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Skin Cancer Removal

A skin cancer is a ‘growth’ of tissue made up from cancer cells which continue to multiply. Cancerous (malignant) tumours can invade into nearby tissues and cause damage as well as spread to other areas of the body via the lymphatic system and the bloodstream. Interestingly, whilst most types of malignant tumour tend to grow fast and then spread (metastasise) to other parts of the body, this is more unusual in the case of skin cancer. In fact, only a small proportion of skin cancers actually cause problems elsewhere in the body. Nethertheless, early recognition and treatment is recommended for all forms of skin cancer and Mr Banwell is a world renowned skin cancer specialist.

Skin cancers can be divided into:

MELANOMA (‘MALIGNANT MELANOMA’)

This type of skin cancer develops from melanocytes. These are the pigment cells at the base of the superficial layer of the skin which can become abnormal.

NON-MELANOMA SKIN CANCER (NMSC)

These are divided into:

  • Basal cell carcinoma (BCC, or ‘rodent ulcer’)- skin cancer which develops from basal cells.
  • Squamous cell carcinoma (SCC)- skin cancer which develops from keratinocytes.
  • Other- other types of skin cancer are rare (sarcoma, dendritic cell carcinoma, porocarcinoma, etc).

PREVENTION IS KEY

We know that skin cancer is caused by exposure to the Solar Constant – ie. the combination of ultraviolet radiation (UV-A and UV-B), infrared (IR) and visible light from the sun. Intense exposure via sunbed use also dramatically increases risk of skin cancer formation (between 30-70%) and thus avoidance of sunbeds is mandatory.

Prevention therefore is the key and minimising sun exposure as much as possible is fundamental. Sun burn episodes are highly predictive of future skin cancer formation so should be avoided. Simple measures such as avoiding the midday sun, wearing a hat, sunglasses and liberal use of sunscreen is key. Use of sunscreen – sun protection factor, SPF – has been shown to reduce the incidence of skin cancer (as well as cause less ageing!). Mr Banwell and his team therefore advocate daily use of sunscreen throughout the year and we can recommend the latest innovations in SPFs. Our current favourite is B3-T from Rationale Skin Care.

TREATMENT OF SKIN CANCER

Treatment of skin cancer is essentially divided into surgical treatments, photodynamic therapy (PDT) and medical treatments.

SURGERY

Simple surgical excision (removal) is probably the commonest modality used to treat both primary and recurrent skin cancers. Most can be performed under a local anesthetic as an outpatient procedure but some cases will require admission and treatment under a general anaesthetic. However, in some cases radiotherapy or medical treatments might be more suitable – if these is more appropriate for you then Mr Banwell will discuss these options.

Surgical removal of a skin cancer involves removing the growth and a certain amount of normal-appearing skin surrounding it (the “margin”): for basal cell and squamous cell carcinomas, margins are often 2 to 5 mm. Most of the time it possible to close the defect by simply sewing up the wound with sutures. However, this is not always possible and a skin graft or reconstruction using a ‘local flap’ (moving skin in the vicinity from one place to another) may be required – this is slightly bigger procedure and the recovery might take a little longer. Again, Mr Banwell will discuss the most suitable method in your particular case.

In over 95% of cases for primary Basal cell carcinomas (BCC) and Squamous Cell carcinoma (SCC) we are able to remove all of the skin cancer in one sitting; of course this is also dependent on the site, size, and pattern of the tumour.  Often a further operation is required to take further tissue – this is considered a ‘belt and braces’ approach to minimise any future problems of recurrence and is termed a ‘wide local excision’.

Removal of skin cancers may be performed in the out-patient or inpatient setting depending on the extent and location of the lesion.

SURGERY FACT SHEETS

Click here for information sheet on Excision of Lesion

Click here for information on Split Skin Grafts (SSG)

Click here for information on Full Thickness Skin Grafts (FTSG)

Click here for information on Local Flap Reconstruction

Photodynamic Therapy (PDT)

Photodynamic therapy is a novel, advanced and refined treatment to treat severe sun-damaged skin, pre-malignant conditions (actinic keratoses and Bowen’s disease) as well as a particular subtype of basal cell carcinomas – superficial BCC (please note that other forms of BCC are not suitable for this kind of treatment).

These abnormal skin cells will absorb a chemical (topically applied to the skin) that, when exposed to light, destroys these abnormal cells. This process is called ‘Photodynamic Therapy’ (PDT).

Process of PDT

Once your skin assessment and diagnosis has been made and you are ready for PDT, Mr Banwell’s team will schedule 2 appointments. In outpatients, Mr Banwell will perform some curettage  (superficial scraping of the lesion) followed by application of a cream called ALA (eg. Metfix). This cream will be applied to your skin and allowed to ‘incubate’, usually for about 2-3 hours. The treatment area is then exposed to a special light (eg. Actilight) to activate the ALA. This process stimulates your body’s immune system to destroy the abnormal sun-damaged cells. It is quite normal to get some redness, scaling and crusting in the treated areas following treatment; unfortunately some patients find the light activation treatment a little uncomfortable but this is usually short-lived. However, any crusting should heal within a few days to a week after which the treated area should be smoother; two treatments may be required to help heal the lesion.

Excitingly, some new so-called DAYLIGHT PDT formulations are also coming on to the market which allows rapid treatment in clinic with minimal inconvenience and return to clinic for activation. Mr Banwell and The Banwell Clinic are currently investigating and trialling these new treatment regimes.

Medical Treatments

CRYOTHERAPY (CRYOSURGERY)
Cryotherapy (using liquid nitrogen) is the process of freezing skin lesions. The extreme cold destroys skin tissue and also helps stimulate the immune system. Both processes help to clear/remove any lesion.

This is a very useful alternative to surgery for pre-cancerous lesions (actinic keratoses and Bowen’s disease) as well as for benign lesions such as warts and seborrhoeic keratoses.

HOW DOES IT WORK?
The cryogen is usually liquid nitrogen, though other substances can be used. It is usually applied with a spray-gun, but sometimes a cotton tip is used.  Traditionally 3 ‘freeze-thaw’ cycles are used lasting a few seconds for each cycle. It stings when applied and can cause painful blistering within a few hours. This usually settles spontaneously and forms a scab.

Healing times are around 1-2 weeks on the face, 2-3 weeks on the trunk and up to 6 weeks on the lower legs. This is a very safe treatment but possible complications include scarring, infection or hypopigmentation (whitening) of the area treated. If the lesion recurs, it may need further treatment with cryotherapy or possibly another option such as surgery or specialised creams.

IMMUNE MODULANTS
Immune modulants are chemotherapeutic topical creams that stimulate the body’s own immune system to fight against the abnormal sun-damaged cells (actinic keratosis) or skin cancer cells (eg. Superficial BCCs).

5 FLUORO-URACIL (5-FU)
Topical 5-fluorouracil 5% cream (Efudix™) is a chemotherapeutic agent prescribed by a skin cancer specialist such as Mr Banwell. It may be very effective in the management of actinic keratoses , in-situ squamous cell carcinoma (Bowen’s disease) but is also effective for superficial basal cell carcinomas [please note that it is not effective for other types of BCC]. It is also sometimes used in combination with salicylic acid in the management of persistent and symptomatic viral warts in adults.

It works best on face and scalp but can be effective on other areas too. Pre-treatment with a topical retinoid may enhance the effect of fluorouracil by peeling off the top layer of skin.

The optimal way to use fluorouracil is unknown. Most skin cancer specialists recommend daily applications for 4 weeks, which may be repeated as necessary. To reduce the severity of adverse reactions, others recommend treatment for a few days, repeated as necessary, or twice weekly applications over several months.

Fluorouracil creates a cytotoxic destructive reaction to dysplastic (abnormal) cells. Treated dysplastic lesions become red, scaly and tender over several days then erode or ulcerate with continued treatment. The more dysplastic the lesion, the more vigorous the response. Treatment should be discontinued at the eroding stage to allow re-epithelialisation over the next one to four weeks.

IMIQUIMOD
Imiquimod (Aldara™) is another immune response modifier / immune modulant which is even stronger than 5 FU. It is used to treat actinic keratoses, Bowen’s and superficial basal cell carcinomas (BCC)s. It may also be useful for the treatment of pigmented patches of skin.

As mentioned above with 5-FU, the degree of inflammation with Aldara is quite variable. The greater the inflammation, in general the shorter the time and number of applications required to eradicate the lesion. About 10% get little or no inflammatory response and treatment is then nearly always ineffective. On the whole, as with other topical treatments, facial lesions clear quicker than those elsewhere. A course of treatment with Aldara usually ranges between 4 to 16 weeks.

PICATO
Picato is the latest generation immune modulant used for severe actinic lesions and BCCs. The chemical name for Picato is ingenol mebutate and it is formulated as a gel but unlike other immune-modulants, it is important to keep in the fridge. Picato use for skin cancers and actinic lesions is only used for a short period (2-3 days) and can cause quite significant responses on the skin with redness (erythema) and crusting. Whilst the manufacturers explain that most skin reactions settle after a few weeks, Mr Banwell usually observes that the erythema a skin changes can take 2-3 months to completely settle. Mr Banwell can chat to you regarding your suitability for Picato (ingenue meditate) treatment in Sussex, Kent, Surrey and London.

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Skin Cancer Removal
At a Glance

30-90 MINUTES

TREATMENT TIME

Skin Cancer Removal
At a Glance

Outpatient or inpatient depending on complexity

HOSPITAL STAY

Skin Cancer Removal
At a Glance

Maybe

ANAESTHETIC ASSESSMENT

Skin Cancer Removal
At a Glance

Maybe

PRE ADMISSION TESTS

Skin Cancer Removal
At a Glance

Sleeping on back recommended for a week

SLEEPING POSITION

Skin Cancer Removal
At a Glance

As directed by Mr Banwell

REASONABLY MOBILE

Skin Cancer Removal
At a Glance

As directed by Mr Banwell

WASHING

Skin Cancer Removal
At a Glance

Depends on complexity of procedure

DRIVING

Skin Cancer Removal
At a Glance

As directed by Mr Banwell

EXERCISE INCLUDING GYM

Skin Cancer Removal
At a Glance

1 week

SEXUAL ACTIVITY

Skin Cancer Removal
At a Glance

1-2 weeks

FULL RECOVERY

Skin Cancer Removal
At a Glance

1 week

TIME OFF WORK

The cause of most skin cancers is secondary to sun damage to the skin or from sunbed usage. About 90% of NMSCs and about 60% of melanomas are thought to be caused by excessive exposure to the sun. In particular, past episodes of sunburn significantly increase the risk. It is the ultraviolet (UV) radiation in the sunshine which does the damage although more recent research has shown that Infrared (IR) and visible light also plays a key role. Skin cells which are damaged are at greater risk of becoming abnormal and cancerous. Although skin cancer is rare in children, the amount of sun exposure during childhood is thought to increase the risk of developing skin cancers in adult life. Therefore, it is vital to protect children from too much sunshine.

All three main types of skin cancer – BCC, SCC and melanoma – are curable if they are detected at an early stage. A small minor operation or other method to remove the affected area of skin is all that is required in early cases.

For non-melanoma skin cancers (BCC & SCC) the overall cure rate is over 95%, even for those which have been present for a while. However, the larger they grow, the more difficult they are to treat. More extensive surgery with skin grafting or other forms of reconstruction as well as other localised treatments may be needed if they grow large or deep before they are treated.

For melanomas, the risk of spread to other parts of the body is higher than for Squamous Cell Carcinomas. This is why urgent early treatment is recommended. If it has already spread to other areas of the body then there is less chance of a cure. Other treatments such as chemotherapy, or immunotherapy may sometimes be used for melanomas.

Keep a close check on the look of existing moles or marks on your body so that you will know if there has been any change. If you notice any new growth or new change on your skin then you should consult with a doctor or be referred to Mr Banwell. In particular, if you notice any change in the size, shape, colour or outline of an existing mole, or if a new dark area of skin develops then you should be seen by a skin cancer specialist such as Mr Banwell. Please observe for any moles that also crust, itch or bleed.

Most skin cancers are caused by excessive exposure to the sun. We should all limit our sun exposure in the summer months (or all year when in hot countries nearer the equator) by:

  • Staying indoors or seeking the shade as much as possible between 11am and 3pm.
  • Covering up with clothes and a wide brimmed hat when we are out in the sunshine as well as wear sunglasses.
  • Applying sunscreen with a sun protection factor of 30 or more to all exposed areas of skin when we are out in strong sunlight.

In particular, children should be protected from the sun. Sunburn or excessive exposure to the sun in childhood is thought to be the biggest risk factor for the developing of skin cancer as an adult.

…total expertise and attention to detail in surgery.

Procedure was quick, pain fee and I was made to feel at ease. I would highly recommend Mr Banwell, he provided an honest opinion of the result and all the options. I barely have a scar to speak of! Great result.


Claire H.

I decided to have treatment with Mr Banwell due to recommendations from other healthcare professionals and knowledge of his surgical skills. My expectations were for reduced ptosis and fuller breasts, my expectations were exceeded. Mr Banwell provided me with honest and realistic expectations for my clinical outcome. I found it a very positive experience. I was originally very apprehensive about undertaking a cosmetic procedure and questioned the need for proceeding, but following my breast augmentation I have much more self confidence and I realise that I’d underestimated how much the ptosis had been getting to me. The outcome has been fantastic! Thank you.


Sharon B.

Mr Paul Banwell performed a wider excision for me in April 2008 following a diagnosis of melanoma. The care and support provided by him has been second to none and I would have no hesitation in recommending him. Paul’s approach to surgery and post-surgery is one of honesty and excellence in his field of expertise. I feel safe in his care.


Sarah B.

I was made to feel at ease with everything. Nothing was too much, lots of care and thought. Pain was very minimal. Lots of follow up care which was first class. I got exactly what I wanted, I have a lovely new look which I could not achieve on my own. If something is bothering you and you can not get to your goal there is help. I had an excellent experience.


Margaret S.

I thought the team were helpful and efficient because they helped me to schedule my appointments around my working hours. They were always at hand to discuss any questions I had with a friendly and professional manor. Mr Banwell was amazing. He was totally honest and helped me decide which type of breast implant and procedure to have. We talked through my torrent of questions and concerns with ease. He asked me how I wanted my breast to look and I said I wanted them as natural as possible and that is exactly what I got. My new breasts have certainly made me feel more confident with ym body. I previously felt inadequate in the breast area and now I can?t stop smiling! I am so pleased with the outcome I only wish I?d done it sooner. The operation certainly wasn?t as scary as I thought it would be and I was looked after with the utmost care.


Samantha S.

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The Banwell Clinic is recognised as a boutique cosmetic clinic specialising in all aspects of skin health and our philosophy is to help Protect, Restore & Rejuvenate your face and body.  Our extensive portfolio of treatments include injectables, thread lifts, plasma shower, luxurious signature facials, acne treatments, microdermabrasion, hair removal and cellulite treatments, all carried out in a friendly, warm environment by an expert team.

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