6 Reconstructive Surgery Options to Recommend After Skin Cancer
Skin cancer is the most common cancer worldwide, and 1 in 5 Americans will develop some form of skin cancer by the age of 70. Thankfully, skin cancer is highly survivable. However, it often leaves patients with scars and negative changes to their appearance that may require reconstructive surgery.
What Are the Types of Skin Cancer?
There are several types of skin cancer, which vary in severity and frequency. In rough order by how common they are, these include:
- Basal cell carcinoma, which generally develops after years of frequent sun exposure or indoor tanning.
- Squamous cell carcinoma, which often develops from a precancerous skin growth called actinic keratosis.
- Melanoma, which is generally considered the most serious skin cancer as it tends to spread to other organs.
- Cutaneous T-cell lymphoma, a rare blood cancer that affects the skin.
- Dermatofibrosarcoma protuberans, a cancer that affects the middle layer of skin.
- Merkel cell carcinoma, a rare and aggressive form of cancer generally found in older people with fair skin.
- Sebaceous carcinoma, which generally starts on or in the eyelid, but can form in any sebaceous gland.
What Are the Risk Factors for Skin Cancer?
The primary risk factor for skin cancer is sun exposure. It is, thus, more common in people who work outside or engage heavily in outdoor activities, without taking steps to protect their skin. Risk is dramatically increased by commonly using indoor tanning services, which doctors and dermatologists do not recommend.
Other risk factors include:
- Fair or light skin. However, the risk for darker-skinned individuals is sometimes increased by the perception that they are less at risk and thus need to take fewer precautions.
- Skin that burns or reddens easily
- Blue or green eyes
- Blond or red hair
- Having a large number of moles
- Family history
- Personal history (once you have had skin cancer once, you are more likely to get it again)
What Are the Symptoms of the Most Common Forms of Skin Cancer?
Skin cancer generally manifests as lumps or marks on the skin, but different types can look quite different, as follows:
Basal Cell Carcinoma
- A bump that resembles a pearl, pink or red in color but sometimes with darker areas.
- Scar-like lesion
- A reddish patch of skin, that often itches.
- Pink growths with raised edges and a lower center
- Open sores that heal and return.
Squamous Cell Carcinoma
- A rough or scaly red patch, which may bleed
- A raised growth or lump with a lower center
- Open sores that heal and return
Melanoma may start inside a previously-harmless mole, and you should keep an eye on any moles you have which are larger than a pencil eraser or asymmetric. Watch for moles with:
- Uneven edges
- Multiple shades
- Larger than a pencil eraser
- Changing in shape, color, or elevation
- Bleeding or itching
Sometimes it may be worth removing a problem mole as a precaution.
Cutaneous T-Cell Lymphoma
- A rash that often resembles, and may be mistaken for, eczema
- A rough patch of skin
- Scar or birthmark
Merkel Cell Carcinoma
- A mark on the head or neck that appears like an insect bite, sore, cyst, stye, or pimple.
- The mark is pink, red, or purple
- It grows quickly
- It is painless
- A painless, round tumor on the upper or lower eyelid.
Much of detecting skin cancer is knowing what is normal for your skin and what is unusual.
Reconstructive Surgery Options
Small tumors can often be removed with minimal scarring. In some cases, they might even be treated non-surgically. However, more advanced skin cancer often leaves disfiguring scars and defects that, especially on the face, need to be corrected with reconstructive surgery. Ideally, the cosmetic surgeon should be involved in the treatment process from the start so that reconstruction can be planned during cancer treatment.
Here are some options often recommended to patients:
Primary Repair of Defect
For some surgical wounds, the easiest option is to repair the wound edges with sutures, changing the shape of the wound and the scar. This may involve extending the incision for a more natural look. The resulting scar is oriented along the natural lines of the face to minimize visibility.
During a skin graft, doctors take skin from another part of the body to repair the defect. Doctors cute the skin to the exact shape of the wound to suture into place.
For facial issues, full-thickness skin grafts are generally used, as partial-thickness grafts can result in color changes. However, the skin may not be a full match in color and contour, due to personal variation. This method is most suitable for shallow cancer defects but can provide a very good aesthetic outcome.
Local Flap Reconstruction
This is a preferred method for facial damage because it uses skin from immediately next to the cancer site, resulting in a better match in color and texture. Then, doctors enlarge the incision to reorient the skin to cover the area. This generally results in an irregular scar, but a good surgeon will “design” the scar to ensure minimum visibility (this is another reason why the cosmetic surgeon should be involved from the start). It also has less risk of the graft dying.
Often, local flap reconstruction repairs nose defects, however, it is only effective for the outer skin and limited to small areas. It generally has good aesthetic results and while there is usually some scarring, it generally fades over time.
Major Nasal Reconstruction
The nose is considered a particular challenge, due to its central position, aesthetic importance, and, of course, structural importance. Nasal reconstruction often involves transferring not just skin but blood vessels from other parts of the body, with the forehead being a common choice.
These procedures combine cartilage grafting and lining reconstruction to restore the nose.
Sometimes the damage to the nose is so extensive that a prosthetic is the best option. Nasal prosthetics match the size, shape, and color of the original nose. This requires a specialist in maxillofacial prosthodontics.
Rarely, if cancer damage is extensive, you may need full facial reconstruction. This generally happens when muscle and bone are also involved. This requires not just skin but tissue being transplanted from a distant part of the body, usually the arm, leg, or back. Specialist surgeons are needed to perform this level of reconstruction, but it is sometimes the only option.
Learn More About Reconstructive Surgery Options After Skin Cancer
For all of these options, followup is vital. Minor surgery may be warranted after a few months to reduce the appearance of the scar, although in most cases, scars can be treated with steroids or laser treatment. The goal is to produce a natural-looking final result.
Facial surgery requires specialist training and the best gear. obp’s ONETRAC OMS is an ideal tool for illumination of the mouth, jaw, and face during any oral and maxillofacial surgery. Contact us to find out more about how it can help you and your patients.