- Home
- Procedures
- Body
- Skin Cancer
Skin Cancer
Skin cancer on the trunk and limbs makes up a large share of the skin cancers treated in Australia. The three main types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. On the body they are most common on the back, shoulders, chest, forearms and lower legs, where sun exposure has accumulated over decades and where a lesion can go unnoticed simply because it is hard to see.
Body sites usually allow a wider margin than the face, so excisions are often larger. The question then becomes how the wound is closed. Skin over the back and shoulders is under tension with movement, and skin on the shin and forearm is thin with little tissue beneath it, so direct closure is not always possible and a skin graft or local flap may be needed.
Dr Maryam Seyedabadi is a Specialist Plastic Surgeon who performs excision and reconstruction of skin cancers on the trunk and limbs, and reconstruction after Mohs surgery carried out by a Mohs surgeon. If you or someone else notices a spot on your back, chest, arm or leg that is new, changing or not healing, see your GP or dermatologist. Where melanoma is a possibility, do not delay.
Signs to look out for
- A new or changing mole that looks different from your other spots.
- A lesion that is growing, altering in colour, developing an irregular border or becoming raised.
- A scaly or crusted patch on the forearm, shin or shoulder that does not clear.
- A sore or ulcer on the leg that has not healed within a few weeks.
- A firm lump under the skin that is enlarging, tender or bleeding when rubbed by clothing.
- Itching, bleeding or oozing from an existing spot.
How body skin cancer is diagnosed
Assessment involves examining the lesion with dermoscopy and checking the rest of your skin, since people who develop one skin cancer often have others. Where there are many moles, photography or mole mapping may be used so that change can be compared over time.
Diagnosis is confirmed by biopsy and histopathology. For a pigmented lesion, removing the whole lesion is often preferred so that thickness can be measured accurately. The pathology report describes the type of cancer, its depth and whether it reaches the margins, and it determines the margin needed at definitive surgery and whether a graft or flap is likely. Where a melanoma or a higher risk SCC is reported, examination of the draining lymph nodes, imaging or a sentinel node biopsy may be discussed.
Conditions we treat
Basal Cell Carcinoma (BCC)
On the trunk and limbs a BCC often appears as a shiny nodule or a flat, pink scaly plaque. It rarely spreads but enlarges locally, and excision with margins checked by pathology is the usual treatment.
Read more about basal cell carcinoma
Squamous Cell Carcinoma (SCC)
Common on the forearms, hands and lower legs. SCC can grow more quickly than BCC and has some potential to spread, so it is generally excised promptly with a wider margin.
Read more about squamous cell carcinoma
Melanoma
Melanoma is most often found on the back and shoulders in men and the lower legs in women. Treatment begins with excision biopsy, followed by wider excision based on the reported thickness, with further staging where indicated.
Post-Mohs Reconstruction
Mohs surgery is used less often on the body than the face. Where a Mohs surgeon has removed a tumour and cleared the margins, Dr Maryam can reconstruct the resulting defect with a flap or a graft.
Read more about post-Mohs reconstruction
Recovery and follow up
Smaller excisions on the trunk and limbs are day procedures under local anaesthetic. Larger excisions, grafts and flaps may be done under general anaesthetic. Lower leg wounds heal more slowly than wounds elsewhere on the body.
- Dressings are kept dry and reviewed at planned intervals, and grafts are usually checked within the first week.
- Sutures on the trunk and limbs often stay in longer than on the face, commonly around ten to fourteen days.
- Lifting, stretching and exercise are limited for a period so wounds on the back, shoulder or leg are not pulled apart.
- Elevation, and at times compression, is advised for leg wounds to limit oedema.
- Regular skin checks with your GP or dermatologist and daily sun protection, including clothing that covers the shoulders, arms and legs, remain part of long term care.
Your care with Dr Maryam
Dr Maryam Seyedabadi is a Specialist Plastic Surgeon, MBBS FRACS, AHPRA registration MED0001341746. Consultations are held at 2c Heeley Street, Paddington, and surgery takes place at East Sydney Private Hospital, St Luke’s Hospital in Potts Point, Sydney Day Hospital, Double Bay Day Hospital or The Skin Hospital in Darlinghurst, depending on the procedure and the anaesthetic. With a referral from your GP or dermatologist, a Medicare rebate can be claimed for these procedures.
Your treatment plan, and the result you can reasonably expect, depend on the type, size, site and stage of the lesion. Bring any pathology reports or referral letters you already have to your appointment. To arrange a consultation in Sydney, call 1300 067 668.
What actually happens
Your Journey, Step by Step
Before your consultation
Common questions, answered plainly.
What do skin cancers on the trunk and limbs look like?
On the back, chest, shoulders, arms and legs, skin cancers can appear as a firm pink lump, a shiny or pearly nodule, a rough scaly patch, an ulcer that keeps crusting, or a mole that is changing in size, shape or colour. Spots on the back are easy to miss, so ask someone to check for you. If something is new or changing, see your GP or dermatologist.
How is a skin cancer on the body confirmed?
Assessment starts with your GP or dermatologist, who may use dermoscopy and then take a biopsy under local anaesthetic. Diagnosis is confirmed by histopathology, which identifies the type of skin cancer and its depth. This guides the excision margin recommended, whether any staging tests apply, and how the wound is likely to be closed. A referral allows a Medicare rebate to be claimed for these procedures.
Why do excisions on the trunk and limbs sometimes need a skin graft or flap?
Skin over the back, shin and shoulder sits under tension and has limited spare laxity, so a wider excision cannot always be closed directly. Options then include a local flap, which moves adjacent skin, or a skin graft taken from another site. Larger or deeper lesions need more tissue to cover them. What suits you depends on the type, size, site and stage of the lesion.
What is recovery like after skin cancer surgery on the body?
Most excisions are done under local anaesthetic or sedation as day surgery, and some larger areas under general anaesthetic. Expect swelling, bruising and a scar that settles over many months. Wounds on the leg, back and shoulder heal more slowly and usually need a period of restricted activity. Your pathology result is discussed at review, and further surgery is sometimes needed if the margins are not clear.
