When is skin cancer reconstruction necessary?
The sun is out and bright here in Georgia and all of us need to be aware. For those of us with fairer skin the risk of cancer should always be in the back of our minds as we spend time at the pool or on the lake. And, the lighter the skin color the greater the cancer risk. There are three main types of skin cancer: squamous cell carcinoma (SCCa), basal cell carcinoma (BCCa) and melanoma.
Though SCCa and BCCa are different cancers, for the most part, the two cancers act similarly and are treated similarly. Both are the result of prolonged, unprotected exposure to ultraviolet radiation from the sun or tanning beds. In both situations, early detection is important, therefore, any chronic changes to the skin should be evaluated by a board certified dermatologist. In the event of early detection, these cancers can frequently be treated with non-surgical or topical treatments. However, if the cancer is detected later surgery is often indicated. The good news is that when these cancers are completely excised, the surgery is mostly curative. There are a minority of patients in which SCCa is left untreated for long periods of time. In these cases, the cancer can spread to regional lymph nodes and this requires lymph node resection. Luckily, these cases are much less frequent.
Melanoma, on the other hand, is a much more aggressive cancer and it requires timely evaluation, workup and surgical treatment. Whereas BCCa and SCCa grow slowly and have a much smaller risk of spread (metastasis), melanoma can invade into the deeper levels of the skin very quickly and can metastasize throughout the body rapidly. Sometimes, if melanoma is caught early, simple excision is curative. However, if the melanoma is found to have certain microscopic characteristics or a deeper depth of spread, surgical sampling or comprehensive removal of regional lymph nodes is necessary to ensure that widespread metastasis is prevented. Over recent years new chemotherapeutic agents have been effective at slowing down or halting the progression of metastatic melanoma, but, of course, it is advantageous to prevent the need for these agents.
First, regular, scheduled dermatologic evaluations are paramount, especially for those individuals who have significant sun or tanning bed exposure, history of frequent sunburns at an early age, flaking and chronic skin lesions, rapidly changing or growing skin lesions, or a history of previous skin cancer. All dermatologists are capable of biopsying suspicious lesions and most skin cancers can be excised in an office setting. It is important to remember that once you have a skin cancer diagnosis, you are at greater risk for more skin cancers. Therefore, these patients should be diligent in their follow-up.
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The most common form of skin cancer removal is wide local excision in which normal tissue surrounding the skin cancer is removed to ensure that all surrounding, unseen microscopic disease is also removed. This is usually a straightforward process in the chest, abdomen, or extremities where there is plenty of extra skin to ensure a tension free closure of the defect. However, in parts of the face and neck, simple closure is not possible due to the lack of needed skin. Take for example, the ear, a structure that is skin wrapped around a distinct cartilaginous frame without any laxity or extra skin. If a wide local excision is performed on the ear, there will be a significant defect with exposed cartilage that is not amenable to simply pulling the skin back together: attempting to do this type of closure would drastically alter the anatomy of the ear relative to the normal side. Similarly, the eyelids, nose, lips and skin of the face all require the same consideration.
In these complex cases, a Mohs Micrographic Surgeon comes into the picture. These specially trained dermatologists are uniquely skilled at removing the skin cancer in segments while preventing the unneeded loss of normal skin. This type of surgery is necessary because, as mentioned before, in delicate areas of the face, the more normal skin that can remain, the better the chance of camouflaging any scars or signs of surgery. Many Mohs surgeons spend all day performing these resections and reconstructive procedures that close and hide the scars and defects. However, there are times when the reconstructive needs fall outside of the comfort zone of the Mohs surgeon. It is in these cases that a board-certified facial plastic surgeon is imperative.
When the defect is too great for simply rotating some adjacent skin for closure, or if there is a need for additional building materials, such as cartilage to rebuild the nose, eyelids or ears, Garlich Facial Plastics and Limestone Surgery Center (LSC) are here to help. With 15 years of experience, Dr. Garlich has worked on many complicated skin cancer defects of the face. And, because these reconstructions are more complex procedures, patients can take comfort in knowing that the MD anesthesiologists who staff LSC will ensure the safest, most comfortable experience. Dr. Garlich has worked with the Mohs surgeons in Northeast Georgia for years and can coordinate a timely reconstructive process following the initial cancer resection.
Contact us today to learn more, 678-343-2190. We are delighted to see you in either our Gainesville or Braselton office.