SKIN CANCER SURGERY
What is a skin cancer?
In Queensland, skin cancers are very common due to our sun exposure and high year-round UV rates.
Like all body tissues our skin is made up of cells: basal cells, squamous cells and melanocytes.
Skin cancers are cell mutations in the skin, often triggered by environmental factors such as sun exposure or chemicals. Genetics and skin colour also play a role in the development of skin cancers.
Over 70% of us will develop skin cancers at some point, most of which will be benign basal cell carcinomas (BCC). While they need to be removed, these are usually slower-growing, less invasive skin cancers that are not life threatening if promptly treated.
Squamous cell carcinoma is also a common skin cancer; it can be faster growing than a BCC and can quickly spread.
Melanoma is the most serious of skin cancers. It can spread very quickly and requires prompt removal and very specific clearance margins (the gap between the lesion and the incision) in accordance with the melanoma clinical guidelines. It can appear on skin not normally exposed to the sun.
Skin cancer, much like any form of cancer, may require surgery to remove cancerous growths. Dr Sharp can surgically remove cancerous and other skin lesions using specialised techniques to preserve your health and your appearance.
Will I have scars?
Yes, all surgery leaves scars. Some will fade nicely and be very subtle in years to come, while others might be raised and prominent. This is largely dependent upon the location of the incision on your body, how well you follow scar optimisation post operative care instructions, your skin type and natural predisposition to scarring (eg keloid or hypertrophic).
Understanding that treating your skin cancer may result in scars or disfigurement can also be troubling. Dr Sharp understands your concerns and will guide you through treatment and explain the resulting effect on your health and appearance.
Although no surgery is without scars, Dr Sharp will make every effort to treat your skin cancer without dramatically changing your appearance.
Why does the incision need to be larger than the skin cancer?
Skin cancer can be like an iceberg; what’s visible on the skin surface sometimes is only a small portion of the actual cancer. Beneath the skin, often there are cancerous cells that cover a much larger region and there are no defined borders. After y9our surgery, the removed tissue is microscopically examined by a pathologist to ensure all cancerous cells have been removed. The goal is to achieve a clear margin – an area where the skin cancer has not spread. If clear margins are found, further excision might be required.
Skin cancer reconstruction
The vast majority of skin cancers Dr Sharp removes, leave small incisions that are stitched back together in what we call a ‘direct closure’. This leaves a single line as a scar.
Skin cancers that are particularly large, or are located on specific parts of the body such as the nose or shin, can sometimes be difficult to close using the ‘direct closure’ technique and in these circumstances, trying to bring the sides of the incisions together in one line can over stretch the wound, causing it to separate or cause disfigurement.
In this case, the wound might need to be reconstructed with a skin graft or flap.
Flaps enable Dr Sharp to follow the natural creases and curves of the face or body if possible, to minimise the obviousness of the resulting scar.
A skin graft is a thin bit of skin removed from one area of the body and relocated to the wound site.
Skin cancer removal recovery
During your skin cancer removal surgery recovery, incision sites may be a little sore, red or drain small amounts of fluid following surgery. It is important to follow all wound care instructions such as cleansing and applying topical medications exactly as directed.
You will be able to return to light activity as instructed by Dr Sharp. 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
Healing will continue for many weeks or months as incision lines continue to improve.
It may take up to two years 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.
Skin cancer removal results
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, colour 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 Dr Sharp and your post op recovery nurse’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. We will give you specific instructions on how to care for your wound.
Skin cancer removal risks and safety information
You will have to decide if the risks and potential complications of skin cancer removal surgery are acceptable. You will be asked to sign consent forms to ensure that you fully understand the procedure.
The risks include:
- 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, muscles – can occur and may be temporary or permanent
- 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 Dr Sharp.
Skin graft risks
Skin grafts have an added risk that the graft may not take and therefore additional surgery may be necessary to close the wound. Age, diabetes, smoking, obesity and other chronic health issues can compromise the chance of the graft failing.
Skin cancer prevention
Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer. Skin cancer may 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.
Skin cancer: 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.
- 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.
- Squamous cell carcinoma: an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis)