A cancer diagnosis is very difficult to accept. Knowing that treating your skin cancer may result in scars or disfigurement can also be troubling. Your plastic surgeon understands your concerns and will guide you through treatment and explain the resulting effect on your health and appearance.
Skin cancer, much like any form of cancer, may require surgery to remove cancerous growths. Your plastic surgeon can surgically remove cancerous and other skin lesions using specialized techniques to preserve your health and your appearance. Although no surgery is without scars, your plastic surgeon will make every effort to treat your skin cancer without dramatically changing your appearance.
Your plastic surgeon also will discuss where your procedure will be performed. Skin cancer surgery may be performed in a minor treatment room, an accredited office-based surgical facility, licensed ambulatory surgical center or hospital. If your procedure is performed with any sedation, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
Be sure to ask your plastic surgeon questions. It’s very important to understand all aspects of your skin cancer procedure.
Depending on the size, type and location of the lesion, there are many ways to remove skin cancer and reconstruct your appearance if necessary.
Skin cancer can be like an iceberg. What is visible on the skin surface sometimes is only a small portion of the growth. Beneath the skin, the cancerous cells cover a much larger region and there are no defined borders. In these cases, a specialized technique called Mohs surgery may be recommended.
During this procedure, your plastic surgeon may order a frozen section. During this step, the cancerous lesion is removed and microscopically examined by a pathologist prior to wound closure to ensure all cancerous cells have been removed. The goal is to look for a clear margin – an area where the skin cancer has not spread. If clear margins are found, the resulting wound would be reconstructed. If clear margins are not present, your plastic surgeon will remove more tissues until the entire region has a clear margin.
Medications are administered for your comfort during the surgical procedure. The choices include local, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
A small or contained lesion may be removed with excision – a simple surgical process to remove the lesion from the skin. Closure is most often performed in conjunction with excision.
A skin cancer lesion that is particularly large, is being removed with frozen sections or is likely to cause disfigurement may be reconstructed with a local flap. Healthy, adjacent tissue is repositioned over the wound. If possible, the suture line is positioned to follow the natural creases and curves of the face to minimize the obviousness of the resulting scar. Your surgeon may choose to treat your wound with a skin graft instead of a local flap. A skin graft is a thin bit of skin removed from one area of the body and relocated to the wound site.
After your skin cancer has been removed and any primary reconstruction is completed, a dressing or bandage will be applied to your incisions.
Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer. It’s important to discuss the signs of skin cancer with your physician, regularly perform selfexaminations for suspicious lesions and schedule an annual skin cancer screening.
Skin grafts have an added risk that the graft may not “take” and additional surgery may be necessary to close the wound.
• Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
• Anesthesia risks
• Excessive bleeding
• Change in skin sensation
• Damage to deeper structures – such as nerves, blood vessels and muscles – can occur and may be temporary or permanent
• Infection
• Poor healing of incisions
• Possibility of revision surgery
• Recurrence of skin cancer
• Systemic spread of skin cancer
These risks and others will be fully discussed prior to your consent.
It’s important that you address all your questions directly with your plastic surgeon.
Following your skin cancer surgery, incision sites may be sore, red or drain small amounts of fluid.
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow up care?
• How long will it take before healing is complete?
Healing will continue for many weeks or months as incision lines continue to improve. It may take a year or more following a given procedure for incision lines to refine and fade to some degree. In some cases, secondary procedures may be required to complete or refine your reconstruction.
Sun exposure to healing wounds may result in irregular pigmentation and scars that can become raised, red or dark. Sun exposure may increase the risk of the development of skin cancer in another region of your body.
Your plastic surgeon can treat your skin cancer by surgically removing cancerous skin and closing the resulting wound. Some forms of skin cancer require additional treatment such as radiation therapy. Your physician will advise you about any follow-up treatment recommendations.
Reconstruction closes the skin cancer defect, but no reconstruction is perfect. Visible scars will always remain at incision sites. You may also see textural, color or other visible differences of the skin in reconstructed areas. In some cases, treating your skin cancer can be disfiguring to your appearance. Although every effort is made to restore your appearance as closely and naturally as possible, the most important factor is that your skin cancer is effectively cured.
Following your physician’s instructions is essential to the success of your surgery. It’s important that the surgical incisions are not subjected to excessive force, swelling, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Prices for skin cancer surgery vary. A surgeon’s cost may be based on his or her experience, the type of procedure used and the geographic location of the office.
• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Prescriptions for medication
• Surgeon’s fee
Your health insurance plan should cover skin cancer surgery, related complications or another surgery to reconstruct your appearance. Precertification is generally required for reimbursement or coverage. Be sure to consult with your insurance company in advance of any surgery.