New Zealand has the highest incidence of skin cancer in the world. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun. Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds. There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Basal Cell Carcinoma (BCC) This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not spread to other areas of the body. Sometimes BCCs can ulcerate and scab so it is important not to mistake it for a sore. BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour. Treatment Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis. Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal. A new treatment called imiquimod is now available for topical treatment of some BCCs, please make an appointment to discuss. Squamous Cell Carcinoma (SCC) This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated. A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal. All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC. Malignant Melanoma This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease. A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles. What to look for: • an existing mole that changes colour (it may be black, dark blue or even red and white) • the colour pigment may be uneven • the edges of the mole/freckle may be irregular and have a spreading edge • the surface of the mole/freckle may be flaky/crusted and raised • sudden growth of an existing or new mole/freckle • inflammation and or itchiness surrounding an existing or new mole/freckle. Treatment It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading. A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread, more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread. A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Malignant Melanoma This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease. A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles. What to look for: • an existing mole that changes colour (it may be black, dark blue or even red and white) • the colour pigment may be uneven • the edges of the mole/freckle may be irregular and have a spreading edge • the surface of the mole/freckle may be flaky/crusted and raised • sudden growth of an existing or new mole/freckle • inflammation and or itchiness surrounding an existing or new mole/freckle. Treatment It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading. A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread, more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread. A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Growths, lumps, tumours or masses on the head and neck can be benign (noncancerous) or cancerous and can form in the larynx, pharynx, thyroid gland, salivary gland, mouth, neck, face or skull. Tests to diagnose a mass may include: • Neurological examination – assesses eye movements, balance, hearing, sensation, coordination etc • MRI – magnetic resonance imaging uses magnetic fields and radio waves to give images of internal organs and body structures • CT Scan – computer tomography combines x-rays with computer technology to give cross-sectional images of the body • Biopsy – a sample of tissue is taken for examination under a microscope. Enlarged Lymph Nodes Lymph nodes in the neck often become swollen when the body is fighting an infection. Benign Lesions Noncancerous masses such as cysts are often removed surgically to prevent them from pressing on nerves and other structures in the head and neck. Cancer Cancerous masses spread to surrounding tissues and may be: • Primary – they arise in the head or neck. Mostly caused by tobacco or alcohol use • Secondary – they have spread from a primary tumour in another part of the body. Cancers may be treated by a combination of radiotherapy, chemotherapy and surgery.

Abnormalities of the endocrine system treated by general surgery include disorders of the pancreas and adrenal glands in the abdomen and the thyroid and parathyroid glands in the neck. These are often very complex conditions requiring extensive investigations. If surgery is required it is often quite complicated and will usually mean a stay in hospital for several days or even longer. Thyroidectomy An incision (cut) is made in the front of and at the base of the neck and part or all of the thyroid gland is removed. Parathyroidectomy An incision (cut) is made in the front of and at the base of the neck and one or more of the parathyroid glands are removed. Parotidectomy An incision (cut) is made in front of the ear and runs down below the jaw line. Part or all of the parotid gland is removed. Superficial Parotidectomy: an incision is made in front of the ear and runs down beneath the ear lobe. The superficial (top) lobe of the parotid gland is removed.

General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

Ingrown toe nails can been painful and get infected. They are easily fixed under local anaesthetic or day stay surgery for more comfort.

Lipomas are fatty lumps that can occur anywhere on the body. Most are single although some people have multiple lipomas. If small they can be removed under local anaesthetic but if large or multiple they should be done under day stay general anaesthetic.