Skin Cancer

What is Skin Cancer?

Skin cancers (Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma) are the most common of all cancers. Accounting about 80% of all cancers diagnosis. This can have an impressive impact on patients’ lives. Common aesthetic area of concern for patients undergoing skin cancer excision is the face.

Facial reconstructive surgery aims to restore the normal and symmetric appearance of the details of the face. Skin cancer treatments are life-saving, but they may leave scars or disfigure patients. Restoring facial harmony demands the unique skills of a plastic surgeon. Bringing together reconstructive and aesthetic aspects of plastic surgical techniques can minimize the impact of skin cancer treatment.

Types of Skin Cancer

  • Malignant melanomas account for approximately 5% of skin cancer diagnosis. These can be serious and very aggressive.
  • Squamous cell cancers (15% of skin cancers) can metastasize and spread to distant sites and therefore must also be considered more seriously.
  • Basal cell cancers (80% of skin cancers), typically do not spread to distant sites and tend to be slow growing. Basal cell carcinomas will extend into adjacent tissues (by direct invasion) and therefore CAN be very destructive. If ignored, they can lead to the loss of important tissues, and could conceivably eventually lead to death.

Treatment of Skin Cancer

Removal is best done with the complete excision of the lesion, including a small margin of the unaffected tissue, as this gives the greatest assurance that the lesion is removed in its entirety and will not recur.

In some cases (especially in recurrent cancers, cancers on the eyelid or nose edge margins, and in some other circumstances) a Dermatologist specially trained in the “Mohs” technique might be able to look at the tissue as it removed to determine the adequacy of removal. This provides not only the greatest possible assurance of complete removal but also that the least amount of normal tissue is disturbed.

In all cases of skin cancer, removed tissue MUST be sent for pathology.

Although treatment of one area may completely remove skin cancer, there is always a possibility that the inciting insult (i.e. sun exposure) to the skin would potentially affect other areas of the body. Recurrence is also a possibility with any treatment. Sun protection and early recognition of new lesions is essential. It is necessary for you to be followed closely by your Dermatologist and Primary Care Physician.

Surgery in Skin Caner

After we determine the type of skin cancer and the treatment involves excision, the resulting defect would then require soft tissue repair. This could range from simply closing the defect with sutures, to mobilizing and rearranging surrounding tissues (a flap), or even employing a skin graft. Some degree of permanent scar will follow, but the important issue is how noticeable the scar will be.

 

Often, excision can be done in the office under local anesthesia, but sometimes excision needs to be done in the operating room under anesthesia. This is especially true in cases of larger lesions and those lesions which require more complicated reconstructions.

Malignant melanomas require definitive excision, possibly with excision of the associated sentinel nodes. Prior to surgical excision, a Radiologist can inject a radioactive marker into the area of the tumor, which can be followed with a scan to identify which lymph nodes are associated with that area of the body. In the operating room, with the aid of a sterile Geiger counter, these lymph nodes can then be identified, removed, and sent for pathology to see if there is any evidence of metastatic disease. If the nodes are positive or there are other indications that the melanoma could spread, then chemotherapy would need to be considered and an Oncologist would need to be consulted.