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Malignant & Premalignant Conditions 
 
Melanoma
 
It is the most aggressive type of skin cancer and it is the only type of cancer with a death rate still on the rise.  Early detection of this type of skin cancer can be difficult.  Although there are many different subtypes of melanoma clinically and histologically, they can ultimately be divided into two categories:
  • Fast growing melanoma, usually thick or nodular melanoma;
  • Slow growing melanoma, usually thin or superficial spreading melanoma;

Fast growing melanomas can be fatal within a few weeks.  In many instances patients do not have a chance to present to their doctor before it is too late.  However if it is detected and treated early enough there is a chance that it can be cured. Slow growing melanoma can take months or years to grow before it becomes fatal. It is very often indistinguishable from a normal mole with a naked eye therefore careful skin examination to detect this type of skin cancer is very important.  If you have regular skin checks no one should die from it.

                        

 
 
 
Invasive Melanoma                 Melanoma                                   Melanoma                                Melanoma in situ
 
                               
 
 
 
Melanoma in situ         Lentigo Maligna (early melanoma)  Invasive melanoma    Invasive Melanoma
 
                              
  
Invasive Melanoma                  Severely Dysplastic Naevus          Lentigo Maligna
 
 
Another way of looking at melanoma is the same as any kinds of cancer, the most important factor to determine survival and prognosis is the stage of the tumour. Early melanoma such as melanoma in situ can be cured with a definitive surgical treatment whereas late stage melanoma can be fatal or associated with very poor outcome. Therefore it is vitally important to present to your doctor or specialized clinics such as our clinic if you have any concerns with your moles or any changes of your moles. Our aim is to make sure no one walks out of our clinic with an undiagnosed skin cancer especially melanoma.
 
Basal cell carcinoma (BCC)
 
It is the commonest type of skin cancer and represents 65% to 80% of skin cancer. It occurs most commonly on the face and neck with raising incidence on the trunk in recent years. Appearances of basal cell carcinomas are often small round or flatten in shape and red, pale or pearly in colour. It typically affects individuals between the ages of 40 and 79 years.  BCCs usually grow slowly but can become locally invasive and penetrate deeper tissue causing significant tissue destruction and disfigurement. Metastasis of this type of cancer is rare.
 
                 
 
Superficial BCC                     Nodular BCC                    Ulcerative BCC             Superficial multifocal BCC
 
Squamous Cell Carcinoma (SCC)
 
SCC is the second most common form of skin cancer.  It usually arises in an area that has had some premalignant change such as solar keratosis secondary to sun damage. There is a strong correlation with damage to the skin by the sun and can be experimentally produced by ultraviolet light.  The appearances of these tumours are more inflammatory, indurated and ulcerate sooner compared with BCC.
 
                          
 
Well differentiated SCC             SCC               Keratoacanthoma (a variant of SCC)     Multiple BCC & SCC      
 
Premalignant conditions
 
Actinic keratosis (AK) or Solar Keratosis (SK)
 
Australia has the highest prevalence of actinic keratosis also known as solar keratosis in the world.  It affects 40 - 60% of the Australian Caucasian population over 40 years of age and 80% of those aged between 60 and 69 years.  It is a premalignant condition often a precursor to squamous cell carcinoma (SCC).  Its appearances are usually discrete, erythematous, scaly or crusty patches of skin and for that reason are often indistinguishable to SCC.  They are either visible or subtle lesions clinically. Actinic keratosis is strongly associated with chronic sun exposure and sun burns and typically occurs on the face, scalp, arms, dorsum of hands and upper back.  A vast majority of squamous cell carcinomas derive from AK.  Therefore, anyone with multiple AK lesions should have regular follow up and be treated accordingly.
 
As described above Actinic Keratosis can be difficult to distinguish from squamous cell carcinoma clinically. It is also very hard to differentiate from another benign chronic condition which is Lichenoid Keratosis as illustrated in the pictures shown below and above. In most cases a punch biopsy or total lesion excisional biopsy is necessary to confirm a clinical diagnosis as the treatment options for these conditions will depend on it.
 
                                                          
Actinic Keratosis of the back                Actinic Keratosis of the upper arm
 
Dysplastic Naevi & Dysplastic Naevus Syndrome
 
Dysplastic Naevi are high risk moles and have a high potential to progress to malignant melanoma. The appearance of these moles are usually irregular, uneven distribution of colour, raised or flat, large moles which share some of the features of early melanoma. They can be dark, brown or pink in colour. Management of these moles is either surgical excision for biopsy to exclude melanoma or close monitoring program to detect if any changes, which may suggest early melanoma. In the case of severely dysplastic naevi they should be treated as melanoma in situ and wider skin surgical excision is warranted.
 
Dysplastic Naevus Syndrome (DNS) is diagnosed when a person has 5 or more of dysplastic moles and they need to be confirmed histologically. Patients with DNS usually have multiple moles which make management more difficult. Life time risk of developing melanoma in this group of patients is 40 to 47 times higher than general population. Therefore it is mandatory that everyone with DNS should be in a close monitoring program such as total body photography with digital monitoring and some of these moles should be removed and sent for histological confirmation to exclude melanoma.
 
                      
 
Dysplastic Naevus           Dysplastic Naevus               Dysplastic Naevus             Dysplastic Naevus
 
                   
 
Dysplastic Naevus           Dysplastic Naevus               Dysplastic Naevus             Dysplastic Naevus
 
 
                    
 
Dysplastic Naevus           Dysplastic Naevus               Dysplastic Naevus             Dysplastic Naevus
 
 
The single most important determinant of whether an individual is prone to develop melanoma or not, is the presence or absence of dysplastic naevi. There are numerous epidemiological studies that confirm the significant of dysplastic naevi as markers for increased risk for developing melanoma.
 
Drummoyne Surgery & Skin Cancer Clinic run by Dr Andrew Li is located near the heart of Sydney. It is a centre for melanoma and non melanoma skin cancer prevention, diagnosis and treatment. Dr Andrew Li's other interests are circumcision and body surface tumour and cyst removal.