Skin lesions may be of a concern if they are occurring in aesthetically sensitive areas (ie face, nose, eyelid) or if there is a possibility of malignancy. Dr Teh does not routinely perform skin checks and most of his patients have been referred on to see him by a dermatologist or a GP experienced with skin lesions either for a biopsy or an opinion on excision.
Benign Skin lesions
The majority of skin lesions are benign and will not lead to future health issues. Those that present to see a surgeon have largely aesthetic concerns but occasional lesions may present functional issues such as frequent trauma with shaving or recurrent infections (especially with cysts). Some lesions may exhibit unusual behaviour and these are best biopsied prior to definitive management. Some benign lesions have an increased tendency to turn malignant and some malignant skin tumours can look benign. If a lesion is exhibiting change or symptoms (ie itchy, bleeding, ulcerating or painful), it is best to have it checked.
When you see Dr Teh, he will examine the lesion(s) and will recommend options based on the nature of the lesion, its size and location.Not all lesions will need to be fully excised as some will be amenable to being shaved flat. Biopsy, shaved excision and simple excisions can be performed in the clinic setting under local anaesthesia. More complicated lesions will require surgery in a hospital.
Malignant Skin lesions
With our great mostly sunny climate, skin cancers are unfortunately far more common in Australia than in most other countries in the world. Up to 1 in 3 Australians will develop a skin cancer in their lifetime. The most common skin cancers are basal cell carcinomas(BCC), squamous cell carcinoma(SCC) and malignant melanoma(MM) in that order. Fortunately the same order holds true in their potential to spread. There are also other more rare types of skin cancers such as Merkel cell carcinoma, adnexal carcinomas, and dermal sarcomas. To expedite your treatment, it is usually best to have your biopsy performed prior to seeing Dr Teh. Remember to take a photo of the lesion and its location prior to the biopsy on your mobile device as occasionally the lesion can be hard to find after the biopsy has been taken and the wound healed. If this hasn’t been done, Dr Teh will generally perform the biopsy at his rooms unless the lesion is clinically an obvious skin cancer.
Most skin cancers will require a margin of normal skin to be excised along with the lesion. This margin can be reduced with Mohs micrographic surgery technique which is only performed by a handful of dermatologist in Perth. If you wish to have your lesion excised by this method, Dr Teh will coordinate the surgical excision with the dermatologist with the reconstruction to be performed on the same day by Dr Teh.
Smaller skin cancers can be excised and directly closed. Larger lesions may need a skin graft or local flap (read about the difference here). The surgery may be done by local anaesthetic, twilight (local with sedation) or under a full general anaesthetic. The excised specimen is always sent off to be tested in a pathology laboratory.
The results of the excision generally takes 2-5 working days. Dr Teh will usually advise you of the results during the first clinic followup for removal of sutures. Should you wish to receive the results earlier, please contact the rooms. If you live outside of the Perth metropolitan area, you may opt to see your GP instead for suture removal and results. Please check with your local GP first to make sure that he/she is happy with this arrangement.