Skin Cancer Treatment? Think Plastic Surgery.

May is Skin Cancer Awareness Month and the American Society of Plastic Surgeons (ASPS) is raising awareness about the importance of incorporating a plastic surgeon into your skin cancer care plan.

"Plastic surgeons are one, if not the only specialty, that can do head-to-toe surgery, whether the cancer is on the tip of the nose, big toe or palm of a hand," said Brian Gastman, MD, plastic surgeon and director of melanoma surgery at Cleveland Clinic. "Our knowledge of the anatomy in skin cancer and beyond is a tremendous advantage for patients and referring physicians."

ASPS statistics report there were nearly 4 million skin cancer tumor removal procedures performed in 2017.

"The most common reason for skin cancer is damage from ultraviolet (UV) radiation, either from direct sunlight, or from tanning beds," said Stephan Ariyan, MD, MBA, Clinical Program Leader, Yale Melanoma Program. "What we call a "healthy tan" is really a reflection of the amount of damage by the UV radiation."

Rogerio Neves, MD, PhD, Deputy Director, Penn State Melanoma and Skin Cancer Center, says long-term exposure to the sun can cause damaging results many years later.

"It's not clear exactly when the DNA damage from UV exposure occurs," Dr. Neves noted. "Some of the damage may take place in the few years before the cancer appears, but much of it may be from exposures that happened many years earlier."

Treating the Skin Cancer Patient

William Dzwierzynski, MD, Professor of Plastic Surgery at the Medical College of Wisconsin, says immunotherapy has changed skin cancer treatment and patient outcomes.

"Former president Jimmy Carter had metastatic melanoma that spread to his brain," noted Dr. Dzwierzynski. "He was treated with immunotherapy and no longer has evidence of the disease. It was unheard of six years ago to treat a 90-year-old with any type of chemotherapy or for people to live with a cancer that spread to their brain, but the new advances in immunotherapy have really changed the prognosis."

Becky Troy, 33, was diagnosed with Stage 2 melanoma. Her dermatologist referred her to a plastic surgeon because removing the cancer required a skin graft.

"Knowing that you have a skin cancer diagnosis is so frightening," Troy said. "I thought I would lose a portion of my face and never be the same. My plastic surgeon removed the cancer, kept scarring to a minimum and helped me keep the shape of my nose. I didn't have to walk around with an obvious deformity for the rest of my life."

While the treatment process varies depending on the skin cancer and stage, skin cancer removal surgery remains the predominant treatment for skin cancer.

"The surgical treatment of non-melanoma skin cancers is invariably curative, while the surgical treatment of more advanced melanoma may require lymph node dissections, which may leave more scars at the site of the surgery," said Dr. Ariyan. "Plastic surgeons are trained to not only remove the cancers, but also to reconstruct the operative wound and restore the area to normal appearances as much as is possible."