Dr Colin Rayner

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Dr Colin Rayner Skin cancers and melanomas are so prevalent in Australia 🇦🇺 today !!! GET YOUR SKIN CHECKED !!!

This was a diagnostic dilemma. This was NOT the reason for the patient being referred for a skin check. The patient had ...
12/09/2026

This was a diagnostic dilemma. This was NOT the reason for the patient being referred for a skin check. The patient had an obvious Basal Cell Carcinoma, skin cancer, on his Right upper medial eyelid. But during my detailed full skin examination, I instantly noticed a giant 70m x 25mm, red, crusty, scaly, weepy non-healing skin lesion on the Right upper chest, with a history of it being present for 3 to 6 months. Previous diagnostic opinions ranged from 1.) a very atypical infection of the skin (previous antibiotics apparently improved the lesion, but it relapsed as soon as the antibiotics were stopped) 2.) some type of unusual immunological skin rash ; maybe related to psoriasis 3.) some sort of injury or scar which become inflamed and was slow to settle.
But the GOLDEN RULE OF SKIN CANCER is that if ANY skin lesion has not settled or healed within 3 months … CONSIDER SKIN CANCER ‼️Obviously my opinion ‘came out of nowhere’ because this lesion had NEVER EVER been considered to be a skin cancer. So to do an extremely large excision on the basis of a POSSIBLE DIAGNOSIS was essentially out of the question. So I suggested a large biopsy of the worst part of the lesion ; so the diagnosis would then be 100% sure. The histopathology result was … an infiltrating Basal Cell Carcinoma, Right upper chest which invades the deep dermis. You can see the biopsy ‘hole’ in the upper part of this skin cancer, in the initial photographs. This now left the problem of excising this massive basal cell carcinoma, such that all the cut edges, as well as at the deep invasive surface would be clear of the cancer. The sequence of photo’s show how this was successfully achieved. A very happy and relieved patient resulted after the final histopathology report stated … SUMMARY
BASAL CELL CARCINOMA. EXCISION COMPLETE‼️

This was a 30mm diameter aggressive Squamous Cell Carcinoma on the Left Upper Outer Ear (Helix)This skin cancer was crus...
18/07/2026

This was a 30mm diameter aggressive Squamous Cell Carcinoma on the Left Upper Outer Ear (Helix)
This skin cancer was crusty, fragile and wanting to bleed 🩸 easily. When I first saw this lesion, the skin cancer area was also weepy, with red inflamed surrounding skin tissue and it was also extremely tender to touch. These signs and symptoms classically indicated that the skin cancer had an acute bacterial infection.
I couldn’t go anywhere near the lesion without the patient screaming in agony. The skin cancer also stuck out above the surrounding ear tissue indicating that it was thick in depth from its outer surface to it inner deepest roots.
This was the traditional NIGHTMARE scenario
😱😱😱‼️‼️‼️
1.) Before any surgery could even be thought of ; the obvious infection needed to be got under control
2.) Also … without getting a clear margin of non-cancerous skin around the skin cancer at the top, the bottom, on both sides and in the depth ; then the surgery would be an utter waste of time
3.) How on earth does a surgeon close a 30mm diameter hole on an ear 👂???
4.) Also … the depth was unknown. Are the deepest roots touching the rubbery ‘bone’ underneath (the cartilage) or does the skin cancer roots pe*****te the
cartilage ‼️
5.) Hopefully the skin cancer roots are not penetrating right through the cartilage and establishing themselves at the rear of the cartilage ; just a millimetre inside the posterior skin of the ear
6.) Will the surrounding fragile skin even support any stitching without tearing ; with the wound just falling apart in the next few days after the surgery is completed
7.) Would a skin graft even work ?
8.) What about a skin flap transfer ? Is this even possible ? If so … would there be any ear left to rest the patient’s glasses on ; or a hearing aid if this ever was necessary ?
9.) Also … research 🧐 indicates that of all skin surgery areas operated on ; the ear is the most likely area to cause bleeding 🩸; bruising and hemorrhagic complications ; more than any other skin area post operative ‼️
WELL … THE SURGERY STILL NEEDED TO GO AHEAD URGENTLY ; OTHERWISE OUR WONDERFUL PATIENT WOULD LOSE HIS EAR
Ironically ; with everything looking pretty ‘gloom and doom’ ; the surgery was a great success 💙
The histopathology report ; measured very acceptable clear margins from the cancerous edges and the deep roots were reported as ‘implanted’ onto the upper outer cartilage ; but not penetrating the cartilage. Since the cartilage was fully removed underneath the squamous skin cancer during the surgical excision ; this meant the deep margins of the skin cancer were also clear. The removal of the deep cartilage below the skin cancer allowed the posterior skin to flap forward to amazingly close the giant surgical defect without too much trouble and without too much cosmetic deformity. Also the remaining cartilage edges gave great support to the stitches, so that they could not tear the fragile surrounding skin. Also bleeding and pain were not a problem
I always have been my own worst critic ‼️But in this case I would give myself 12 out of 10 😂

Medicare would categorise a skin cancer on the nose as LARGE if it was 6mm in diameter or larger. This histologically pr...
10/06/2026

Medicare would categorise a skin cancer on the nose as LARGE if it was 6mm in diameter or larger. This histologically proven Basal Cell Carcinoma was almost 20mm in diameter. In terms of the excision of skin cancers from the nose 👃 ; I divide them into 3 categories
a.) The proximal nose (near where the glasses go!) also known as the ‘bridge of the nose’
This is the EASIEST area. There is plenty of loose skin around and you could cut along the length of the nose or across the breadth of the nose and you would get away with either. Moreover, there are no important nerves or blood vessels around and if you cut too deep ; you would just hit the bone below which would prevent any further damage 🤣
b.) The mid nose ; this area is moderately difficult.
Spare skin is limited and if closure of the excision wound is difficult ; a flap would be required where 100% of the skin is rotated from the bridge of the nose and 0% of the skin from the tip of the nose.
This avoids causing asymmetry of the nose and flaring of the nostril(s) causing breathing difficulties and disfigurement and a cosmetic disaster
Also if the excision was too deep, you would be cutting through the rubbery bone called cartilage and this would be the ultimate catastrophe.
c.) The distal nose (tip of the nose) Extremely difficult !!! High concentration of very sensitive nerves ; multiple blood vessels that literally sq**rt like a hose pipe ; and all covering delicate cartilage that often has to be carefully trimmed (without coming out the inner side) because many cancers in this area grow their ‘roots’ right up to and onto the outer surface of this cartilage. Unless the cancer is 2mm or 3mm in diameter ; the only way to close the excision ‘hole’ is by a skin graft. My personal favourite donor site for the skin graft is the skin behind the ear. It has no hair on it ; there is plenty of good matching skin available and the defect, where the skin graft is taken from, is easy to close
In the case below ; this skin cancer was super large ; and right onto the cartilage below. It proved to be a huge challenge to excise this cancer fully and completely and still have a nose that can pass public scrutiny 🧐 I feel the final outcome here was ultimately pretty successful.
Waiting another 6 to 12 months for diagnosis and surgery may well have ended up as an amputation and a ‘click on’ plastic nose or worse

Our Medical Home, Gold Coast, has recently partnered with Medicare to launch a new URGENT CARE CLINIC at the Cornerstone...
06/06/2026

Our Medical Home, Gold Coast, has recently partnered with Medicare to launch a new URGENT CARE CLINIC at the Cornerstone Medical Clinic in Oxenford, where I am presently the local skin cancer surgeon. Notably, I hold a medical degree from the University of Witwatersrand in Johannesburg, South Africa. At that time, I had a strong interest in emergency medicine, accident and trauma care and literally ‘lights and sirens’ ambulance call out and first responder supervision.
Between 1985 and 1987 I established an after hours house call service called Nite-Doc that morphed into URGENT CARE CLINICS in both Durban and Johannesburg, called Clinic-Call. I also established the first private ambulance service in the whole of South Africa, which was not merely a patient transport service between private hospitals. Swift-Care Ambulance Service had a great reputation for being just that ‘Swift’ and ‘Caring’
Unfortunately it was way before its time ‼️At the time, Medical Insurance Companies paid private ambulances per kilometre travelled. For example we transported a stable war veteran from Durban to Pretoria ; about 615 kilometres and were paid in the region of $6,200. But when we rescued a man with life threatening burns and multiple injuries from a burning ute (after a very serious motor vehicle accident) we were only paid $200 because the scene of the accident was only 20 kilometres from the hospital.
The fact that x 2 ambulances 🚑 🚑 x 4 paramedics and a doctor (myself) attend the accident. The fact that $1,000 of disposable equipment was consumed ; made no difference to the fee paid by the Medical Insurance Company. As most of the call outs were short distances from the hospital; this wonderfully innovative, ground breaking private ambulance service could not survive financially and was eventually sold out to a prominent private hospital group in 1992.

This lady presented with a giant irregular, darkly pigmented, speckled ‘freckle’ of 35mm diameter on her Right wrist. It...
06/06/2026

This lady presented with a giant irregular, darkly pigmented, speckled ‘freckle’ of 35mm diameter on her Right wrist. It was highly suspicious of malignant melanoma ; so I did an excision biopsy of the whole lesion. The histopathology report confirmed an invasive malignant melanoma. The problem now was that a formal wide re-excision was required ; with clear margins of at least 10mm from each edge of the existing wound and 10mm clear at the base of the wound. But the original excision had removed all the excess surrounding skin ; such that even a 1mm clear margin surrounding the original excision wound would have been difficult. A decision was made to take 35mm of skin from the Right arm near the elbow and use it as a skin graft to close the skin defect (the hole) created after the formal wide re-excision of melanoma was completed. The final outcome was extremely successful. The lady had her finger nails 💅 attractively manicured to celebrate this life saving outcome.

05/06/2026

Oldie and Goldie Three
Excision of a giant tumour from the knee. Suturing and repair of the surgical wound. Associated commentary

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