upgrade that training. The courses of the Skin Cancer College Australasia or The Australian Institute of Dermatology are recommended.