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A surgical margin of at least two millimetres around a cancerous skin lesion is the minimum requirement to ensure total removal of cancer cells and to avoid the need for further surgeries, according to a study by researchers at Perlmutter Cancer Center at NYU Langone Health.
The results of a study enlisting 138 skin cancer patients was published in the Journal of the American Academy of Dermatology, and found that excising a two millimetre margin beyond the edges of a suspicious mole was best practice for complete removal.
In this skin cancer update video, Associate Professor Giuseppe Argenziano discusses the revolutionary results of a study comparing lymph-node dissection with observation in patients with advanced metastatic melanoma. Of patients who had a positive sentinel-node biopsy, the study compared the outcomes of patients who underwent complete lymph-node dissection with the outcomes of patients who were just observed after a positive sentinel-node biopsy and did not undergo a dissection.
Pivotal flaps can be a preferable excision method for lesions which can’t be excised using an ellipse. However this method requires a great degree of planning as considerable tension may be present and extensive undermining needed to close the excision without tension. In the short video below (Part I), surgical lecturer Tony Dicker demonstrates how to plan and perform a pivotal flap with optimal outcomes. This is a video sample from the Professional Certificate of Skin Cancer Surgery. Continue reading “A Quick Guide to Pivotal Flaps [Part 1]”
Skin Cancer Summit & Masterclasses
The 9th Skin Cancer Summit and Masterclasses saw international thought leaders in skin cancer medicine converge in Brisbane to collaborate with GPs from across Australia.
A multi-centre study has explored the prevalence of melanoma on hairy scalps in comparison to bald scalps. Associate Professor Giuseppe Argenziano explains in this skin cancer update video that – while around 76 percent of scalp melanomas are found on people with thinning or no hair – a quarter appear on people with hairy scalps.
Scalp melanoma can be aggressive and has a poorer prognosis compared to melanoma found elsewhere on the body, because scalp melanoma is generally thicker at the time of diagnosis. It also looks different depending on where it is located on the scalp itself, making it trickier to identify. Continue reading “Skin Cancer Update with A/Prof Giuseppe Argenziano [August]”
In this skin cancer update video, Associate Professor Giuseppe Argenziano discusses a study by the International Dermoscopy Society that sheds light on melanoma under the fingernail. He explains the causes of nail pigmentation and what criteria are used for diagnosing such irregularities as melanoma.
If you are doing skin cancer work, you are doing local anaesthesia! This paper provides the best, most up-to-date review on local anaesthesia in skin cancer surgery.
For most GPs the reality is that we use small amounts of lignocaine (or similar) anaesthesia, and it is all very easy and routine. That said, it is always wise to review our practice every now and then:
How should GPs manage a report of peri-neural invasion (PNI) in non-melanoma skin cancer? Close to 3,000 GPs have attended the Professional Certificate of Skin Cancer Medicine course that I teach around Australia each year. It is always of interest to me that many don’t fully appreciate the importance of PNI when reported in BCC or SCC biopsy or excision.
“Well, here it is. After teaching my foundations of skin cancer course with HealthCert for 10 years, and with almost 3000 alumni, Paul and I have finally written the book! Many, many doctors ask me “which is the best book for me?”. Well, if you are a mainstream GP, this is it – in my view.
We wrote this because, as far as we could see, there is no such book on the market. And, most patients with skin cancer are treated by GPs. And, it is not easy. The book is simple and straightforward. All evidence based, clear and basic one to keep on your desk.
I hope you like it.”
This week we have another real life, apparently simple case from Dr David Smith. A small, apparently innocuous pink lesion on the nose.
What is the differential diagnosis?
How would you confirm diagnosis here? Continue reading “Case discussion: How would you treat this patient? [5 September]”