Remuera Surgical Care

Skin Cancer Surgery

Skin cancer (also known as "skin neoplasms") are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma, each of which is named after the type of skin cell from which it arises. Skin cancer generally develops in the outermost layer of skin, so a tumour can usually be seen. This means that it is often possible to detect skin cancers at an early stage. Unlike many other cancers, only a small minority of those affected will actually die of the disease, though it can be disfiguring. Melanoma survival rates are poorer than for non-melanoma skin cancer, although when melanoma is diagnosed at an early stage, treatment is easier and more people survive.

The choice of technique in excision and reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers is generally more challenging due to presence of highly visible and functional anatomic structures in the face. Reconstruction is best performed by a specialist reconstructive plastic surgeon to give you the best result possible.

When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.

Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site, regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed. Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.

Local skin flaps are a method of closing defects with tissue that closely matches the defect in colour and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body.

All lesions removed are sent to the laboratory for testing.  Your specialist will discuss the diagnosis and treatment plan at your consultation and follow up appointment.

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