1. Preparation
WHAT IS A SKIN TUMOUR?
A skin tumour is an abnormal mass of tissue growth that generally provides no useful function. They may be classified as benign or malignant, described as follows:
Benign – This type of tumour is slow growing and rarely spreads to surrounding tissues. The cells do not separate and travel via the bloodstream or lymphatic vessels to form masses in other parts of the body. Benign tumour cells closely resemble the normal cells from which they originate. In most cases, unless the benign tumour becomes a problem by either growing bigger, being uncomfortable or unsightly, there is no need for removal.
Malignant – These tumours multiply rapidly and are composed of cancerous cells that do not have the ability to perform the functions of mature cells. There is a variation of size and shape in these cells and they are not orderly, piling themselves on top of each other in a disorganised manner. Malignant tumours can separate from the main site and pass through the blood or lymphatic vessels to create a new tumour far from the original. The second tumour is called a metastasis. Malignant tumours need to be removed because they rapidly grow and spread to other areas of the body.
TYPES OF SKIN TUMOURS
There are numerous kinds of non-cancerous skin tumours, so the following is just a brief summary of the most common types:
Lipoma – These tumours are made up of fat cells under the skin and are normally round or oval in appearance. Even though they are harmless and do not cause any pain, they slowly get larger and require surgical removal.
Keratoses – There are two types of keratoses:
-
Actinic (solar) keratoses – These abnormal lesions are scaly or lumpy (resembling a wart). They can either be flat or thick in appearance and in some cases reddened. Actinic keratoses generally appear on the skin of older people with a fair complexion and are more prominent in those who have had chronic sun exposure. The areas most affected would be the hands and face because they would have the most exposure to the ultra violet light of the sun.
-
Seborrheic keratoses – These are sometimes referred to as age warts as they generally appear on the outer layer of skin as you age, however they can appear on the skin of young adults as well. Seborrheic keratoses are normally brown or black and they start out with a waxy, slightly raised appearance. After time they can become thicker and look like they have been stuck on the skin. Unlike actinic keratoses, these tumours can also appear on skin that has not been exposed to the sun. Even though these tumours can appear suddenly and increase in size rapidly, they are usually benign.
In most cases, there is no reason to remove keratoses unless they grow very large or become troublesome. If removal is required treatment may include cryosurgery. This is the application by either cotton swab or a spray of extremely cold liquid called liquid nitrogen. It freezes the tumour and causes it to fall off after a few weeks. Because actinic keratoses can in some cases develop into skin cancer, they may be treated with topical chemotherapy, chemical peel, dermabrasion or laser skin resurfacing.
There are many forms of skin cancer, so the following is just a brief summary of some important types:
Basal cell/squamous cell carcinoma – These are also sometimes classified as non-melanoma skin cancer. A basal cell carcinoma looks like a lump or scaly dry area on the skin. It is the most common of the skin cancers and the least dangerous. It grows slowly and very seldom spreads to other parts of the body unlike the squamous cell carcinoma that, if not treated right away, grows quickly and can spread. The squamous cell carcinoma looks like a sore that is not healing and can bleed easily or ulcerate.
Melanoma – This is the least common form of skin cancer but it is far more dangerous than the others. This cancer can begin in mole cells but frequently grow on normal skin as well. Early detection is very important as the growth of melanomas is rapid and they tend to spread (metastasise) to other parts of the body.
AM I AT RISK?
Because of Australia’s climate we have the highest incidence of skin cancer in the world. One in every two Australians will have some form of skin cancer in their lifetime. All Australians, regardless of skin colour, who spend time in the sun are at risk of developing skin cancer.
The factors associated with a higher risk are:
-
failing to use sun protection, or inadequate sun protection
-
working or spending a lot of time in the sun
-
use of solariums, sunlamps or tanning beds
-
a family history of skin cancer
-
people with spots or moles
The importance of prevention cannot be underestimated, so – Slip (on a shirt), Slop (on a sunscreen) and Slap (on a hat). The Cancer Council of Australia has specific information about how best to protect yourself at http://www.cancer.org.au.
Early Detection
Early detection is one of the key elements to successfully treat skin cancer. As skin tumours are visible, the Cancer Council of Australia recommends you check your skin regularly. Seek immediate help for any new skin spots, or changes to existing spots or moles. Your local doctor may perform a skin biopsy of anything that may look to be of some concern.
WHAT ARE THE TREATMENT OPTIONS?
If the tumour is large, cancerous and/or has spread, then hospitalisation for surgical removal of the tumour is required.
However, most skin tumours are treated as an outpatient in the Dermatologist’s rooms. Some of the treatment options for these types of tumours are removal under local anaesthetic, treated by photodynamic therapy or cryotherapy.
As these options are performed in the doctor’s rooms, HCF is unable to cover the procedures under your hospital cover.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a specialist. Depending on the nature of your lesion and the treatment required, you will either need to see a Dermatologist (skin specialist), and/or a Plastic surgeon.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Australian College of Dermatologists through their website at www.dermcoll.asn.au, and the Australian Society of Plastic Surgeons at www.plasticsurgery.org.au.
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Dermatologists or Plastic Surgeons who participate in HCF’s Medicover no gap arrangement:
-
Call HCF Member Services on 13 13 34
-
Visit one of HCF’s customer service branches
-
Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor
WHAT SHOULD I ASK MY SPECIALIST?
-
What are my treatment options
-
What are the success rates and potential side effects of any treatment (but be aware that your doctor may not always be able to give you absolute numbers)
-
Make sure you fully understand the procedure that is planned and the associated costs; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
-
In addition to what the procedure involves, you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the procedure. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products),
-
Blood thinners (Warfarin, Heparin.),
-
Arthritis medication,
-
Pain medication,
-
Insulin.
If HOSPITALISATION IS REQUIRED, WHERE IS IT DONE?
The procedure is usually carried out as a day surgery patient in a specialised day surgery facility, or in the day surgery unit of an overnight hospital.
HOW LONG IS THE PROCEDURE?
The length of the procedure is dependent on the type and size of the tumour, whether the tumour has spread, and if skin grafting is required.
WHO IS INVOLVED?
-
The Dermatologist or plastic surgeon
-
Anaesthetist: Will give you medication to either fully anaesthetise or sedate you, and look after you whilst the procedure is being carried out
-
Nurses will assist with assessment, the procedure and your recovery
-
Pathologist if any blood tests are necessary
HOW DO I PREPARE FOR REMOVAL OF A SKIN TUMOUR?
If you are required to have a general anaesthetic, you may need to undergo some basic tests to determine your fitness for surgery. These will depend on your age and general health, and may include things such as an ECG (recording of the rhythm of your heart), chest x-ray, and blood tests. If you are a smoker and you can't give up completely, try to avoid smoking in the weeks leading up to your operation. This may help avoid post-operative complications such as chest infection and poor wound healing.
You will normally be required to fast if sedation or a general anaesthetic is to be used. The type of fasting required will depend on the type of anaesthetic used. Please follow any instructions given to you by the day surgery or hospital.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home, a wedding ring is acceptable
-
Wear comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Remove all nail polish and do not wear any make-up
2. Day of Procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the ward area, a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. Your surgeon will talk you through the operation, explaining any potential risks and side effects, and ask you to sign a form to indicate you understand and give your consent to the procedure.
An anaesthetist will visit you prior to your operation, and explain the type of anaesthetic to be used. The decision to use local anaesthetic, sedation, or general anaesthetic is usually based on the type and extent of surgery required, and sometimes your general health.
WHAT CAN I EXPECT DURING THE REMOVAL OF A SKIN TUMOUR?
If you are having a general anaesthetic or sedation, prior to the procedure you will be given medication to make you relaxed and drowsy. These will be administered through a cannula, a small plastic tube inserted into a vein in your arm or hand. An intravenous drip may also be started at this time.
Once the anaesthetic has taken effect, the surgeon will begin the tumour removal.
If the tumour has not spread, it will be removed along with the surrounding skin and the wound will be closed with sutures.
If the tumour is great in size, a large portion of skin will be excised to ensure that all of the cancer cells have been removed. This may require skin grafting, where a layer of skin is taken from another area of your body and carefully placed over the wound. In the vast majority of cases you will be aware of the need for skin grafting prior to surgery. A dressing will be placed over the wound site and will be left for several days. Another dressing will be placed over the site where the graft was taken.
3. Aftercare
WHAT HAPPENS AFTER REMOVAL A SKIN TUMOUR?
Once the surgery is complete, you will be taken to the recovery room. If a general anaesthetic or sedation was used, nursing staff will monitor your vital signs until your blood pressure, pulse and breathing are stable, and you are alert.
Your surgeon will visit you prior to discharge and give you any discharge information that is required.
You may be sore and uncomfortable for a few days after your surgery, so your doctor may prescribe pain medication to take whilst at home. If you have sedation or a general anaesthetic you cannot drive for 24 hours, so you will require someone to take you home and ideally stay with you that night. The day surgery or hospital will give you specific instructions about what you can expect, and any care required after discharge. They will inform you of issues for which you should seek further medical attention.
Depending on the nature of your skin tumour, you will be required to see your doctor for follow up care. In some instances, for example if you have had a melanoma removed, you may also be referred to an oncologist (cancer specialist) for assessment and/or further treatment.
1. Preparation
WHAT IS A SKIN TUMOUR?
A skin tumour is an abnormal mass of tissue growth that generally provides no useful function. They may be classified as benign or malignant, described as follows:
Benign – This type of tumour is slow growing and rarely spreads to surrounding tissues. The cells do not separate and travel via the bloodstream or lymphatic vessels to form masses in other parts of the body. Benign tumour cells closely resemble the normal cells from which they originate. In most cases, unless the benign tumour becomes a problem by either growing bigger, being uncomfortable or unsightly, there is no need for removal.
Malignant – These tumours multiply rapidly and are composed of cancerous cells that do not have the ability to perform the functions of mature cells. There is a variation of size and shape in these cells and they are not orderly, piling themselves on top of each other in a disorganised manner. Malignant tumours can separate from the main site and pass through the blood or lymphatic vessels to create a new tumour far from the original. The second tumour is called a metastasis. Malignant tumours need to be removed because they rapidly grow and spread to other areas of the body.
TYPES OF SKIN TUMOURS
There are numerous kinds of non-cancerous skin tumours, so the following is just a brief summary of the most common types:
Lipoma – These tumours are made up of fat cells under the skin and are normally round or oval in appearance. Even though they are harmless and do not cause any pain, they slowly get larger and require surgical removal.
Keratoses – There are two types of keratoses:
-
Actinic (solar) keratoses – These abnormal lesions are scaly or lumpy (resembling a wart). They can either be flat or thick in appearance and in some cases reddened. Actinic keratoses generally appear on the skin of older people with a fair complexion and are more prominent in those who have had chronic sun exposure. The areas most affected would be the hands and face because they would have the most exposure to the ultra violet light of the sun.
-
Seborrheic keratoses – These are sometimes referred to as age warts as they generally appear on the outer layer of skin as you age, however they can appear on the skin of young adults as well. Seborrheic keratoses are normally brown or black and they start out with a waxy, slightly raised appearance. After time they can become thicker and look like they have been stuck on the skin. Unlike actinic keratoses, these tumours can also appear on skin that has not been exposed to the sun. Even though these tumours can appear suddenly and increase in size rapidly, they are usually benign.
In most cases, there is no reason to remove keratoses unless they grow very large or become troublesome. If removal is required treatment may include cryosurgery. This is the application by either cotton swab or a spray of extremely cold liquid called liquid nitrogen. It freezes the tumour and causes it to fall off after a few weeks. Because actinic keratoses can in some cases develop into skin cancer, they may be treated with topical chemotherapy, chemical peel, dermabrasion or laser skin resurfacing.
There are many forms of skin cancer, so the following is just a brief summary of some important types:
Basal cell/squamous cell carcinoma – These are also sometimes classified as non-melanoma skin cancer. A basal cell carcinoma looks like a lump or scaly dry area on the skin. It is the most common of the skin cancers and the least dangerous. It grows slowly and very seldom spreads to other parts of the body unlike the squamous cell carcinoma that, if not treated right away, grows quickly and can spread. The squamous cell carcinoma looks like a sore that is not healing and can bleed easily or ulcerate.
Melanoma – This is the least common form of skin cancer but it is far more dangerous than the others. This cancer can begin in mole cells but frequently grow on normal skin as well. Early detection is very important as the growth of melanomas is rapid and they tend to spread (metastasise) to other parts of the body.
AM I AT RISK?
Because of Australia’s climate we have the highest incidence of skin cancer in the world. One in every two Australians will have some form of skin cancer in their lifetime. All Australians, regardless of skin colour, who spend time in the sun are at risk of developing skin cancer.
The factors associated with a higher risk are:
-
failing to use sun protection, or inadequate sun protection
-
working or spending a lot of time in the sun
-
use of solariums, sunlamps or tanning beds
-
a family history of skin cancer
-
people with spots or moles
The importance of prevention cannot be underestimated, so – Slip (on a shirt), Slop (on a sunscreen) and Slap (on a hat). The Cancer Council of Australia has specific information about how best to protect yourself at http://www.cancer.org.au.
Early Detection
Early detection is one of the key elements to successfully treat skin cancer. As skin tumours are visible, the Cancer Council of Australia recommends you check your skin regularly. Seek immediate help for any new skin spots, or changes to existing spots or moles. Your local doctor may perform a skin biopsy of may look to be of some concern.
WHAT ARE THE TREATMENT OPTIONS?
If the tumour is large, cancerous and/or has spread, then hospitalisation for surgical removal of the tumour is required.
However, most skin tumours are treated as an outpatient in the Dermatologist’s rooms. Some of the treatment options for these types of tumours are removal under local anaesthetic, treated by photodynamic therapy or cryotherapy.
As these options are performed in the doctor’s rooms, HCF is unable to cover the procedures under your hospital cover.
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a specialist. Depending on the nature of your lesion and the treatment required, you will either need to see a Dermatologist (skin specialist), and/or a Plastic surgeon.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Australian College of Dermatologists through their website at www.dermcoll.asn.au, and the Australian Society of Plastic Surgeons at www.plasticsurgery.org.au.
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Dermatologists or Plastic Surgeons who participate in HCF’s Medicover no gap arrangement:
-
Call HCF Member Services on 13 13 34
-
Visit one of HCF’s customer service branches
-
Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor
WHAT SHOULD I ASK MY SPECIALIST?
-
What are my treatment options
-
What are the success rates and potential side effects of any treatment (but be aware that your doctor may not always be able to give you absolute numbers)
-
Make sure you fully understand the procedure that is planned and the associated costs; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
-
In addition to what the procedure involves, you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the procedure. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products),
-
Blood thinners (Warfarin, Heparin.),
-
Arthritis medication,
-
Pain medication,
-
Insulin.
If HOSPITALISATION IS REQUIRED, WHERE IS IT DONE?
The procedure is usually carried out as a day surgery patient in a specialised day surgery facility, or in the day surgery unit of an overnight hospital.
HOW LONG IS THE PROCEDURE?
The length of the procedure is dependent on the type and size of the tumour, whether the tumour has spread, and if skin grafting is required.
WHO IS INVOLVED?
-
The Dermatologist or plastic surgeon
-
Anaesthetist: Will give you medication to either fully anaesthetise or sedate you, and look after you whilst the procedure is being carried out
-
Nurses will assist with assessment, the procedure and your recovery
-
Pathologist if any blood tests are necessary
HOW DO I PREPARE FOR REMOVAL OF A SKIN TUMOUR?
If you are required to have a general anaesthetic, you may need to undergo some basic tests to determine your fitness for surgery. These will depend on your age and general health, and may include things such as an ECG (recording of the rhythm of your heart), chest x-ray, and blood tests.
If you are a smoker and you can't give up completely, try to avoid smoking in the weeks leading up to your operation. This may help avoid post-operative complications such as chest infection and poor wound healing.
You will normally be required to fast if sedation or a general anaesthetic is to be used. The type of fasting required will depend on the type of anaesthetic used. Please follow any instructions given to you by the day surgery or hospital.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home, a wedding ring is acceptable
-
Wear comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Remove all nail polish and do not wear any make-up
2. Day of Procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the ward area, a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and will ask about any known allergies. Your surgeon will talk you through the operation, explaining any potential risks and side effects, and ask you to sign a form to indicate you understand and give your consent to the procedure.
An anaesthetist will visit you prior to your operation, and explain the type of anaesthetic to be used. The decision to use local anaesthetic, sedation, or general anaesthetic is usually based on the type and extent of surgery required, and sometimes your general health.
WHAT CAN I EXPECT DURING THE REMOVAL OF A SKIN TUMOUR?
If you are having a general anaesthetic or sedation, prior to the procedure you will be given medication to make you relaxed and drowsy. These will be administered through a cannula, a small plastic tube inserted into a vein in your arm or hand. An intravenous drip may also be started at this time.
Once the anaesthetic has taken effect, the surgeon will begin the tumour removal.
If the tumour has not spread, it will be removed along with the surrounding skin and the wound will be closed with sutures.
If the tumour is great in size, a large portion of skin will be excised to ensure that all of the cancer cells have been removed. This may require skin grafting, where a layer of skin is taken from another area of your body and carefully placed over the wound. In the vast majority of cases you will be aware of the need for skin grafting prior to surgery. A dressing will be placed over the wound site and will be left for several days. Another dressing will be placed over the site where the graft was taken.
3. Aftercare
WHAT HAPPENS AFTER REMOVAL A SKIN TUMOUR?
Once the surgery is complete, you will be taken to the recovery room. If a general anaesthetic or sedation was used, nursing staff will monitor your vital signs until your blood pressure, pulse and breathing are stable, and you are alert.
Your surgeon will visit you prior to discharge and give you any discharge information that is required.
You may be sore and uncomfortable for a few days after your surgery, so your doctor may prescribe pain medication to take whilst at home. If you have sedation or a general anaesthetic you cannot drive for 24 hours, so you will require someone to take you home and ideally stay with you that night. The day surgery or hospital will give you specific instructions about what you can expect, and any care required after discharge. They will inform you of issues for which you should seek further medical attention.
Depending on the nature of your skin tumour, you will be required to see your doctor for follow up care. In some instances, for example if you have had a melanoma removed, you may also be referred to an oncologist (cancer specialist) for assessment and/or further treatment.