Skin Cancer Information

• Introduction
• What types of skin cancers can be removed by plastic surgeons?
• What should I expect from the consultation?
• How is skin cancer removed?
• What should I know about the safety of skin cancer removal?
• What can I do to prepare for the procedure?
• How will I be cared for on the day of my procedure?
• How will I look and feel right after skin cancer removal surgery?
• What should I know about my results?
• How long will I continue to see my plastic surgeon?
• Choosing a plastic surgeon
• It's advisable to consider the following points before scheduling a consultation
• Ask about the surgeon's hospital privileges

Introduction

If you have been diagnosed with skin cancer, you are not alone. Skin cancer is the most common form of cancer in the United States and its incidence continues to rise. Anyone can get skin cancer—no matter what your skin type, race or age, no matter where you live or what you do. Although skin cancers can be found on any part of the body, about 80 percent appear on the face, head or neck, where they may be disfiguring as well as dangerous.

Fortunately, most skin cancers can be removed by plastic surgeons. If the cancer is small, the procedure usually can be performed quickly and easily in your doctor's office or in an outpatient facility. In many cases, the resulting scar will be barely visible, or will be concealed within the natural folds and contours of your face.

You will find basic information about skin cancer removal in this brochure. However, the only way to get complete answers to specific questions that relate to your needs is to have a face-to-face consultation with a plastic surgeon certified by the American Board of Plastic Surgery.

What types of skin cancers can be removed by plastic surgeons?

Although most skin cancers can be removed surgically, your specific treatment will depend on the type of cancer you have, its stage of growth and its location on your body. Skin cancer is diagnosed by removing all or part of the growth and examining its cells under a microscope. Plastic surgeons treat all of the following types of skin cancers:

• Basal cell carcinoma—This is the most common and least dangerous form of skin cancer. It tends to grow slowly and rarely spreads beyond its original site.
• Squamous cell carcinoma—This is the second most-common type of skin cancer. Squamous cell carcinoma frequently appears on the lips, face or ears. It sometimes spreads to distant sites, including the lymph nodes and the internal organs.
• Malignant melanoma—This is the least common, but the most dangerous form of skin cancer. If discovered early enough, it can be completely cured. If it's not treated quickly, however, malignant melanoma may spread through the body and become life threatening.

Your plastic surgeon can treat other types of skin growths as well, including:

• Moles—these growths appear as clusters of heavily pigmented skin cells that may be flat or raised above the skin's surface. While most pose no danger, some may develop into malignant melanoma, particularly those that have mottled colors or irregular edges. Often, moles are removed for cosmetic reasons, or because they're constantly irritated from rubbing against clothing and jewelry.
• Kerotoses—These rough red or brown patches on the skin are usually found on areas exposed to the sun. They sometimes develop into squamous cell cancer.

What should I expect from the consultation?

A personal consultation is the first step for every patient who either has been diagnosed with skin cancer or who suspects that he or she may have it. During this meeting, your surgeon will examine your skin and evaluate your general physical health.

You should arrive at the consultation prepared to provide complete information about:

• Previous skin cancers or other abnormal skin conditions that have been diagnosed or previously treated
• Any family history of skin cancer or personal history of blistering sunburn
• Medications you are taking or have taken previously, including dietary and herbal supplements
• Acne treatments you may have had as an adolescent, especially if you received therapeutic radiation treatments
• Skin allergies or facial injuries you have had and how they have been treated

During your physical examination, your plastic surgeon will evaluate the affected area. If you haven't been diagnosed, your surgeon can offer you a preliminary diagnosis based on the area's appearance.

Basal cell and squamous cell carcinomas can vary widely in appearance. The cancer may first appear as:

• A small, white or pink nodule or bump;
• A red spot that is rough, dry or scaly;
• A firm, red lump or a crusted group of nodules or lumps;
• A sore that bleeds and doesn't heal after 2-4 weeks or that appears to heal then recurs;
• A white patch that looks like scar tissue.

Malignant melanoma is usually signaled by a change in the size, shape or color of an existing mole, or a new growth on normal skin.

How is skin cancer removed?

The method used to remove your skin cancer depends largely on the type of cancer you have, its stage of growth and its location on the body. Your plastic surgeon's goal is to remove the growth in a way that maintains function and offers the most pleasing final appearance—a consideration that may be especially important if the cancer is in a highly visible area.

If the cancer is small, your surgeon may remove it with a simple excision, which leaves a thin, barely visible scar. In some cases, the cancer may be removed with curettage and desiccation. In this procedure, the cancer is removed with a sharp instrument and the area is treated with an electric current to control bleeding and to eliminate any remaining cancer cells. Other methods of treatment may include radiation therapy, cryosurgery (freezing the cancer cells); topical chemotherapy, in which anti-cancer drugs are applied to the skin; or Moh's surgery, a procedure in which the cancer is shaved off one layer at a time.

If the cancer is larger in size, or if it has spread to the lymph nodes, more complex surgery may be required. If removing the cancer leaves a cosmetic defect, your plastic surgeon can use reconstructive techniques—ranging from simple scar revision to a more complex transfer of skin and tissue—to repair damaged areas, rebuild facial structures and help restore appearance and function.

What should I know about the safety of skin cancer removal?

Each year thousands of men and women undergo skin cancer-removal surgery and experience no major complications. However, it's important for you to be informed of the risks as well as the benefits of the treatment you choose.

One of the most important parts of your consultation is the discussion that you and your surgeon will have about the possible complications associated with your cancer-removal surgery.

By carefully following your doctor's instructions—both before and after your treatment—you can do your part to minimize some of the risk.

What can I do to prepare for the procedure?

Your plastic surgeon will provide you with specific instructions for the days immediately before and after your treatment. A number of points may be covered, including:

• Avoiding certain medications that may complicate recovery
• Stopping smoking for a period of time before and after your treatment
• Arranging for a ride home after your procedure
• Arranging your postoperative work and social schedule, with the understanding that you won't be looking your best.

How will I be cared for on the day of my procedure?

Most small skin cancers can be removed in your doctor's office surgical suite or in an outpatient surgery center under local anesthesia. However, if your cancer is larger or if you are having a more complex reconstructive procedure to restore a normal appearance, you may be admitted to a hospital.

For larger cancer removals or surgical repairs, you may be given general anesthesia so that you'll sleep through the entire procedure. Your doctor will recommend the best and safest anesthesia option for keeping you relaxed and comfortable.

How will I look and feel right after skin cancer removal surgery?

After your procedure, the scar may be red or pink in color. Of course, if you've had a more complex tissue-transfer procedure, your recovery time will be longer than if you had a simple excision. However, with any kind of cancer-removal surgery it's important to follow our surgeon's instructions to help the treated area heal properly.

What should I know about my results?

As you heal, keep in mind that a scar, however large or small, is the tradeoff for removing the cancer from your body. How quickly the scar heals depends on the size of the wound, the nature and quality of your skin and how well you care for the wound after the procedure.

How long will I continue to see my plastic surgeon?

After you've been treated for skin cancer, you will return to your plastic surgeon's office for regular follow-up visits to make sure the cancer hasn't recurred. It's important to keep these appointments so that your surgeon can assess your long-term results and address any questions or concerns you may have. In the meantime, it's up to you to reduce your risk of skin cancer recurrence by taking the following precautions:

Avoid prolonged exposure to the sun, especially between the hours of 10:00 a.m. and 2:00 p.m. and during the summer months. Remember that ultraviolet rays pass right through clouds and reflect off sand, snow and water.

When you go outdoors for an extended period of time, wear protective clothing such as wide-brimmed hats and long sleeves.

On any exposed skin, use a sunscreen with an SPF (sun-protection factor) of at least 15. Apply it about an hour before you go out and reapply it frequently, especially after you've been swimming or sweating.

Finally, examine your skin regularly. If you find anything suspicious, see your doctor as soon as possible.

Choosing a plastic surgeon

No matter what type of plastic surgery you're considering, one of the most important factors in its success is the surgeon you choose. Although it may seem hard to believe, some of the physicians who are performing cosmetic surgery today have had no formal surgical training at all.

It's advisable to consider the following points before scheduling a consultation:

Find out if your doctor is certified by the American Board of Plastic Surgery. Surgeons with this certification have completed a minimum of five years of surgical training following medical school, including a plastic surgery residency program. During this intensive program, surgeons learn to perform surgical procedures for the entire body and face. At the same time, they develop their technical skill and aesthetic judgment. After training, a surgeon must pass comprehensive oral and written exams before being granted certification.

The two organizations that have prepared this brochure, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, require their members to be certified by the American Board of Plastic Surgery. Plastic surgeons with this certification have completed approved training and examinations in plastic surgery including both cosmetic and reconstructive procedures.

Ask about the surgeon's hospital privileges

Even if you are planning to have your surgery in your doctor's office or at a surgery center, it is important to find out if your surgeon has operating privileges in an accredited hospital for the same procedure that you would like to have performed. Before granting privileges, hospital review committees evaluate a surgeon's training and competency for specific procedures.

To find out more, click on Making Sense of Certification.

• Contact us for additional information or to schedule a consultation.

       

STEVEN J WHITE, MD
PRESBYTERIAN HOSPITAL OF DALLAS
TEXAS HEALTH PRESBYTERIAN DALLAS
PROFESSIONAL BUILDING 3, SUITE 814
8230 WALNUT HILL, DALLAS, TX 75231-4485

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