Facial Skin Cancer

Facial Skin Cancer

What is Skin Cancer?

Skin cancer is the uncontrolled growth of abnormal cells in the skin. There are three main groups of skin cancers divided into 1. melanoma, 2. non-melanoma skin cancers, and 3. other rarer skin cancers that are treated differently to the cancers below.

Non-melanoma skin cancers

Non-melanoma skin cancers include squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

Basal Cell Carcinoma (BCC)

BCCs start in the lower layer of the epidermis. BCCs make up about 70% of non-melanoma skin cancers. BCCs grow slowly over months or years and rarely spread to other parts of the body. The earlier a BCC is diagnosed, the easier it is to treat. If left untreated it can grow deeper into the skin and damage nearby tissue, making treatment more difficult. Having one BCC increases the risk of getting another. It is possible to have more than one BCC at the same time on different parts of the body. 

Squamous Cell Carcinoma (SCC)

SCCs start in the upper layer of the epidermis. SCCs account for about 30% of non-melanoma skin cancers. SCC may spread to other parts of the body if left untreated. SCC on the lips and ears is more likely to spread and should be examined by a medical practitioner as soon as possible. If it does spread to the deeper structures, it can also spread to the lymph nodes of the head and neck.
BCC right cheek

Bowen Disease

Bowen Disease or squamous cell carcinoma in situ, is an early form of skin cancer that begins in the top layer of the skin (epidermis). It looks like a red, scaly patch and can develop into invasive squamous cell carcinoma if left untreated. 
Melanoma midline forehead

Melanoma skin cancers

Melanoma skin cancers start in the melanocyte cells of the skin. Although it is not as common as BCC and SCC, melanoma is considered the most serious type of skin cancer. This is because it is more likely to spread to other parts of the body, such as the lymph nodes, lungs, liver, brain and bones, especially if not detected early. Australia and New Zealand have the highest rates of melanoma in the world.

What about other skin lesions?

Many spots and lumps on the facial skin can cause concern for cancer or cosmetic concern if untreated. The following are examples of other non-cancerous lesions that Specialist Oral & Maxillofacial Surgeon are highly trained at removing on the delicate areas of the face and neck.

Moles (naevi)

A mole (naevus) is a normal growth on the skin that develops when the skin’s normal pigment-producing cells (melanocytes) grow in groups. Moles are very common. Some people have many moles on their body – this can run in families. Overexposure to the sun, especially in childhood, can also increase the number of moles. If you have a facial mole you would like examined or wish to discuss removal of for a cosmetic reason Dr John Webster can discuss the treatment options with you.

Dysplastic naevi

People with many dysplastic naevi have a greater risk of developing melanoma and need to be monitored regularly at a GP based Skin Clinic or Specialist Dermatologist. If there are clinical concerns of suspicious change, a biopsy should be considered to rule out any concerns.

Sunspots (solar or actinic keratoses)

Anyone can develop sunspots, but they occur more often in people over 40 years of age, generally on skin that’s frequently exposed to the sun, such as the head, neck, hands, forearms and legs. Sunspots are a warning sign that the skin has had too much exposure to the effects of the sun which increases the risk of developing skin cancer.

Warts

Facial warts are rare but if present can cause emotional and cosmetic concerns for patients and there are many non-surgical and surgical treatments to manage warts on the face and neck region. If you are interested in facial wart removal for cosmetic reasons Dr Webster may assist you.  A referral will be required by your general practitioner. 

What does treatment of facial skin cancers involve?

The treatment recommended with depend on the pathology. At your initial consultation with Dr John Webster, if a skin cancer is suspected clinically a biopsy will be required to confirm the diagnosis. A small biopsy is completed under local anaesthetic at the Oral Facial & Implant Centre and sent for examination under a microscope with a Specialist Pathologist. The histopathology report will be provided to Dr John Webster and he  will guide the appropriate treatment for your skin lesion.

If the lesion is reported as a benign (non-cancerous) lesion such as a mole, wart, skin tag or cyst then these lesions do not invade surrounding tissues and can be removed with little or no margin of healthy skin removed.

If the lesion is reported as malignant (cancer), then these cells have the potential to invade the tissue around them and spread to other parts of the body. The specific diagnosis in the report will determine how much margin of healthy appearing tissue needs to be removed around the cancer to increase the chance of removing all the cancer cells. The earlier a lesion is detected as cancerous and the smaller it is, the better the long-term prognosis for the patient.

As the face is a very important area to cosmetic appearance an identity, most patients would like the surgical area repaired in such a way to maintain their appearance with minimal scarring. Dr John Webster is experienced in various surgical techniques to ensure optimum outcomes are achieved. The location and depth of the lesion to be removed will determine if the lesion can be removed under local anaesthetic in the practice, Oral Facial & Implant Centre or require a general anaesthetic in a hospital setting.

Advanced cancers and most melanomas of the head and neck should be referred for discussion at Head & Neck Cancer Multi-Disciplinary Team (MDTs) meetings where professionals from Oral and Maxillofacial, ENT, Plastic and Reconstructive, Medical Oncologists, Radiation Oncologists, Dentists, Dietitians and wound management nurses are present to advise best practice management and information for patients with these rare conditions. 

How long will it take to recover?

Recovery time depends on the type of surgery, reconstruction performed and the size of the surgical wound. For simple small lesions requiring simple sutures you can return to normal daily function the same day so long as you can keep the surgical site clean.

With more extensive surgery that may require a flap, or graft to reconstruct the area then expect to take a few days of time off for recovery before returning to your usual routine. 

Each wound is different, but the principles of care remain the same. It is recommended to keep the wound clean, dressed with an ointment or covering dressing, remove sutures at the earliest time point, avoid sun damage before surgery and during recovery and seek review if the wound healing is not progressing as expected.

For further information please see our Post-Operative Care Instructions for more information about caring for your surgical site or contact one of our friendly team via 07 4580 4733.

Are there other options for treatment?

  • Surgery is the most common and successful treatment for skin cancer. 
  • Mohs surgery, also known as microscopically controlled excision, is a specialised procedure that is only available at some private clinics and private hospitals. The surgeon removes layers of cells and checks them under a microscope immediately. The aim is to remove the cancer cells and leave only healthy tissue. Mohs surgery is recommended is some areas of the facial skin where every millimetre (mm) of skin removed affects the ability to achieve a functional and cosmetic outcome.
  • Curettage and cautery is when the doctor gently removes the cancer with a sharp tool called a curette. Then low-level heat (cautery) is used to stop the bleeding and destroy any remaining cancer cells. 
  • Cryotherapy is used to treat sunspots and some skin cancers. The doctor will spray liquid nitrogen onto the skin to freeze and destroy the cancer cells. 
  • Topical treatment with creams, lotions and gels can be used to treat some skin spots and cancers. This topical treatment includes immunotherapy, 5-FU chemotherapy, ingenue mebutate gel and vismodegib. 
  • Photodynamic therapy is the use of a light source and a cream to treat sunspots and some skin cancers. 
  • Radiation therapy is sometimes used on the face and neck for cancers in areas that are hard to treat with surgery.
  • Lymph Node Removal will be required if the cancer has spread to the lymph nodes. Removal of the lymph nodes will usually form part of the initial surgical plan if lymph node involvement is detected with clinical palpation or radiological investigations.

Who should I see for management of my facial skin cancer?

There are many professionals who manage skin cancer and monitor skin lesions however if you want the reassurance that your face is in the hands of a facial expert then consider a consultation with Dr John Webster at the Oral Facial and Implant Centre. After your initial consultation, biopsy results and any imaging have been explained to you, Dr John Webster will be able to advise you of the latest evidence-based treatments available, and combine this with a comprehensive understanding of your functional and cosmetic needs.

If you would like to know how we can help you further, or to book a no obligation initial consultation please phone 07 4580 4733 or alternatively request an appointment now online.
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