Dr Colin Rayner

19/01/2025

This was a proven 20mm invasive SQUAMOUS CELL CARCINOMA of the Right lower lip, with deep infiltration to muscle depth! What I thought would be absolutely ‘nightmare’ surgery, turned out to be
‘a walk in the park’!!! Everything worked out to perfection. Histopathology report stated that the cancer was fully and adequately excised. And the healing process was fantastic. 3 weeks later, no one could tell that the patient had ever had any surgery to his lip. This was an extremely successful result.

19/01/2025

This was a 10 out of 10 surgical presentation. The patient was referred to me to have a routine ‘blood-wart’ (haemangioma) removed. It was very similar to the one in the first picture but was not position on the dorsal (upper, outer) wrist ; but on the ventral (lower, inner) wrist. There was not a lot of suspicion regarding this lesion, as it had been there for about 10 years. But in hindsight, it had recently become irritated and instead of being red or purple, it was a deep purple (🎸🥁🎶) almost black. So pretty unexpectedly the histopathology from the shave biopsy and diathermy came back as a Clark level 3 malignant melanoma. So, the next step was a formal wide re-excision of this malignant melanoma.
But as shown in picture 2, the giant radial artery (where the nurse takes your pulse) was just below the biopsy wound and the wide re-excision would include the extremely important median nerve.
So this involved hair-raising blunt dissection, constantly feeling for the pulsation of the radial artery and very careful avoidance of the median nerve.
Eventually the job was done and the outcome was 100% perfect

19/01/2025

This is a relative common (in my skin cancer clinic) non-healing ‘sore’ for 3 to 6 months. Typically the patient comes to see the doctor, not for a suspected skin cancer (that is the last thing on their mind) but because “doctor I am getting blood on my pillow sheets!!!”
This was in fact a large invasive BASAL CELL CARCINOMA. No need for a biopsy as the diagnosis is dead obvious. With a good deep and wide excision, the problem in this case was complete cured.

19/01/2025

New ‘slip-on’ shoes with no heel support caused significant plantar skin thickening, with deep cracking and splitting of the heel skin and immense pain and suffering!!! Successful shaving back of the thick, hard skin to the split/crack level, resulted in immediate relief 😅 🤍🤣

15/09/2024

Here I am going to talk about THE GREAT PRETENDER!
So on the LEFT is what is known as a RINGWORM
There is actually NO ring 💍 and NO worm 🐛
The name was given to this common skin condition hundreds of years ago when the cause was unknown. So the name was merely descriptive. More recently (in the last century) it was discovered to be caused by a localised fungal infection. Certainly in the last 50 years, it has been, and still is, treated by an uncomplicated anti-fungal cream.
So I asked the patient who had a skin condition similar to the one on the RIGHT … what do you think that is on your skin? The immediate reply was “it’s a RESISTANT RINGWORM!”
So I said … how do you know it’s resistant?
So doctors A said it was a ringworm and gave me special cream that didn’t work!
So doctor B gave me extra special extra strong cream that didn’t work!
So the dermatologist gave me strong oral anti-fungal tablets that also didn’t work!
So I was told it was a resistant ringworm
THE FINAL OFFICIAL DIAGNOSIS
On formal excision (not easy, because it was 40mm in diameter) it was reported by the histopathologist to be a form of SQUAMOUS CELL CARCINOMA!!!
This was THE GREAT PRETENDER!!!

15/09/2024

Left earlobe ‘stretcher’ repair part 3

15/09/2024

Left earlobe ‘stretcher’ repair part 2

15/09/2024

15/09/2024

Sometimes I get the impression that the average person who attends Our Medical Home Gold Coast thinks that all I do is just a few skin checks, squeeze a few pimples and refer all the rest to a plastic surgeon. Everyday I get questioned in regards to who am I going to refer a particular patient to, in order to get the surgery done. As it turns out, I have referred less than 5 cases in the last 20 years to a plastic surgery unit. I have enthusiastically planned and carried out all the other surgeries (however complex) with a high level of success. However, long before I ever focused more on skin cancer surgery, I did a lot of cosmetic surgery and still do to some extent.
This is a case of ‘no longer wanted’ ‘stretchers’ (stretched ear lobes) being reversed in my clinic last week

11/08/2024

A recent giant melanoma on the lower leg
The patient never knew it was there!
Essentially she was a tourist from another country
She went to a Gold Coast beach
Her local Australian friends immediately said “What is that on your leg?” “You better get that checked immediately!”
Also … it turned out that one of her friends had heard about my clinic and we ‘fitted her in’ as an EMERGENCY SAME DAY APPOINTMENT
I was obviously concerned that the lesion was potentially dangerous … so I booked her in for AFTER HOURS … SAME DAY SURGERY!!!
(that evening … after everyone else has gone home!)
So if you know someone who needs an URGENT ASSESSMENT (not a routine skin check) I can almost always ‘fit the patient in’ somewhere on the same day of the request
For anyone who doesn’t know what I do …
Here is a summary …
I work exclusively in the assessment and checking of peoples skin for mainly skin cancers, but often end up discussing every possible human skin blemish
The reason for this is that the average person just does not know what to look for and what not to look for ... what might be dangerous and what is probably not dangerous
IRONICALLY I often find people coming to my clinic to get a perfectly harmless skin growth (medical term “skin lesion”) assessed ... when in fact they have a melanoma “hiding” on another part of their body
Often ... trying to “Google” 10,000 skin lesion images is for the average person absolutely confusing and can lead to poor decision making
My “take home” instructions have little to do with exact appearance !!!
THIS IS MY QUICK CHECK LIST ... which will cover 99% of “red flag” lesions
1.) All completely black spots of any size ... not dark brown ... but black ... particularly on a very fair skin (note : some people with a much darker skin ... can have spots that are almost black in colour ... but are harmless)
BIG NOTE ... in skin cancer study ... like life in general ... there always is an “exception to the rule”
2.) Brown pigmented lesions of
a.) 6mm diameter or more
b.) Asymmetrical shape ... more like a geography map ... than a round or oval shape
c.) Smudgy edge / border ... looks like the pigmented lesion is “staining” the surrounding skin
d.) Variation of colour ... often light / dark speckled appearance ... but hints of blue and white and other colours would be very worrying
e.) “Last but not least” ... extremely important ... the lesion is changing ... shape ... size ... colour ... any change in appearance (this is called evolving or evolution)
If you wait for all 5 factors to be present ... YOUR
LIFE WILL BE THREATENED ... you can get away with one positive factor if it is not e.) ... but even two positive factors is a big “red flag”
3.) Non-healing sores for 3 months or more
If the person is very “non observant” this time period could extend to 2 years ... the original problem may originally have been a skin injury like a burn or an insect bite or spider bite or a “cold sore” (Herpes viral sore) on a lip or a strange “pimple” on a cheek ... but a fractured leg can heal fully in 3 months ... so why can’t a simple sore on the skin heal in 3 months ... simple!!! ... it not a simple sore!!! ... it’s a skin cancer that looks like a simple sore ... on many occasions ... a patient has become very angry and raised their voice saying “I actually saw the b..... white tail spider bite me ... so you are b..... wrong” ... But in actual fact ... biopsy or excision histopathology laboratory report always proves I am correct and the angry patient is incorrect (EXPLANATION ... the spider bite overwhelmed the immune system in the local skin area ... while the spider bite was healing ... the skin cancer was able to establish itself in exactly the same skin area ... making it look like ... the original spider bite never healed properly
THANKS FOR READING ....
SO MUCH MORE TO COME ....
ALSO ... FOR CASUAL VIEWERS ... LOTS OF PHOTOS

01/06/2024

This patient previously had a small 3mm biopsy done on his nose at another clinic. The result was an invasive Basal Cell Carcinoma (BCC skin cancer) The residual BCC was measured to be 12mm in diameter. This means that any normal skin cancer excision would probably lead to a multitude of problems including breathing problems, pugg nose, asymmetry, cosmetic ugliness and potentially ‘incomplete excision’
For the average patient who does not have medical insurance, the cost of plastic surgery under general aesthetic done in the operating theatre of a private hospital can be in the region of $8,500. Also, I had one patient who landed on my doorstep recently who had been waiting since December 2022 to have a giant 80mm
(8 centimetre) fatty cyst (lipoma) removed from his scapula (shoulder blade). This lipoma was larger that an enormous tennis 🎾 ball. I was able to successfully remove this lipoma the following week.
Anyway … getting back to this large BCC skin cancer on the tip of the nose.
It needed wide excision down to nasal cartilage to ensure complete excision in the depth of the cancer and on all peripheral edges. The residual skin defect was impossible to close via any normal skin stitches and even via a complicated rotation or transposition flap. The answer was to remove ‘donor’ skin from behind the ear and transplant it onto the nose.
The skin defect behind the ear was then stitched together and the donor skin was stitched on to the skin defect on the nose. The degree of difficulty was 8 out of 10. The nose can bleed 🩸 like crazy and can be difficult to stop. The nasal cartilage can be damaged in many ways if strict attention to detail is not adhered to.
This procedure is not 10 out of 10 due to the fact that there are no named veins, arteries, nerves or tendons in the area that would make the procedure in the highest risk category.
I commonly do 10 out of 10 procedures and all have been successful
I also commonly do many, many, many 1 out of 10 procedures which is what the average person thinks I do all day and that all the difficult ones I just refer to some magical place that is just waiting for the referral ; or to some magical person who has studied for at leased 13 years after leaving high school, who will gladly do the surgery for free, and his friend the anaesthetist will likewise do his share at no cost, and just to complete this mythical scenario, the private hospital will also render their services without charge !!!
I did thus surgery on Friday 31st May 2024.
(Basically 2 days ago)
The procedure was bulk-billed to Medicare
(No charge to the patient)
The procedure was supposed to take 1 hour 15 minutes. I actually took 1 hour 48 minutes.
So to all the following booked patients on Friday afternoon who waited 33 minutes to be seen … sorry 😢