British Association of Plastic Reconstructive and Aesthetic Surgeons

The increasing incidence of skin cancer is due primarily to excessive sun exposure and an ageing population. Plastic surgeons are involved in making the public aware of the dangers of excessive exposures to sunlight and combine with dermatologists to service pigmented skin lesion clinics. They recognise that over the next five to ten years there will be a large increase in the amount of time they spend treating skin cancer.

In local acute hospitals patients with skin cancer may be referred primarily to plastic surgeons, dermatologists, radiotherapists or general surgeons. Dermatologists treat patients with superficial skin lesions by techniques such as cryotherapy, curettage and cautery or the application of topical creams. For those patients who have invasive skin cancers, adequate excisional and reconstructive surgery is required and they need the particular skills of a plastic surgeon. The majority of patients with these skin cancers can be treated under local anaesthetic as day case or short stay patients. Ideally, patients should be treated near their home. There are strong arguments for day case operating facilities to be available for plastic surgeons in every acute hospital to deal with such common cancers.

The primary treatment of malignant melanoma, the most rapidly increasing cancer in the U.K. is surgical at present, and many patients require skin grafts and skin flaps. A large number are dealt with by plastic surgeons. Follow-up is best carried out by the operating surgeon who is prepared to carry out regional lymph node removal if necessary. This does, however, add considerably to the workload of the plastic surgeon and is a further reason for increasing plastic surgery presence in the local acute hospital.

The British Association of Plastic, Reconstructive and Aesthetic Surgeons has joined with the Melanoma Study Group of The United Kingdom to establish a prospective randomised trial on the width of skin excision margins for thick malignant melanomas. 33 centres, many of them plastic surgery units, have already entered patients into this trial.

Skin cancer is one of the four cancers cited by the government white paper on The Health of the Nation for special attention. Plastic surgeons are part of a combined working party on skin cancer established by the British Association of Dermatologists which reports to the Health of the Nation representatives, on the increasing incidence of malignant melanoma and the ways of educating the population in the hope of reducing the risk. (The Working Party on Skin Cancer was established by the British Association of Dermatologists with representatives from the British Association of Plastic, Reconstructive and Aesthetic Surgeons, which reports to the Health of the Nation.)

The management of advanced skin cancer may involve collaboration with other medical specialities, e.g. for chemotherapy and radiotherapy, and it is important when services are being planned that the needs of these patients are considered.