Skin Cancer Services at gpmaroubra
Dr. Shane Christensen
MBChB; FRACGP; MPH&TM; GCMedEd; Dip.Surgery (Skin Cancer)
Clinical Senior Lecturer University of Sydney
Dr. Christensen is a highly qualified skin cancer doctor with advanced training in skin cancer surgery. Most skin cancer surgery can be performed by Dr Christensen in his rooms at GP Maroubra, including more complicated surgery involving skin flaps and grafts.
Dr. Christensen runs a comprehensive skin cancer service which includes:
MBChB; FRACGP; MPH&TM; GCMedEd; Dip.Surgery (Skin Cancer)
Clinical Senior Lecturer University of Sydney
Dr. Christensen is a highly qualified skin cancer doctor with advanced training in skin cancer surgery. Most skin cancer surgery can be performed by Dr Christensen in his rooms at GP Maroubra, including more complicated surgery involving skin flaps and grafts.
Dr. Christensen runs a comprehensive skin cancer service which includes:
- Skin Checks - detailed & comprehensive
- Preventative Skin Cancer education and management
- Advanced Skin Cancer Surgery in rooms under local anaesthetic
- Photodynamic Therapy (PDT) - as field treatment to prevent skin cancer in sun-damaged skin
- Field Treatment - with topical creams such as Fluorouracil to prevent skin cancer in sun-damaged skin
- Topical Treatment of Skin Cancer - some early, superficial skin cancers can be treated without surgery
- Improving the quality and appearance of sun damaged skin - exposure to the sun (specifically UV radiation) causes the skin to become thin, dry, blotchy and wrinkly. There are many treatments that I provide that improve both the quality and the appearance of your skin. These treatments include: IPL, Microneedling, anti wrinkle injections and skin boosters
Skin Checks:
It is important to get your skin checked regularly by a doctor qualified to undertake a detailed, comprehensive skin check. To do this a doctor must be trained to use a type of skin microscope called a dermatoscope.
All our doctors at GP Maroubra are qualified to undertake detailed, comprehensive skin checks with a dermatoscope.
In addition to having your skin checked comprehensively for skin cancer, our doctors will give you professional advice on how to care for and protect your skin to prevent skin cancer and to improve the quality and appearance of your skin.
All our doctors at GP Maroubra are qualified to undertake detailed, comprehensive skin checks with a dermatoscope.
In addition to having your skin checked comprehensively for skin cancer, our doctors will give you professional advice on how to care for and protect your skin to prevent skin cancer and to improve the quality and appearance of your skin.
Skin Cancer:
Skin cancer is the most common cancer in Australia and Australia has one of the highest rates of skin cancer in the world. Skin cancer is almost exclusively caused by ultraviolet (UV) radiation.
The three most common types of skin cancer are:
1. Basal cell cancer (BCC)
BCCs are not only the most common skin cancer, they are the most common cancer in Australia. BCCs are caused by UV radiation damage to the DNA of a basal cell in the epidermis of the skin. BCCs generally enlarge slowly. They must be removed, usually by surgery, or they continue to grow larger over time and cause significant disfigurement.
2. Squamous cell cancer (SCC)
SCCs are the second most common skin cancer and are caused by UV radiation damage to the DNA of a squamous cell in the epidermis of the skin. SCCs generally enlarge and invade the skin more rapidly than BCCs and must be removed, usually by surgery, soon after they are found by your doctor.
3. Melanoma
Melanoma (malignant melanoma) is the most dangerous form of skin cancer and can be fatal if not diagnosed early. It develops in the pigment producing skin cells, melanocytes and is usually associated with UV radiation exposure. In rare cases melanoma can appear in parts on the body that have never been exposed to the sun, inside the eye, brain and under the nails of the hands and feet.
The three most common types of skin cancer are:
1. Basal cell cancer (BCC)
BCCs are not only the most common skin cancer, they are the most common cancer in Australia. BCCs are caused by UV radiation damage to the DNA of a basal cell in the epidermis of the skin. BCCs generally enlarge slowly. They must be removed, usually by surgery, or they continue to grow larger over time and cause significant disfigurement.
2. Squamous cell cancer (SCC)
SCCs are the second most common skin cancer and are caused by UV radiation damage to the DNA of a squamous cell in the epidermis of the skin. SCCs generally enlarge and invade the skin more rapidly than BCCs and must be removed, usually by surgery, soon after they are found by your doctor.
3. Melanoma
Melanoma (malignant melanoma) is the most dangerous form of skin cancer and can be fatal if not diagnosed early. It develops in the pigment producing skin cells, melanocytes and is usually associated with UV radiation exposure. In rare cases melanoma can appear in parts on the body that have never been exposed to the sun, inside the eye, brain and under the nails of the hands and feet.
“It is estimated that 16,221 new cases of melanoma will be diagnosed in Australia in 2020.”
(Cancer Council Australia)
(Cancer Council Australia)
Ultraviolet (UV) Radiation and cancer:
Ultraviolet (UV) radiation is a form of electromagnetic radiation that comes from the sun. Man made sources include tanning beds and welding torches. Radiation that increases the risk of cancer is ionising radiation. When we talk of “radiation” and cancer risk we are generally referring to ionising radiation. Ionising radiation has enough energy to remove an electron from an atom or molecule and cause damage to the DNA (genes) of a cell. When DNA is damaged significantly it can not repair itself and it makes mistakes, replicating abnormal cells over and over again. Cancer is essentially caused by damaged DNA repeating this process unchecked.
There are different types of UV radiation, based on wavelength and how much energy the different wavelengths have. UV radiation is a form of ionising radiation which as discussed above may lead to cancer.
UV radiation is divided into three main groups:
1. UVA radiation: UVA radiation is everywhere. UVA accounts for up to 95 percent of the UV radiation reaching the earth and maintains the same level of strength during daylight hours throughout the year. UVA can penetrate windows and cloud cover. Which is why it is so important to wear sunscreen every day, 365 days a year, on cold wet cloudy days, and in the depths of winter! UVA radiation is slightly less intense than UVB but it penetrates your skin more deeply and is a major factor in premature ageing of the skin by destroying collagen making your skin thinner and more wrinkly. Exposure causes genetic damage to cells on the innermost part of your top layer of skin, where most skin cancers occur. The skin tries to prevent further damage by darkening, resulting in a tan. There is NO SUCH THING AS A SAFE TAN
2. UVB radiation has more energy than UVA radiation. It is the main cause of sunburn (which is a radiation burn). UVB radiation is thought to be the major cause of skin cancers.
3. UVC radiation is entirely absorbed in the upper atmosphere and does not contribute to skin cancer or ageing.
There are different types of UV radiation, based on wavelength and how much energy the different wavelengths have. UV radiation is a form of ionising radiation which as discussed above may lead to cancer.
UV radiation is divided into three main groups:
1. UVA radiation: UVA radiation is everywhere. UVA accounts for up to 95 percent of the UV radiation reaching the earth and maintains the same level of strength during daylight hours throughout the year. UVA can penetrate windows and cloud cover. Which is why it is so important to wear sunscreen every day, 365 days a year, on cold wet cloudy days, and in the depths of winter! UVA radiation is slightly less intense than UVB but it penetrates your skin more deeply and is a major factor in premature ageing of the skin by destroying collagen making your skin thinner and more wrinkly. Exposure causes genetic damage to cells on the innermost part of your top layer of skin, where most skin cancers occur. The skin tries to prevent further damage by darkening, resulting in a tan. There is NO SUCH THING AS A SAFE TAN
2. UVB radiation has more energy than UVA radiation. It is the main cause of sunburn (which is a radiation burn). UVB radiation is thought to be the major cause of skin cancers.
3. UVC radiation is entirely absorbed in the upper atmosphere and does not contribute to skin cancer or ageing.
The main types of UV rays that can affect your skin include UVA rays and UVB rays. UVB rays have more energy and are a more potent cause of at least some skin cancers, but both UVA and UVB rays can damage skin and cause skin cancer. There are no safe UV rays. (American Cancer Society 2019)
“Studies have found that people who use tanning beds (or booths) have a higher risk of skin cancer, including melanoma and squamous and basal cell skin cancers. The risk of melanoma is higher if the person started indoor tanning before age 30 or 35, and the risk of basal and squamous cell skin cancer is higher if indoor tanning started before age 25.” (American Cancer Society 2019)
Sunscreen SPF and Skin Care:
Sunscreen is essential to protect your skin from skin cancer. Protective clothing such as long-sleeve rashies, a hat, sunglasses and avoiding the sun are also essential components of stopping ultraviolet radiation from penetrating your skin and causing skin cancer.
Always choose SPF 50+ sunblock but SPF only applies to UVB radiation and sunburn (a radiation burn!)
SPF stands for Sun Protection Factor. The number represents how long the sun’s UVB radiation would take to cause a radiation burn to your skin if you apply the sunscreen exactly as directed compared with the amount of time without sunscreen. If you use an SPF 50 product properly, it would take you 50 times longer to burn than if you used no sunscreen.
There is no SPF or label on sunscreen that gives you a measure of UVA radiation protection, and remember UVA radiation comprises 95% of all UV radiation that penetrates your skin: causing damage including dyschromia (pigment blotches) rosacea (flushing redness, visible blood vessels, enlarged pores and red blotches), wrinkles, thin and dry skin; and UVA is now known to contribute to an increased risk of skin cancer.
The most protective active ingredients against UVA radiation are listed below. Remember: and SPF 50+ sunscreen has the highest protection against UVB radiation: and if an SPF sunscreen includes any of the active ingredients listed below, then it has the highest AVB AND AVA radiation protection.
Always choose SPF 50+ sunblock but SPF only applies to UVB radiation and sunburn (a radiation burn!)
SPF stands for Sun Protection Factor. The number represents how long the sun’s UVB radiation would take to cause a radiation burn to your skin if you apply the sunscreen exactly as directed compared with the amount of time without sunscreen. If you use an SPF 50 product properly, it would take you 50 times longer to burn than if you used no sunscreen.
There is no SPF or label on sunscreen that gives you a measure of UVA radiation protection, and remember UVA radiation comprises 95% of all UV radiation that penetrates your skin: causing damage including dyschromia (pigment blotches) rosacea (flushing redness, visible blood vessels, enlarged pores and red blotches), wrinkles, thin and dry skin; and UVA is now known to contribute to an increased risk of skin cancer.
The most protective active ingredients against UVA radiation are listed below. Remember: and SPF 50+ sunscreen has the highest protection against UVB radiation: and if an SPF sunscreen includes any of the active ingredients listed below, then it has the highest AVB AND AVA radiation protection.
Sunscreen and UVA Protection:
- Butyl Methoxydibenzoylmethane (Avobenzone)
- Diethylamino hydroxybenzoyl hexyl benzoate (DHHB) (Uvinul A Plus)
- Bemotrizinol (bis-ethylhexyloxyphenol methoxyphenyl triazine) (Tinosorb S or Escalol S)
- Bisoctrizole (Methylene bis-benzotriazolyl tetramethylbutylphenol) (Tinosorb M)
- Zinc Oxide
- Titanium dioxide
We are very lucky in Australia that nearly all SPF 50+ sunscreens have BOTH the highest level of protection against AVB AND AVA radiation.
Sunscreen and nanoparticles
“…zinc oxide and titanium dioxide nanoparticles aren't absorbed through the skin into the bloodstream and, in the event that they do get into the bloodstream, via accidentally eating or inhaling the particles, say, the body's immune system can deal with them effectively…The overall conclusion is that there's no known health risk from these nanoparticles and you can safely use sunscreens that contain them.” (CHOICE, 2017)
Sunscreen and endocrine disruptors
The Skin Cancer Committee at Cancer Council Australia, points out that … “there is now very strong evidence that the list of commonly used active ingredients in sunscreen do not pose a concern for human health.”
“…zinc oxide and titanium dioxide nanoparticles aren't absorbed through the skin into the bloodstream and, in the event that they do get into the bloodstream, via accidentally eating or inhaling the particles, say, the body's immune system can deal with them effectively…The overall conclusion is that there's no known health risk from these nanoparticles and you can safely use sunscreens that contain them.” (CHOICE, 2017)
Sunscreen and endocrine disruptors
The Skin Cancer Committee at Cancer Council Australia, points out that … “there is now very strong evidence that the list of commonly used active ingredients in sunscreen do not pose a concern for human health.”
What about vitamin D?
“Whenever possible, it’s better to get vitamin D from your diet or vitamin supplements rather than from exposure to UV rays. Dietary sources and vitamin supplements do not increase skin cancer risk, and are typically more reliable ways to get the amount you need.” (American Cancer Society 2019)
“Whenever possible, it’s better to get vitamin D from your diet or vitamin supplements rather than from exposure to UV rays. Dietary sources and vitamin supplements do not increase skin cancer risk, and are typically more reliable ways to get the amount you need.” (American Cancer Society 2019)
Photodynamic Therapy (PDT)
PDT is a type of field treatment used to kill precancerous skin cells (actinic keratoses) on the face and/or scalp that have been damaged by years of sun (UV radiation) exposure. By destroying the damaged cells, the body is able to replace these with new healthy skin cells. PDT significantly reduces the chance of developing some types of skin cancer in the treated areas, and improves the quality and feel of your skin.
Photodynamic therapy (PDT) uses a topical medication called a photosensitising agent, together with light, to kill the precancerous skin cells. The drug approved for PDT is Aminolevulinic acid (ALA). It only works after it has been activated by certain kinds of light. Over three hours the drug is absorbed by the precancerous cells. Light is then applied to the area to be treated and causes the ALA to react and form a special kind of oxygen molecule that kills the cells. The photodynamic reaction is between the photosensitising agent, light and oxygen that kills the precancerous cells.
Benefits of PDT:
The other effective field treatment for precancerous skin cells on the face & scalp is Fluorouracil (Efudix). Both PDT and Fluorouracil are equally effective for this.
Advantages of PDT:
Photodynamic therapy (PDT) uses a topical medication called a photosensitising agent, together with light, to kill the precancerous skin cells. The drug approved for PDT is Aminolevulinic acid (ALA). It only works after it has been activated by certain kinds of light. Over three hours the drug is absorbed by the precancerous cells. Light is then applied to the area to be treated and causes the ALA to react and form a special kind of oxygen molecule that kills the cells. The photodynamic reaction is between the photosensitising agent, light and oxygen that kills the precancerous cells.
Benefits of PDT:
- Reduces risk of non-melanoma skin cancer (BCC & SCC)
- Improves skin quality and feel
- Performed at the practice over 3.5 hours
- Face is red for a few days only (minimal downtime)
- Safe and effective
- Burning/stinging sensation (usually no more than 1-2 days)
- Swelling and redness (swelling is usually minimal and lasts 1-2 days, redness lasts a few days only)
- Crusting (uncommon) & Itchiness (minimal)
- Peeling and blisters (Peeling is common, blisters are rare)
- Skin infections (rare)
The other effective field treatment for precancerous skin cells on the face & scalp is Fluorouracil (Efudix). Both PDT and Fluorouracil are equally effective for this.
Advantages of PDT:
- Treatment completed by doctor at the clinic in 3.5 hours (Fluorouracil takes 3-4 weeks)
- Downtime (face shows the effects of treatment) one week (Fluorouracil downtime 4-6 weeks)
- Cost is $750 for entire treatment (no Medicare rebate)