Skin Cancer Surgery
The Most Common Form of Cancer
Skin Cancer is by far the most common form of cancer, and its incidence is increasing worldwide. Individually, the risk of Skin Cancer increases as you age, which is likely due to the accumulated exposure of UV radiation and to the aging process itself. A history of frequent sunburns, especially when they occurred during childhood, is especially associated with a higher risk of developing Skin Cancers.
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Squamous Cells arise from the uppermost layers of the skin and typically present as scaly, ulcerated patches that easily bleed.
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Basal Cells arise from the deeper basal layer of the epidermis and often present as upraised, pearly white lesions that eventually ulcerate in the center.
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Melanomas arise from melanocytes, also within the basal layer, and often present as pigmented lesions with very irregular borders and pigmentation.
Types of Skin Cancer
Skin Cancer Diagnosis
Sign of suspicious skin legions:
Scaling and ulceration/bleeding
Unusual growth patterns
Failure to heal
Firm, upraised borders with depressed center
Irregular edges and pigment distribution
Such lesions should be biopsied to rule out the possibility of malignancy. Small “punch” or “shave” biopsies may be obtained of suspicious lesions as very limited office procedures. Alternatively, if the lesion is not too large, the “biopsy” may consist of removing the lesion in its entirety. Again, this can usually be done as a minor procedure in the office under local anesthesia only.
Most skin cancer surgeries are performed by Dr. Lober as minor treatment procedures in his Surgery Center using Local Anesthesia only. If the lesions are in areas that are particularly sensitive, such as the nose, the eyes, or the lips, these surgeries can be performed under IV Sedation to provide the patient with a much more comfortable overall surgical experience.
Only rarely is General Anesthesia required for the definitive excision and reconstruction of skin cancers. This is particularly true for the treatment of Melanomas, where wider margins must be removed around the primary lesion and where Lymph Nodes must be excised to rule out the regional spread of cancer. These procedures are almost always done on an outpatient basis in the hospital.
Patients are discharged home after almost all surgeries, even if done in the hospital. Specific postoperative limitations are very much dependent upon the location and the extent of the surgical procedure that is being performed.
Patients can expect to return to driving and most other activities by the following day. Intense physical exertion should be refrained from until the closure is adequately healed.
Surgery & Recovery
If the lesion proves to be malignant, it may be necessary to remove a larger area of surrounding tissue to adequately treat the skin cancer and help prevent future recurrence. Definitive removal is typically performed either with the help of Frozen Section Control or via Mohs Surgery. If the lesion is a Melanoma, it may also be necessary to sample lymph nodes at the time of primary excision to rule out lymphatic spread.
After adequate excision, the resulting defect can be closed by a number of different methods. Again, if the defect is relatively small it can often be closed primarily. Larger lesions may require rearrangement of the adjacent tissues as Local Flaps to achieve full closure. Finally, some defects may require skin grafts or composite grafts to completely cover the exposed defect.