Skin Cancer and Your Plastic Surgeon

Choose a surgeon you can trust

Plastic surgery involves many choices. The first and most important is selecting a surgeon you can trust.

Choosing an ASPS Member Surgeon ensures that you have selected a physician who:

• Has completed at least five years of surgical training with a minimum of two years in plastic surgery.
• Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
• Operates only in accredited medical facilities
• Adheres to a strict code of ethics.
• Fulfills continuing medical education requirements, including standards and innovations in patient safety.
• Is board certified by The American Board of Plastic Surgery or in Canada by the Royal College of Physicians and Surgeons of Canada^®.

ASPS Member Surgeons are your partners in cosmetic and reconstructive plastic surgery.

Look for the ASPS Member Surgeon logo.

Skin cancer surgery

Hearing a diagnosis of “cancer” 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.

Quick facts about skin cancer treatment:

• Treatment of skin cancer, much like any form of cancer, may require surgery to remove cancerous growths
• 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
• For some people, reconstruction may require more than one procedure to achieve the best results

What to expect during your consultation

The first step in treating skin cancer is a consultation with your plastic surgeon. The success and safety of your skin cancer surgery depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

Be prepared to discuss:

• Your type of skin cancer
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries
• The likely outcomes of your treatment and any risks or potential complications

Your surgeon may also:

• Evaluate your general health status and any other pre-existing health conditions or risk factors
• Examine your skin
• Take photographs for your medical record
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of surgery and any risks or potential complications

Preparing for surgery

Prior to surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking well in advance of surgery
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

• What to do on the day of surgery
• The use of anesthesia during your skin cancer surgery
• Post-operative care and follow-up

Your plastic surgeon will also discuss where your procedure will be performed. Skin cancer surgery may be performed in an accredited outpatient or ambulatory surgical center, or a hospital.

What happens during skin cancer surgery?

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

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, a specialized technique called Mohs surgery may be recommended.

Your plastic surgeon may order a frozen section. In this procedure, the cancerous lesion is removed and microscopically examined by a pathologist prior to wound closure to ensure all cancerous cells have been removed.

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 would be reconstructed. If clear margins are not present, your plastic surgeon will remove more tissues until the entire region has a clear margin.

Step 3 – Reconstruction

A large lesion or one that has been removed with frozen sections can be reconstructed with a local flap. A flap may also be necessary where excision may result in a disfiguring appearance. A local flap repositions healthy, adjacent tissue over the wound. 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.

A skin graft, healthy skin removed from one area of the body and relocated to the wound site, may also be applied.

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.

Important facts about the safety and risks of spider vein treatment

The decision to have skin cancer surgery is extremely personal. Your physician will explain all of the potential risks. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo, the alternatives and the most likely risks and potential complications.

Possible risks include:

• Bleeding (hematoma)
• Infection
• Poor healing of incisions
• Anesthesia risks
• Unfavorable scarring
• Frozen-section inaccuracy
• Recurrence of skin cancer
• Systemic spread of skin cancer
• Change in skin sensation
• Skin contour irregularities
• Skin discoloration/swelling
• Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
• Damage to deeper structures — such as nerves, blood vessels, muscles, and lungs — can occur and may be temporary or permanent
• Pain, which may persist
• Possibility of revisional surgery

Be sure to ask questions: It’s very important to ask your plastic surgeon questions about your procedure. It’s natural to feel some anxiety; don’t be shy about discussing these feelings with your plastic surgeon.

Other important considerations:

Skin grafts have an added risk that the graft will 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 than the general population. Skin cancer also can 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.

Be careful

Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are no subjected to excessive force, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Your child’s recovery and results

Following your skin cancer surgery, 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 may be able to return to light activity the day of your surgery
• 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.

• Where will I be taken after my surgery is complete?
• 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?

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.

Practice diligent sun protection every day of your life and quit smoking to insure continued healing and good health. Sun exposure on healing wounds may result in irregular pigmentation and scars that can become raised, red or dark. Sun exposure may result in a recurrence of your skin cancer, or the development of skin cancer in another region of your body.

Results and outlook

Your plastic surgeon can treat your skin cancer by surgically removing cancerous skin and reconstructing a more normal appearance. But some forms of skin cancer require additional treatment such as radiation therapy. Your physician will advise you about any follow-up treatment recommendations.

Reconstruction can restore a more natural appearance, but no reconstruction is perfect. Visible scars will always remain at incision sites. You may also expect 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 cured.

How much will skin cancer surgery cost?

Cost is always a consideration in surgery, whether to remove the skin cancer or to reconstruct your appearance. A surgeon’s cost may vary based on his or her experience, the type of procedure used, as well as geographic location.

Cost may include:

• Surgeon’s fee
• Hospital or surgical facility costs
• Anesthesia fees
• Prescriptions for medication
• Post-surgery garments, and
• Medical tests

Your health insurance plans should cover skin cancer surgery, related complications or another surgery to reconstruct your appearance. Pre-certification is generally required for reimbursement or coverage. Be sure to consult with your insurance company in advance of any surgery.

Your satisfaction involves more than a fee

When choosing a plastic surgeon for skin cancer 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.

Words to know

• 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 microscopically examined by a pathologist prior to wound closure 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 defined borders.
• 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.

Questions to ask my plastic surgeon

Use this checklist as a guide during your consultation

• Are you certified by the American Board of Plastic Surgery?
• Are you a member of the American Society of Plastic Surgeons?
• 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 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?