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Skin Cancer Surgery and Reconstruction

Skin Cancer Surgery and Reconstruction, Tucson, Arizona

Skin cancer surgery

Hearing a diagnosis of ‚Äúcancer‚ÄĚ is very difficult to accept. Understanding that treating your skin cancer may result in scars or disfigurement can also be troubling.¬†Dr Hess and Dr Sandeen¬†understand your concerns and will guide you through treatment and explain the resulting effect on your health and appearance.

Quick facts about skin cancer treatment:

  • Treatment of skin cancer, much like any form of cancer, may require surgery to remove cancerous growths
  • Dr Hess and Dr Sandeen¬†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
  • For some people, reconstruction may require more than one procedure to achieve the best results

What to expect during your consultation

The first step in treating skin cancer is a consultation.  The success and safety of your skin cancer surgery depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be prepared to discuss:

  • Your type of skin cancer
  • Medical conditions, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries
  • The likely outcomes of your treatment and any risks or potential complications

We may also:

  • Evaluate your general health status and any other pre-existing health conditions or risk factors
  • Examine your skin
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes of surgery and any risks or potential complications

Prior to surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Stop smoking well in advance of surgery
  • Avoid taking aspirin, anti-inflammatory drugs and herbal¬†¬†¬†¬†¬† supplements as they can increase bleeding

Special instructions you receive will cover:

  • What to do on the day of surgery
  • The use of anesthesia during your skin cancer surgery
  • Post-operative care and follow-up

Dr Hess, Dr Sandeen or our staff will  discuss where your procedure will be performed. Skin cancer surgery may be performed in our office, in an ambulatory surgical center, or a hospital.

You’ll need help

If your procedure is performed on an outpatient basis (in an ambulatory surgery center or hospital), be sure to arrange for someone to drive you home after surgery and to stay with you for at least the first night following surgery.  If your procedure is performed in our office, you may want to have someone available to drive you home depending on the size and location of your procedure.

Step 1 ‚Äď Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include local, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 ‚Äď Removal

A small or contained lesion may be removed with excision ‚ÄĒ a simple surgical process to remove the lesion from the skin. Closure is most often performed in conjunction with excision and may range from a simple sutured repair to a more complicated procedure, depending on the size of the defect.

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.

Dr Hess or Dr Sandeen¬†may order a frozen section. In this procedure, 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 with frozen section is to look for a clear margin ‚ÄĒ¬†¬† 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 presen¬†Dr Hess or Dr Sandeen willl remove more tissues until the entire region has a clear margin.¬† This

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.

 

Step 3 ‚Äď Reconstruction

A large lesion or one that has been removed with frozen sections can be reconstructed with a local flap. A flap may also be necessary where excision may result in a disfiguring appearance. A local flap repositions healthy, adjacent tissue over the wound. A suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the appearance of the resulting scar.

A skin graft, healthy skin removed from one area of the body and relocated to the wound site, may also be applied.

 

Step 4 ‚Äď See the results

After your skin cancer has been removed and any primary reconstruction is completed, a dressing or bandages will be applied to your incisions.

Important facts about the safety and risks of skin cancer

The decision to have skin cancer surgery is extremely personal. Your physician will explain all of the potential risks. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.  You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo, the alternatives and the most likely risks and potential complications.

Possible risks include:

  • Bleeding (hematoma)
  • Infection
  • Poor healing of incisions
  • Anesthesia risks
  • Unfavorable scarring
  • Frozen-section inaccuracy
  • Recurrence of skin cancer
  • Systemic spread of skin cancer
  • Change in skin sensation
  • Skin contour irregularities
  • Skin discoloration/swelling
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
  • Damage to deeper structures ‚ÄĒ such as nerves, blood vessels, muscles, and lungs ‚ÄĒ¬† can occur and may be temporary or permanent
  • Pain, which may persist
  • Possibility of revisional surgery

Other important considerations:

Skin grafts have an added risk that the graft will not ‚Äútake‚ÄĚ and therefore additional surgery may be necessary to close the wound.

Preserve your health: Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer than the general population. Skin cancer also can reoccur. So, it’s important to discuss the signs of skin cancer with your physician, regularly perform self-examinations for suspicious lesions, and schedule an annual skin cancer screening.

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are no subjected to excessive force, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Your Recovery

Following your skin cancer surgery, incision sites may be sore, red or drain small amounts of fluid.

  • It is important to follow all wound care instructions such as cleansing and applying topical medications exactly as directed
  • You may be able to return to light activity the day of your surgery
  • Make certain to keep your incision sites clean and well protected from potential injury
  • Try to limit movement that may stress your wound and your¬†¬†¬†¬†¬† sutures

Be sure to ask Dr Hess or Dr Sandeen specific questions about what you can expect during your individual recovery period.

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.

Practice diligent sun protection every day of your life and quit smoking to insure continued healing and good health. Sun exposure on healing wounds may result in irregular pigmentation and scars that can become raised, red or dark. Sun exposure may result in a recurrence of your skin cancer, or the development of skin cancer in another region of your body.

Results and outlook

Dr Hess or Dr Sandeen can treat your skin cancer by surgically removing cancerous skin and reconstructing a more normal appearance. But some forms of skin cancer require additional treatment such as radiation therapy. Your physician will advise you about any follow-up treatment recommendations.

Reconstruction can restore a more natural appearance, but no reconstruction is perfect. Visible scars will always remain at incision sites. You may also expect 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.

How much will skin cancer surgery cost?

Cost is always a consideration in surgery, whether it be to remove the skin cancer or to reconstruct your appearance.

Cost may include:

  • Surgeon‚Äôs fee
  • Hospital or surgical facility costs
  • Pathology and or Pathologist fees
  • Anesthesia fees
  • Prescriptions for medication
  • Post-surgery garments, and
  • Medical tests

Your health insurance plans should cover skin cancer surgery, related complications or another surgery to reconstruct your appearance. Pre-certification may be required for reimbursement or coverage. Be sure to consult with your insurance company in advance of any surgery.

Your satisfaction involves more than a fee

When choosing a plastic surgeon for skin cancer surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

Words to know

  • Basal cell carcinoma: The most common form of skin cancer.¬†¬†¬†¬†¬† Occurs in the epidermis. These growths are often round and pearly or¬†¬†¬†¬†¬† darkly pigmented.
  • Cancer: The uncontrolled growth of abnormal cells in the body.¬†¬†¬†¬†¬† Cancerous cells are also called malignant cells.
  • Epidermis: The uppermost portion of skin.
  • Excision: A simple surgical process to cut the lesion from the skin.
  • Frozen section: A surgical procedure in which the cancerous lesion is removed and microscopically examined by a pathologist prior to¬†¬†¬†¬†¬† wound closure to ensure all cancerous cells have been removed.
  • General anesthesia: Drugs and/or gases used during an operation¬†¬†¬†¬†¬† to relieve pain and alter consciousness.
  • Intravenous sedation: Sedatives administered by injection into a¬†¬†¬†¬†¬† vein to help you relax.
  • Local flap: A surgical procedure used for skin cancer in which¬†¬†¬†¬†¬† healthy, adjacent tissue is repositioned¬†¬† over the wound.
  • Melanoma: A skin cancer that is most often distinguished by its¬†¬†¬†¬†¬† pigmented blackish or brownish coloration and irregular and¬†¬†¬†¬†¬† ill-defined borders is the most serious form of skin cancer. It¬†¬†¬†¬†¬† occurs in the deepest portion of the epidermis, and for this reason,¬†¬†¬†¬†¬† melanoma is the most likely form of skin cancer to spread quickly in¬†¬†¬†¬†¬† the skin and to other parts of the body.
  • Mohs surgery: A surgical procedure that‚Äôs used when skin cancer¬†¬†¬†¬†¬† is like an iceberg. Beneath the skin, the cancerous cells cover a much¬†¬†¬†¬†¬† larger region and there are no defined borders.
  • Nevi: A mole.
  • Skin graft: A surgical procedure used for skin cancer. Healthy skin¬†¬†¬†¬†¬† is removed from one area of the body and relocated to the wound site. A suture line is positioned to follow the natural¬†¬†¬†¬†¬† creases and curves of the face if possible, to minimize the appearance¬†¬†¬†¬†¬† of the resulting scar.
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