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A plastic surgeon who treats skin cancer on what to do if you suspect a melanoma-The Day Ahead

A plastic surgeon who treats skin cancer on what to do if you suspect a melanoma

“Don’t ignore it!”

Australia has staggering statistics when it comes to skin cancer. The good news is that early detection is a life saver. But as Dr. Marc Langbart, a specialist plastic surgeon based in Sydney, tells us, prevention is the best line of defence.

Second to that: don’t ignore anything suspicious-looking on your skin. For Melanoma Awareness Month, we sat down with Dr. Langbart to discuss his job in treating skin cancer, what signs make a skin spot concerning and what puts us at higher risk of developing skin cancer.

Can you please explain your job as a specialist plastic surgeon?

“When I tell people I’m a plastic surgeon, they immediately assume that I’m involved in cosmetic surgery. Plastic surgery is actually a broad specialty with multiple sub-specialty areas, including treating cancer, cancer reconstruction, cleft lip and palate, burns, maxillofacial surgery, hand surgery and more.

“My area of subspecialty is cancer treatment and cancer reconstruction. I’m commonly involved in the diagnosis and treatment of skin cancer. For me, this includes excision of the cancer and reconstruction of a defect. Most of my cancer work involves excising skin cancer on the face and tricky areas to reconstruct such as the eyelids, nose and lips. Reconstruction is achieved with what’s called a local flap or skin graft to reconstruct the hole that is made by removing the skin cancer. I’m also involved in larger, more complex reconstructions in other parts of the body, such as breast reconstruction for a woman who’s had a mastectomy for breast cancer, or reconstructing part of the oral cavity or jaw after head and neck cancer.”

Dr Marc Langbart

Dr Marc Langart

What does an average day at work look like for you?

“There is no average day for me and that’s what I love about my job–every day is completely unique. The day usually begins with ward rounds of in-patients, followed by consulting or operating. The range of things I see varies from small skin cancers to emergency surgery after a major road traffic accident.”

What sparked your interest in skin cancer and plastic surgery?

“My interest in skin cancer and plastic surgery came from my time as a medical student. The first time I saw plastic surgery was when I saw a bone in the leg being used to reconstruct the patient’s jaw and I thought it was the most fascinating thing I’d ever seen. I now perform that operation regularly. And I still get a buzz every time I operate.”

What procedures do you perform on the skin to remove melanomas?

“In the last decade, there has been huge progress in new ways to treat melanoma. Whether that’s special creams or new drugs or injecting chemotherapy into specific parts of the body. It seems like every few years a new type of treatment is emerging. My role in skin cancer and melanoma treatment involves good old-fashioned surgery to cut out a skin cancer with a safety margin of normal tissue.

“Even for a very small melanoma, we need to excise a lot of normal healthy tissue around the cancer to prevent it from coming back. And this leaves quite a big defect that can obviously have a disfiguring effect and a degree of morbidity, and my job is then to reconstruct the defect that is left.”

What signs should alert me to be concerned about a mole or sunspot?

“When it comes to a mole or sunspot, anything that is new or changing should alert concern and prompt you to go visit your health practitioner. A simple rule of what we look for around pigmented lesions is ABCDE.

“A stands for asymmetry. Any mole that is asymmetrical is more suspicious than one that is nicely symmetrical.

“B stands for border. Anything with an irregular border, scalloped edge or an indistinct edge is more suspicious than one with a regular border.

“C stands for colour. Suspicious lesions have various colours within them. Anything from reds, blacks, blues, browns and greys as opposed to a uniform colour, which is less suspicious.

“D stands for diameter. The larger the lesion, the more suspicious we are. More than 6mm is a concern.

“E is for evolution. Any lesion that is changing in any aspect, becomes itchy or starts to bleed is a source of concern.

What should we do if we suspect a melanoma?

“If you suspect a melanoma, the best thing to do is get in contact with a suitably trained health practitioner. A Plastic Surgeon, General Practitioner, Dermatologist or General Surgeon are all great starting points.”

What are your tips for doing skin self-checks at home?

“When it comes to doing a skin self-check at home, the best thing to do is make sure you’re in a well-lit room. Undress completely in front of a full-length mirror and inspect the various areas of your body. Make sure to also check areas that are not routinely exposed to sun as it is still possible to develop skin cancer in these areas. For example, the soles of your feet or between your fingers and toes.”

What are some lifestyle actions we can take to reduce our skin cancer risk?

“Practice sun safety and avoid indoor solarium tanning. Sun safety is as simple as slip, slop, slap, slide and seek. Slip on protective clothing. Slap on some sunscreen (at least 30 SPF plus). Slap on a hat. Seek shade. Slide on sunglasses.”

What non-lifestyle factors put us at risk of melanoma?

“Some things that put you at higher risk for melanoma are a paler skin tone that doesn’t tan, a family or personal history of melanoma, people with more moles on their body, and people with immunodeficiencies or certain genetic conditions. Age is also a risk factor as melanoma becomes more common with age.”

What are the statistics around melanomas in Australia? Who does it affect and how?

“Australia has the highest rates of melanoma in the world. And the numbers of new cases of melanoma are rising. Around 1300 Australians will die from melanoma annually. It is the third most common cancer in Australia and the most common cause of cancer in all young Australians.

“For those aged 20 to 39, it’s the second most common cancer in Australian men after prostate cancer and the third most common cancer in Australian women after breast and colorectal cancer. The majority of these–95%–are caused from overexposure to UV radiation from the sun.

“It’s not all doom and gloom though. 90% of melanomas can be cured by surgery and the survival rates from advanced melanoma is improving with time. Furthermore, if melanoma is picked up early, it has a much higher survival rate.”

What’s your best piece of advice for Australians this Melanoma Awareness Month?

“The most important message this Melanoma Awareness Month is let’s try to prevent skin cancer. So, practice sun safety and avoid indoor tanning. If cancer does occur, it’s much easier to treat, has much less morbidity and a lower mortality, if it’s picked up and treated early. If you spot a suspicious lesion, if it’s changing, bleeding or doesn’t heal, please see your health professional early. Don’t ignore it!”

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