Skin Cancer of the Head & Neck: Diagnosis and Treatment in Sydney

Skin cancer is the most common cancer in Australia, and the head and neck are among the most frequently affected areas. The face, ears, scalp, lips and neck receive significant cumulative sun exposure over a lifetime, making them particularly vulnerable to basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. ENT (head and neck) surgeons play a critical role in excising skin cancers from these anatomically complex areas while preserving function and achieving the best possible cosmetic result through reconstruction.

Types of Head and Neck Skin Cancer

Basal Cell Carcinoma (BCC)

BCC is the most common skin cancer and accounts for the majority of head and neck skin cancers. It typically appears as a pearly or flesh-coloured bump, a pink patch, or a non-healing sore that bleeds and crusts. BCC grows slowly and very rarely spreads to other parts of the body, but if left untreated it can invade deeper tissues including cartilage and bone, particularly on the nose and ears.

Squamous Cell Carcinoma (SCC)

SCC is the second most common skin cancer and tends to be more aggressive than BCC. It often presents as a firm red nodule, a flat sore with a scaly crust, or a new sore on an old scar. SCC on the head and neck can spread to regional lymph nodes, particularly when arising on the lip, ear, or scalp, or in immunosuppressed patients. Prompt treatment is essential.

Melanoma

Melanoma is the most serious form of skin cancer. It arises from melanocytes (pigment-producing cells) and can occur anywhere on the head and neck, including the scalp and behind the ears. Melanoma may appear as a new dark spot or a changing mole with irregular borders, uneven colour, or increasing size. Early detection and treatment are critical, as melanoma can spread rapidly to lymph nodes and distant organs.

Warning Signs

You should have a lesion on the head or neck assessed by a specialist if you notice any of the following:

A sore that does not heal within four to six weeks
A pearly, waxy, or translucent bump on the face or ears
A firm, red nodule that grows over weeks to months
A scaly, red or pink patch that persists despite treatment
A mole that changes in size, shape, colour or border
A pigmented lesion with asymmetry, irregular borders, multiple colours, or diameter greater than 6 mm (the ABCDE criteria)
Bleeding or crusting from a lesion without clear cause
A new or enlarging lump in the neck (which may indicate lymph node spread)

Diagnosis

At Central Sydney ENT, our surgeons take a thorough approach to assessing head and neck skin lesions:

Clinical examination: Your ENT surgeon will examine the lesion using dermoscopy (magnified, polarised light examination) and assess the surrounding skin, lymph node basins and relevant anatomy.

Biopsy: A punch, shave or excisional biopsy is performed to obtain a tissue sample for pathological examination. This confirms the type, depth and grade of the skin cancer and guides the surgical plan.

Imaging: For larger or more aggressive cancers, ultrasound, CT or MRI scanning may be required to assess the depth of invasion and check for lymph node involvement.

Sentinel lymph node biopsy: For melanoma and high-risk SCC, a sentinel node biopsy may be recommended to determine whether cancer cells have spread to the nearest draining lymph nodes.

Treatment Options

Treatment depends on the type, size, location and stage of the skin cancer. ENT surgeons are particularly well suited to managing head and neck skin cancers because of their expertise in facial anatomy, microsurgical techniques and reconstructive procedures.

Surgical Excision

The standard treatment for most skin cancers is surgical excision with a margin of normal tissue around the tumour. The specimen is sent for histopathological analysis to confirm clear margins. For small lesions, this can often be performed under local anaesthetic in the rooms.

Mohs Micrographic Surgery

Mohs surgery involves the progressive removal of thin layers of tissue with real-time microscopic examination of the margins. It achieves the highest cure rate (up to 99% for primary BCC) while preserving the maximum amount of healthy tissue. This is particularly valuable for cancers on the nose, eyelids, ears and lips where tissue conservation is critical.

Reconstruction

After excision of a head or neck skin cancer, reconstruction of the defect is essential for restoring both function and appearance. Depending on the size and location, reconstruction may involve:

Direct closure: for smaller defects where the skin can be brought together directly
Local flap repair: tissue is rotated or advanced from an adjacent area to fill the defect, matching colour and texture
Skin graft: a thin layer of skin is taken from another site (often behind the ear or from the collarbone area) and placed over the wound
Cartilage graft: for defects involving the ear or nose that require structural support

Neck Dissection

If imaging or sentinel node biopsy confirms that cancer has spread to cervical lymph nodes, a neck dissection may be required to remove the affected nodes. Our head and neck surgeons have extensive experience in selective and modified radical neck dissection.

Adjuvant Therapy

Radiation therapy may be recommended after surgery for high-risk cancers, including those with close or positive margins, perineural invasion, or lymph node involvement. Immunotherapy may be considered for advanced melanoma or inoperable SCC. Treatment is coordinated with our oncology colleagues as part of a multidisciplinary team approach.

When to See an ENT Specialist

Your GP or dermatologist may refer you to an ENT surgeon for head and neck skin cancer when:

The cancer is in a complex anatomical area (nose, ear, eyelid, lip)
Excision will require flap or graft reconstruction
The cancer has spread or is suspected of spreading to neck lymph nodes
Previous treatment has failed and the cancer has recurred
The cancer is large, deeply invasive or high-risk on pathology

Our Specialists

Head and neck skin cancer surgery at Central Sydney ENT is performed by our team of FRACS-qualified surgeons with fellowship training in head and neck surgical oncology. Our surgeons: including Dr Alexander Zhang, Dr Arjuna Ananda, Dr Philip Yeung and Dr Sam Hwang: have extensive experience in skin cancer excision and facial reconstruction. Consultations are available at our Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda locations.

Related Conditions

Skin cancer of the head and neck is closely related to several other conditions treated at Central Sydney ENT:

Head & Neck Cancer: includes mucosal and deep-tissue cancers of the head and neck region
Neck Lumps: enlarged lymph nodes may indicate metastatic skin cancer

Common Questions

Skin Cancer of the Head & Neck FAQ

Why is the head and neck a common site for skin cancer? +

The face, ears, scalp, lips and neck receive high cumulative ultraviolet radiation over a lifetime because they are frequently exposed to the sun. Australia has one of the highest rates of skin cancer in the world, and the head and neck account for a significant proportion of all cutaneous malignancies due to this chronic UV exposure.

What is the difference between BCC, SCC and melanoma? +

Basal cell carcinoma (BCC) is the most common and least aggressive, growing slowly and rarely spreading. Squamous cell carcinoma (SCC) is more aggressive and can spread to lymph nodes if untreated. Melanoma is the most serious form, arising from pigment-producing cells, and requires early detection and wide excision to prevent metastasis.

Why should an ENT surgeon treat my facial skin cancer? +

ENT (head and neck) surgeons have specialised training in the complex anatomy of the face, ears, nose and neck. They are experienced in removing skin cancers with adequate margins while preserving function and achieving the best possible cosmetic outcome through local flap and graft reconstruction techniques.

What happens if skin cancer is found on my ear or nose? +

Skin cancers on the ear or nose require careful surgical planning because of the complex three-dimensional anatomy. ENT surgeons are trained to excise these cancers with clear margins and reconstruct the defect using local tissue flaps, skin grafts, or cartilage grafts to preserve both function and appearance.

Does Central Sydney ENT treat head and neck skin cancer? +

Yes. Central Sydney ENT has seven FRACS-qualified ENT surgeons experienced in the diagnosis, excision and reconstruction of head and neck skin cancers. We offer comprehensive assessment and surgical treatment across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.