Plastic & Reconstructive Surgery

Squamous Cell Carcinoma (SCCA)

Although less common then BCCA, SCCA is generally considered more serious. These tumors have a greater likelihood of spreading to other parts of the body (metastasizing). The incidence of SCCA has increased over the last decade. Like BCCA risk factors for SCCA include sun exposure, ionizing radiation, immunosuppression, certain viruses (human papilloma virus), genetics and chronic skin disorders (burns, sinus tracts, venous stasis wounds).

Premalignant lesions are skin lesions that have the potential of becoming malignant and include actinic keratosis, Bowen's disease, leukoplakia, erythroplakia, keratoacanthoma as well as radiation dermatitis. These lesions can be difficult to distinguish by appearance alone from invasive skin cancers.

Melanoma

Malignant melanomas are arguably the most lethal of the skin cancers, and may arise de novo or from a pre-existing "mole". Melanomas are usually but not always pigmented and can be difficult to distinguish from moles. Irregular borders, change in color or size, ulceration, and bleeding are all signs suggesting possible melanoma. These cancers have a relatively high potential to metastasize, and the prognosis is related to depth of invasion.

Diagnosis of Skin Cancers

The definitive diagnosis of skin cancer is by a biopsy and pathologic examination of the lesion under a microscope. Biopsy may be incisional where only a part of the lesion is surgically removed or excisional where the entire lesion is removed. Punch biopsy and shave biopsies may also be performed for some skin abnormalities suspicious for skin cancer. Shave biopsy should be avoided in melanoma.

Treatment

The treatment of skin cancers is dependent on many factors. For most skin cancers surgical excision is probably the best for of treatment because it allows the diagnosis to be established as well as determining the status of the margins. Other forms of therapy including freezing the lesion (cryotherapy), cauterization, laser vaporization and topical chemical agents. Often premalignant appearing lesions such as actinic keratosis is treated with these later nonsurgical methods.

Frozen section

Frozen section is a technique where the margins can be frozen and examined at the time of the surgery to help to determine if the margins are clear. This technique is not perfect, but can be helpful in cases where the margins are hard to determine by observation alone. In addition, in larger sized lesions where local or regional tissue is to be used to reconstruct the defect frozen sections can be helpful.

Moh's Surgery

Moh's surgery is a technique where the specimen is excised and the surgical margins are immediately inspected. Any residual tumor is resected and the process is completed until all margins are free of tumor. Most surgeons advocate the Moh's urgery only for large skin cancers, skin cancer in anatomically difficult locations, recurrent skin cancers or very poorly defined skin cancers.

Plastic surgeons are often called upon to treat skin cancers particularly when located in places such as the face where preservation of cosmesis or appearance becomes critically important. In addition, plastic surgeons are trained in scar camouflage techniques and the use of "flaps" to reconstruct the defects left by removal of the skin cancer.

Examples of Skin Cancer Reconstruction