New Zealand has a very high rate of skin cancer, when compared to other countries. 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 usually spread to other areas of the body. Sometimes BCC’s 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 possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal. 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. Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer). A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later. There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice. Implants A silicone device filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days. Flap Reconstruction A flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital.

Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped. The surgery is performed under general anaesthesia (you will sleep through it) and will take 2-4 hours. You will probably stay in hospital 1-2 nights and will need to arrange for someone else to drive you home. You may need to take some medication for pain relief for several days and you must wear a special support bra continuously for 2 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take several months for the scars to fade.

Surgery to increase breast size involves inserting silicone devices (implants) filled with silicone gel or salt water (saline) under the chest muscle and skin. The procedure involves making a cut (incision) in the armpit, under the breast or around the areola (the dark area around the nipple) from where the implant is inserted. The surgery is usually performed under general anaesthesia (you will sleep through it) and it will probably take 1–2 hours. You will probably be able to go home the day of the operation, but you will need to arrange for someone else to drive you. You may need to take some medication for pain relief for 2-3 days and you should rest for a few days after the surgery. You will probably be able to return to work after 7-10 days. It will take several months for the scars to fade.

This is an operation that can lift and reshape sagging breasts. The procedure usually involves removing skin from an area below the nipple and reshaping the breast. The surgery is performed under general anaesthesia (you will sleep through it) and will take about 2 hours. You will probably stay in hospital overnight and will need to arrange for someone else to drive you home the next day. Your breasts will be bruised and swollen for several days and you may need to take some medication for pain relief. You will need to wear a special support bra continuously for 3-4 weeks after surgery. You will probably be able to return to work after about 1 week. It will take several months for the scars to fade.

This procedure involves removing excess skin and fat from the stomach and tightening the muscles of the stomach wall. Cuts (incisions) are made across the lower stomach and around the tummy button and the muscles underneath are pulled together and stitched. The skin flap is stretched down and the excess skin removed. A new hole is made and the tummy button replaced. The surgery is performed under general anaesthesia (you will sleep through it) and will take 3-4 hours. You will probably have to stay in hospital for 2 days and will need to arrange for someone else to drive you home. You will possibly have to wear a special support garment for 2-3 weeks after surgery. You will probably be able to return to work after about 2 weeks. It will take 9-12 months for the scar to lighten.

This procedure removes unwanted pockets of fat from under your skin in specific parts of the body such as the chin, neck, upper arms, stomach, hips and thighs. Liposuction should not be regarded as a means of general weight loss, but instead as a way to improve the shape of particular areas of your body. A small cut (incision) is made, through which a narrow, hollow tube (cannula) is inserted. The tube is moved around to loosen the fat cells, which are then sucked out with a vacuum device. During the procedure you will lose a lot of fluid, so you will be given intravenous (injected straight into the vein) fluid to stop you becoming dehydrated. The procedure usually takes 1-3 hours and is carried out under local anaesthetic (the area being treated is numb but you are awake). You will probably be able to go home the same day but will need someone to drive you. However, if the procedure is more extensive and numerous areas are being treated at the same time, it may require general anaesthesia (you will sleep through it) and you may have to remain overnight in hospital. The area treated will be swollen and bruised after the surgery and you may need to take pain relief medication for several days. You will probably be able to return to work after 1-2 weeks.

Problems with the appearance or function of the hand can be the result of injury, birth defects or degenerative conditions. Dupuytren’s Contracture This condition occurs when there is abnormal thickening of the deep tissue between the palm of your hand and your fingers. This thickening occurs very gradually and will start to make your fingers curl toward your palm. Carpal Tunnel Syndrome A pinched nerve in the wrist that causes tingling, numbness and pain in your hand may require surgery to make more room for the nerve. This operation is usually performed under local anaesthetic (the area being treated is numb but you are awake). If this condition gets to the stage where it significantly limits your hand function, surgery may be recommended. This usually involves removal of the thickened tissue, allowing you to straighten your fingers again. Ganglions Swellings may develop on the wrist, in the palm or on fingers ; these ganglions are fluid-filled and communicate with underlying joints or tendon sheaths. Surgery is needed to remove them. Trigger Finger Tendons which flex the fingers can become restricted and can actually lock so that the finger cannot straighten. The thumb can also be affected, requiring surgical release. Arthritis Arthritis is a condition in which a joint and the surrounding tissue become swollen and painful. If surgery is necessary, it may involve replacement of the joint with an artificial joint, fusion (stiffening) of the joint to prevent pain or removal of swollen or damaged tissue. Injuries Damage to tendons, nerves, joints and bones in the hand may require surgical repair. In some cases, tissue may be transferred from a healthy part of your body to the injured site (grafting). Birth Abnormalities Surgery may sometimes be required for hand abnormalities that are present at birth such as too many or too few fingers, webbed fingers or joints that won’t bend. Transplantation Fingers or hands that have been accidentally cut off can be reattached by very detailed surgery that is performed under a microscope (microsurgery) and involves reconnecting tendons, blood vessels and nerves.

A face lift can include several different procedures such as a neck lift and/or a brow lift, all designed to reduce lines and wrinkles and lift sagging skin. In a typical face lift, cuts (incisions) are made within the hairline in front of and around behind the ears. Tissue lying deep below the skin is repositioned, then the skin replaced and any excess is removed. The surgery varies in duration, but can take up to 4 or 6 hours if it is combined with other procedures. General anaesthesia (you sleep through the operation) is usually required, but in some cases you may be given a local anaesthetic and a sedative so the area being treated is numb and you feel drowsy but not asleep. In most cases, you will stay in hospital overnight following the procedure. It may take 2-3 weeks for the worst of the swelling to disappear and up to 1 year for the scars to fade.

Excess skin and/or fat can be surgically removed from your upper and/or lower eyelids to give your skin a less wrinkled and puffy appearance. The procedure typically involves making a small cut (incision) in the fold of the eyelid (for the upper lid) or just below the eyelashes (for the lower lid) and removing any excess skin and/or fat. The surgery will take 1-3 hours and is performed under local anaesthetic (the area being treated is numb) together with a sedative to make you feel drowsy. You will be able to go home the same day. It is recommended that you have complete rest and keep eye pads on for a couple of days after surgery. You should be able to return to work within 1 week.

The appearance of ears that are misshaped or protruding (‘bat ears’) can be improved surgically. This type of operation is often carried out in children. Cuts (incisions) are made behind the ears through which the cartilage in the ear can be reshaped or removed. The surgery lasts 1-2 hours and can be performed under local anaesthetic (the area treated is numb but you are awake), allowing you to go home the same day. For children, the procedure would be performed under general anaesthetic (they sleep through it) and they will remain in hospital overnight. You will need to wear head bandages for about 1 week and will probably be able to return to normal daily routines after that.

A naevus is a common skin growth composed of special pigment-producing cells. Naevi can vary in size, with small naevi requiring only simple surgery for removal, while the removal of larger naevi may require more than one operation and may involve skin grafts.