Skin 2020-03-22T22:53:16+00:00

Skin Cancer


  • Prolonged sun exposure
  • Sun burn at an early age
  • Multiple sun burns
  • Skin type (the fairer the skin type the higher the risk)
  • Genetic factors
  • Other environmental factors
  • Immunosuppression


Basal cell cancer (BCC)

  • BCC is the most common type of skin cancer. It is usually found on the face and limbs (sun exposed areas), 26% occur on the nose.
  • 95% of cases occur between 40-79 years of age.
  • They usually present as a flesh-coloured, pearly nodule, in time these nodules may ulcerate.
    They may also present as a lesion which may be mistaken for eczema or fungal infection, or an ‘enlarging scar’.
  • Treatment includes a number of modalities, however excision is the mainstay of treatment.

Squamous cell carcinoma (SCC)

  • SCC is the second most common skin cancer after BCC. They occur mainly in sun-exposed areas in the face and the body. However, they may arise in other areas of the body from predisposed lesions in the genital area or oral mucosa.
  • Lesions usually present as non-healing ulcers or as a scaly irregular lesion.
  • Treatment includes surgery, radiation and other non-surgical modalities.
  • SCC is more dangerous than BCCs as they have a tendency of spreading to lymphatic system and lymph nodes.


  • Melanoma is a cancer of the melanocytes in the skin (the cells responsible for pigmentation in the skin).
  • Melanoma is a significant clinical problem with increasing morbidity and mortality.
  • Risk factors:
    • UV exposure
    • Increasing age (> 50)
    • Family history
      • Risk may be 8 times higher in a positive family history
    • Phenotype I-II
      • Light skin colour
      • Light hair colour
    • Predisposing conditions:
      • Atypical mole syndrome:
        • More than 100 naevi (moles) 6-15 mm
        • 1 or more larger than 8mm
        • 1 or more with atypical features
        • Nevi present at birth and increase in number around puberty
      • Dysplastic naevus
  • Presentation:
    • Melanomas usually arise from existing nevi undergoing malignant transformation or arising de novo.
    • Lesions appear as pigmented, atypical or ‘funny ‘ looking moles. ABCD
      • Asymmetry
      • Border irregularity
      • Color variegation
      • Diameter more than 6mm
    • NB lesions may be NON- pigmented and therefore careful screening is mandatory especially with the above listed risk factors.
  • Treatment:
    • This involves a multi-disciplinary team, which includes surgeons, oncologists and radiation oncologists.
    • The type of surgery depends on the thickness of the melanoma but typically includes a wide resection of the lesion and possibly a sentinel lymph node biopsy.
    • Depending on the extent of the melanoma, treatment may also include chemotherapy.
    • Preventing skin cancer:
      • Always wear sunscreen (SPF 50)
      • Know your family history
      • Regular medical screening

Dr Dimitri Liakos is a member of the College of Plastic and Reconstructive Surgeons of South Africa and a member of the Association of Plastic, Reconstructive and Aesthetic Surgeons of South Africa (APRASSA).

He is a member of the World Society of Reconstructive Microsurgeons (WSRM) and the International Society of Aesthetic Plastic Surgeons (ISAPS).