What is skin cancer removal?

A cancer diagnosis is very difficult to accept. Understanding that treating your skin cancer may result in scars or disfigurement can also be troubling. Your plastic surgeon understands your concerns and will guide you through treatment and explain the resulting effect on your health and appearance.

Skin cancer, much like any form of cancer, may require surgery to remove the cancerous growth. Your plastic surgeon can surgically remove cancerous and other skin lesions using specialized techniques to preserve your health and your appearance.

Although no surgery is without scars, your plastic surgeon will make every effort to treat your skin cancer without dramatically changing your appearance.

How much does an arm lift cost?

Skin cancer removal is considered a reconstructive procedure and should be covered by health insurance. Pre-certification is generally required for reimbursement or coverage. Be sure to consult with your insurance company in advance of any surgery.

Skin cancer removal costs may include:

• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Prescriptions for medication
• Surgeon's fee

When choosing a board-certified plastic surgeon for skin cancer removal surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery.

What questions should I ask my plastic surgeon about skin cancer removal?

Use this checklist as a guide during your skin cancer removal consultation:

• Are you certified by the American Board of Plastic Surgery?
• Were you specially trained in the field of plastic surgery?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• How many procedures of this type have you performed?
• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Where and how will you perform my procedure?
• What shape, size, surface texturing, incision site and placement site are recommended for me?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if I am dissatisfied with the outcome of my skin cancer surgery?
• Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?

What are the risks of skin cancer removal?

You will have to decide if the risks and potential complications of skin cancer removal surgery are acceptable.

You will be asked to sign consent forms to ensure that you fully understand the procedure.

The risks include:

• Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
• Anesthesia risks
• Excessive bleeding
• Change in skin sensation
• Damage to deeper structures – such as nerves, blood vessels and muscles – can occur and may be temporary or permanent
• Infection
• Poor healing of incisions
• Possibility of revision surgery
• Recurrence of skin cancer
• Systemic spread of skin cancer

These risks and others will be fully discussed prior to your consent. It's important that you address all your questions directly with your plastic surgeon.

Skin graft risks

Skin grafts have an added risk that the graft may not "take" and therefore additional surgery may be necessary to close the wound.

Preserve your health

Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer. Skin cancer may reoccur. So, it's important to discuss the signs of skin cancer with your physician, regularly perform self-examinations for suspicious lesions and schedule an annual skin cancer screening.

What are the steps of a skin cancer removal procedure?

Depending on the size, type and location of the lesion, there are many ways to remove skin cancer and reconstruct your appearance if necessary.

The following are some of the possible procedure steps involved in skin cancer removal surgery:

Step 1 - Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include local, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 - Removal

A small or contained lesion may be removed with excision – a simple surgical process to remove the lesion from the skin. Closure is most often performed in conjunction with excision.

Skin cancer can be like an iceberg. What is visible on the skin surface sometimes is only a small portion of the growth.

Beneath the skin, the cancerous cells cover a much larger region and there are no defined borders. In these cases, your plastic surgeon may use frozen sections during the removal of your skin cancer to discover and define the borders of the cancerous area. Frozen sections are small parts of the tissue that are removed and immediately sent to the pathologist. These pieces of tissue are then quickly frozen so that he or she can examine them for cancer cells at the time of removal of the cancer. This helps your plastic surgeon to make sure that all of the cancer has been removed.

Alternatively, your plastic surgeon may recommend a specialized technique called Mohs surgery. This procedure may be performed by your plastic surgeon, or you may be referred to a dermatologic surgeon that specializes in this procedure.

Mohs surgery is a procedure that is performed through the use of multiple specially prepared frozen sections. The goal is to look for a clear margin – an area where the skin cancer has not spread. If clear margins are found, the resulting wound can be reconstructed. If clear margins are not present, the surgeon will remove more tissue until the entire region has a clear margin.

Step 3 – Reconstruction

A skin cancer lesion that is particularly large, is being removed with frozen sections or is likely to cause disfigurement may be reconstructed with a local flap (also called "adjacent tissue rearrangement").

Healthy, adjacent tissue is repositioned over the wound. The suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the obviousness of the resulting scar. Several variations of local flap procedures may be used to reconstruct a specific area of the face or body, and your surgeon will describe these techniques and resulting scar patterns that are tailored to your specific anatomy. More complex wounds may require more than one procedure (or "stage") to achieve a satisfactory result.

Your surgeon may choose to treat your wound with a skin graft instead of a local flap. A skin graft is a thin bit of skin removed from one area of the body and relocated to the wound site.

Step 4 – See the results

After your skin cancer has been removed and any primary reconstruction is completed, a dressing or bandages will be applied to your incisions. Get more information on skin cancer removal results.

What should I expect during my recovery after skin cancer removal?

During your skin cancer removal surgery recovery, incision sites may be sore, red or drain small amounts of fluid.

• It is important to follow all wound care instructions such as cleansing and applying topical medications exactly as directed
• You will be able to return to light activity as instructed by your surgeon
• Make certain to keep your incision sites clean and well protected from potential injury
• Try to limit movement that may stress your wound and your sutures

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?
• How long will it take before healing is complete?

Healing will continue for many weeks or months as incision lines continue to improve.

It may take a year or more following a given procedure for incision lines to refine and fade to some degree. In some cases, secondary procedures may be required to complete or refine your reconstruction.

Sun exposure to healing wounds may result in irregular pigmentation and scars that can become raised, red or dark. Sun exposure may increase the risk of the development of skin cancer in another region of your body.

What results should I expect after skin cancer removal?

Your plastic surgeon can treat your skin cancer by surgically removing cancerous skin and closing the resulting wound. Some forms of skin cancer require additional treatment such as radiation therapy.

Your physician will advise you about any postoperative treatment recommendations. Follow-up is extremely important for early detection of any new skin lesions.

Reconstruction closes the skin cancer defect, but no reconstruction is perfect. Visible scars will always remain at incision sites. You may also see textural, color or other visible differences of the skin in reconstructed areas.

In some cases, treating your skin cancer can be disfiguring to your appearance.

Although every effort is made to restore your appearance as closely and naturally as possible, the most important factor is that your skin cancer is effectively removed.

Following your physician's instructions is essential to the success of your surgery. It's important that the surgical incisions are not subjected to excessive force, swelling, abrasion or motion during the time of healing.

Your doctor will give you specific instructions on how to care for yourself.

What words should I know about skin cancer removal?

Basal cell carcinoma

The most common form of skin cancer. Occurs in the epidermis. These growths are often round and pearly or darkly pigmented.

Cancer

The uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells.

Epidermis

The uppermost portion of skin.

Excision

A simple surgical process to cut the lesion from the skin.

Frozen section

A surgical procedure in which the cancerous lesion is removed and then frozen before being microscopically examined by a pathologist prior to wound closure. This is done to ensure all cancerous cells have been removed.

General anesthesia

Drugs and/or gases used during an operation to relieve pain and alter consciousness.

Intravenous sedation

Sedatives administered by injection into a vein to help you relax.

Local flap

A surgical procedure used for skin cancer in which healthy, adjacent tissue is repositioned over the wound.

Melanoma

A skin cancer that is most often distinguished by its pigmented blackish or brownish coloration and irregular and ill-defined borders is the most serious form of skin cancer. It occurs in the deepest portion of the epidermis, and for this reason, melanoma is the most likely form of skin cancer to spread quickly in the skin and to other parts of the body.

Mohs surgery

A surgical procedure that's used when skin cancer is like an iceberg. Beneath the skin, the cancerous cells cover a much larger region and there are no easily defined borders.

Nevus (Nevi)

A mole.

Skin graft

A surgical procedure used for skin cancer. Healthy skin is removed from one area of the body and relocated to the wound site. A suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the appearance of the resulting scar.

How do I choose a plastic surgeon for skin cancer removal?

Skin cancer surgery involves many choices. The first and most important is selecting a board-certified plastic surgeon you can trust who is a member of the American Society of Plastic Surgeons (ASPS).

ASPS member surgeons meet rigorous standards:

• Board certification by the American Board of Plastic Surgery^® (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada^®
• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education, including patient safety, each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official-sounding boards and certifications.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with "cosmetic surgery" in its name.

By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly-trained plastic surgeon who is board-certified by the ABPS or the Royal College of Physicians and Surgeons of Canada.