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Skin Cancer

Skin Cancer Excision

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, squamous cell carcinoma, and melanoma. Patients require a plastic surgeon after excising a skin cancer to give them the best appearance possible.

  • 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 from squamous 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 the 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).

Skin Cancer Excision Procedure

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.

Dr. Graham is a Board Certified Plastic Surgeon, which means he is an expert in skin cancer and its reconstruction. There is no specialist, not even a Moh’s dermatologic surgeon,  more qualified to reconstruct a skin cancer defect. He is an expert in reconstructing all areas of the body, most importantly the very sensitive areas of the head and face. In addition, Dr. Graham can often excise your cancer and perform the reconstruction in an office setting. Moh’s surgeons are necessary for some facial skin cancers, but not all. The majority of the time the cancer can be excised without Moh’s surgery. Times when Moh’s is necessary is for recurrent cancers, cancers in the corners of the mouth or eyes, and cancers without clear borders. If you are unsure we can help you decide when Moh’s surgery is necessary. We will always choose the safest course for our patients.

Skin Cancer Screenings

Dr. Graham has extensive experience with dermatology and skin cancer. He is an expert at recognizing skin cancer and if necessary he can perform the screening and biopsy. You can skip the dermatologist and come straight to us for biopsy. No referrals are necessary.

Skin Cancer Excision Candidates

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.

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 have my skin cancer excision procedure at a hospital?

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. We attempt to perform as much as possible in the office as it is more convenient, less expensive, and safer to keep the patient out of a hospital.

What is the recovery time following skin cancer excision?

Time to return to work is dependent on the type of work you perform. Most patients can return to work the same day of surgery or the next day. In most cases you can drive yourself to and from your appointment. Most patients are able to drive within 24 hours. Recovery is typically very simple with instructions necessary, however this varies depending on type of reconstruction. Dr. Graham will customize your skin cancer surgery postoperative course according to your specific situation.