Procedures - Skin Cancer Surgery
- Skin Cancer Surgery
Cutaneous malignancies are the most frequent type of cancer in the world. Skin cancer falls into two common groups, melanotic and non-melanotic. Non-melanotic skin cancer are the most common of cutaneous malignancies with Basal Cell Carcinoma (BCCA) & Squamous Cell Carcinoma (SCCA) being the most frequent types. These Carcinomas are usually localized processes treated with surgical excision and reconstruction. Melanotic skin cancers can be much more aggressive and require specialized treatment. In either case patients often seek out Plastic Surgeons for their expertise to prevent severe disfigurement following extirpation or removal of their cutaneous malignancy.
The number one goal of Skin Cancer Surgery is to completely remove the cancer. Until this goal is achieved reconstructive efforts can be fruitless. The second goal is to maintain function. For example should you have lip cancer, the cancer has been completely removed, your mouth looks great but, you drool all the time then, this is less than an optimal result. The last goal is to produce an aesthetically appearing result and minimize a patients disfigurement. Since, BCCA is the most common cutaneous malignancy on the face many patients seek out the artistry and experience of Plastic Surgeons for favorable outcomes.
There are several different types of BCCA’s (i.e. superficial spreading, nodular, pigmented and sclerosing morpheaform). The extent of resection required to remove these malignancy is often dependent upon the type and extent of cutaneous tumor to prevent recurrence. Your doctor will commonly first perform a simple shave biopsy to determine the exact nature of your cutaneous malignancy. A bad actor with a higher recurrence rate is sclerosing morpheaform BCCA. This cutaneous malignancy is often best removed by a procedure called “MOHS Surgery”. Mohs surgery is named after a General Surgeon named Dr. Moh. He determined that certain BCCA’s such as sclerosing morpheaform BCCA are best removed by excising the lesion with an adequate margin and then removing/ excising what appeared to be normal tissue around and deep to the original tumor. All these specimens where examined to make sure the carcinoma was gone. Any area with a positive margin was re-excised until clear. With this technique Dr. Mohs was able to decrease the recurrence rate of sclerosing morpheaform BCCA from 30 to 40 % to 2 to 3 %.
Slow or Modified Mohs refers to this type of serial excision but, with examination by a Dermatopathologist by permanent pathological sectioning in wax rather than ice. This technique is described as being more accurate to clear surgical margins of resection and is often preferred by pathologists for more aggressive cutaneous malignancies. Permanent pathological sectioning in wax can take about a day to process so, reconstructive surgery can be delayed until your surgeon and pathologist have made absolutely sure all your cancer is gone. Should a margin be positive re-resection of that area would be required. The Slow Moh’s technique is said to have the lowest recurrence rate especially for aggressive cutaneous malignancies. Remember the number one goal should be to make sure your cutaneous malignancy/ cancer is gone.
SCCA can be more aggressive cutaneous malignancies than BCCA’s. Early diagnosis and treatment can help prevent invasion and metastasis/ spreading. Again, an initial biopsy is performed to determine the exact etiology of the tumor. SCCA are classified from Well, Moderate or Poorly Differentiated. The less differentiated the SCCA can result in a poorer prognosis and a higher incidence of possible invasion/ spreading. Early diagnosis and treatment are essential with SCCA. Seek out a Skin Care Specialist like your local Plastic Surgeon should you develop a suspicious cutaneous lesion for appropriate treatment.
Melanoma can be one of the most aggressive cutaneous malignancies. There are four types (i.e. Superficial Spreading, Nodular, Acral Letiginous, and Lentigo Maligna). Superfical Speading is the most common. The depth of invasion of the melanoma into the layers of the skin has a very high correlation with a patients survival. A punch or excisional biopsy best determines the depth of invasion into the skin for a melanoma. The deeper the spread into/ through the layers of the skin by the melanoma results in a worse prognosis for the patients. Biopsy of regional lymph nodes through a process called Sentinel Lymph Node Biopsy (SLN) may be required to determine the exact extent of your disease process. Melanoma can be a complicated and deadly disease. Let your Plastic Surgeon guide you through its treatment and give you your best options.