Skin cancer is a common problem, especially as people grow older. It represents the most common form of cancer and most cases are triggered by a combination of sun exposure and genetic susceptibility. Fortunately, most cases can be treated without significant long-term effects, especially if caught early.
Patients are commonly referred to our office for removal of more complex skin cancers, or those that are located in visible areas, especially the face. We have many years of experience in treating these cancers and will provide the care you need to treat your cancer with the least possible scarring, pain, and downtime.
Types of Skin Cancer
Basal cell carcinoma– The most common and fortunately the most treatable form of skin cancer. Complete removal with a small margin of normal skin usually is adequate treatment, as these cancers rarely metastasize. While many of these can be treated by your primary care physician or dermatologist, we are often referred patients for excision of basal cell carcinomas when they are especially large, located in anatomically sensitive areas, or are on the face.
Squamous cell carcinoma– These can be more aggressive than basal cell carcinoma, although most cases are treated similarly to basal cell carcinoma. Again, we are often referred patients for removal of these when these are large, located in anatomically sensitive areas, or are on the face. Squamous call carcinomas can metastasize, especially those that are large or if the patient is immunocompromised. In these cases, additional treatment beyond simple removal of the skin lesion may be required.
Melanoma– Melanoma can be more aggressive than these other cancers, even fatal. However, if cases are caught early (most are) the prognosis is very good. Surgical treatment requires removal of the melanoma along with a wider border of normal tissue than required with other skin cancers, a “wide excision”. In addition, sampling of the lymph nodes may be recommended. In advanced cases, chemotherapy and radiation are sometimes used as well.
Other cancers– There are numerous other less common cancers that we have treated over the years but basal cell, squamous cell, and melanoma are by far the most common. Other cancers may require simple excision or other treatments that we will discuss with you at the time of your consultation.
If you have been diagnosed with or have a lesion suspicious for skin cancer, your primary physician or dermatologist may refer you to our office. If a biopsy has been performed we ask that you bring a copy of this result with you or have a copy forwarded to our office. At this initial consultation we will evaluate your lesion and discuss how we might best treat this. If surgical removal is required, we will discuss how we plan to do this, how the defect will be closed, and what kind of result you might expect. If you decide to proceed, we will schedule a time for the procedure to be done in our office (most cases) or in the operating room.
We also see patients who are scheduled to have their cancer excised in by another physician using the Mohs’ procedure. This is an excisional technique done by specially trained dermatologists where the tumor is excised and immediately examined microscopically in their office to assure complete removal. If your dermatologist anticipates a large defect or one located in an anatomically complex area, they may refer you to us to close your wound. At your initial consultation in our office (before the planned procedure) we will have an opportunity to meet you, assess what the defect might be after excision, and review our plans for closing this.
Treatment in the office
If excision is required, most cases can be performed in one our well-equipped procedure rooms in our office. A local anesthetic is used and the procedure generally takes 30 minutes or less. In the simplest cases, we excise the cancer and close the skin directly with sutures. If the defect is larger, we may need to rearrange the local tissues to minimize the distortion and tightness of the skin by performing a skin flap procedure. Occasionally we may utilize a skin graft for the closure of defects, using a piece of skin removed from another area of the body where you may have some excess.
In some cases, based on the cancer size, location, and type, we may recommend utilizing “frozen sections” during the procedure. Similar to the Mohs’ technique, your cancer will be removed and the wound left open until we have microscopic confirmation of complete removal. We have your specimen transported to our pathologists at Lawrence Memorial Hospital 2 blocks away, where it is quickly processed and examined by our pathologists. While awaiting the result (typically about 30 minutes) a dressing will be applied and you can relax, read a magazine or book, etc. If complete removal has been accomplished, we will then close the defect. Otherwise, additional tissue removal may be needed until we can be sure all cancer has been removed. Of course, utilizing this technique will add time to your procedure, making it last 1 hour or more.
Treatment in the operating room
Some skin cancers, depending on the size or type, are more appropriately treated in the operating room. This is especially true of cancers that require wide excision (melanoma, merkel call carcinoma, and others) and or are particularly large. Typically, these are outpatient procedures that are performed at Lawrence Memorial Hospital or the Lawrence Surgery Center.
In the case of large or complex cancers, we may work with other specialists (oncologists, radiation oncologists, general surgeons, dermatologists) in a coordinated fashion to provide your care. Some skin cancers, especially early ones, may not require surgical removal and can be treated by cryotherapy (freezing), laser, topical treatments and other methods. If non-surgical treatment seems best for you, we may refer you to your primary doctor or dermatologist.
After simple excisions, sutures will usually be in place for about a week. Minor bruising and swelling are possible, and pain is minimal. A flesh colored tape strip is usually applied and often remains over the stitches until you return. If this is the case no wound care is required. Normal activities may be resumed right away, but we ask that you refrain from strenuous activities and exercise until the following day. When we perform more extensive procedures such as local flaps or skin grafts, recovery may be somewhat longer.
Tumor removal is the most common reconstructive procedure performed by plastic surgeons, with over 4.5 million performed annually. It is one of the most commonly performed procedures in our office.