What is skin cancer?
Skin cancer typically refers to the abnormal growth of cells in the two layers of the skin:The epidermis and dermis. Although there are instances in which one may be predisposed to skin cancer, such as in genetic syndromes or in cases of immunosuppression, the majority of cases are secondary to radiation damage from the sun. There are three main types of skin cancer that we often see. These cancers are
- Basal Cell Carcinoma-The most common skin cancer. Derived from the basal cells in the epidermis. Commonly occur on nose, cheeks, and upper lips. Slow growing. Metastasize .03% of the time, however will grow locally and destroy local tissues. Typically present as a skin lesion with a central depression and raised borders. The lesion is red to pearly pink in color and often has very small blood vessels running through its substance. Many people describe trauma to the area before its appearance.
- Squamous Cell Carcinoma-Second most common skin cancer. Derived fromsquamous cells of epidermis. Commonly occur on ears and lower lips.Typically slow growing.Metastasize 3-5% of the time, varying on anatomic location. Also grow locally. Typically present as a red, crusting lesion. May have a central white core of keratin.
- Malignant Melanoma-Least common of the three, but accounts for
majority of skin cancer deaths. Incidence increasing with use of tanning beds. Derived from melanin producing melanocytes in skin. Fast growing.Metastasize frequently depending on cancer depth. Local destruction with rapid regional spread. Typically black or dark brown in color. Lesions will be slightly raised or can become nodular. Screening for melanoma by ABCDE system looking for :Asymmetry, Border Irregularity, Color variation, Diameter greater than 6 mm, and Evolution(or change in appearance).
What does skin cancer treatment involve?
Skin cancer treatment involves cutting out the dance with a margin of normal skin all the way around the tumor. This margin can range from 2 mm in basal cell carcinoma to 2 cm in melanoma. As a result, for adequate cancer incision you may have a large defect in a very cosmetically sensitive area. In some instances, with more aggressive cancers one may need further surgical treatment with lymph node excision, radiation, or chemotherapy. A plastic surgeon plays a critical role in the treatment of these cancers, as their skill is often necessary for reconstructing the large holes produced by excision. These holes are often on the eyelids, nose, cheeks, and lips.
Who is a good candidate for skin cancer excision?
All patients are good candidates for skin cancer excision, as they will progress or spread if left undisturbed. It is best to address these lesions as early as possible in order to decrease the spread of the cancer, and to a lesser extent, the cosmetic deformity.
Who is a poor candidate for skin cancer excision?
Only patients in the end of life or with life threatening medical illness should observe skin cancers. These patients may succumb to their preexisting illness, or the cancer surgical treatment, before they would ever pass away from their cancer.
Will I need to be admitted to the hospital for skin cancer excision?
No, often skin cancer excision can be performed in the office. However, if the skin cancer excision is performed in the hospital, it will usually be performed on an outpatient basis.
What is the typical postoperative course?
Recovery is typically very simple with no specific instructions necessary, however this varies depending on type of reconstruction. Dr. Graham will customize your postoperative course according to your specific situation.
You may drive when you are off narcotics and feel confident to control the car, even in an emergency. Most patients are able to drive within 24 hours.
Time off of Work? Restrictions?
This is dependant on the type of work you perform. Many patients will require 1-2 weeks. Avoid straining or heavy lifting for 1 month.