Removal and repair of skin cancer
If you have a growth on your skin which irritates you or because your doctor cannot be sure it is not a skin cancer, you may need it to be excised. These are usually skin growths that are changing in size, color or are scabby or bleeding.
Types of skin cancers
There are 3 common skin cancers and, because the nose, ears, cheeks, scalp and lips are rarely covered and therefore exposed to the sun throughout of lives, a larger percentage of skin cancers affect the head and neck. The common skin cancers are basal cell, squamous cell and melanoma.
A.) Basal cell carcinoma (BCC): This is the most common form of skin cancer. Fortunately, this is a cancer that does not spread easily. It is usually treated effectively with a simple excision which sometimes results in a scar, but it is not a threat to one’s life.
B.) Squamous cell cancer (SCC): Most of these skin cancers are not serious. While 96 to 97 percent of SCCs are localized, the small percentage of remaining cases can spread to distant organs and become life-threatening. These skin cancers need to be treated with more caution and timeliness.
C.) Melanoma: This is the most serious form of skin cancer. However, if it is recognized and treated early, it is nearly 100 percent curable. But if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal.
This cancer is very tricky to distinguish from a normal mole. The following features are warning signs.
Asymmetry. Draw a line through this mole, the two halves will not match.
Border.The borders of an early melanoma tend to be uneven.
Color. Having a variety of colors is another warning signal.
Diameter. Melanomas usually are larger in diameter than the size of the eraser on your pencil.
Evolving. Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.
Pre-cancer skin lesions
There are also precancerous changes that can occur frequently: actinic keratosis and dysplastic nevus. The term "precancerous" is used because these abnormal areas of skin are more likely to turn malignant than healthy skin.
Actinic keratosis (AK), also known as solar keratosis, by far the most common precancer, is the result of prolonged exposure to sunlight. It is a small crusty or scaly bump or horn that arises on or beneath the skin surface. The base may be light or dark, tan, pink, red, or a combination of these ... or the same color as your skin. The scale or crust is horny, dry and rough, and is often recognized by touch rather than sight.
Dysplastic nevi, also known as atypical moles, are unusual benign moles that may resemble melanoma. People who have them are at an increased risk of melanoma. The larger the number of atypical moles, the greater the risk. Individuals with 10 or more of them have 12 times the risk of developing melanoma as members of the general public.
Professional surveillance and prompt action, usually a biopsy, are your best protection.
To learn more about this topic, please explore the following website: skincancer.org
When to be concerned
If you have an area on your skin that is not returning to its normal smooth condition, watch that area carefully. Check for any one of the following signs. And, if the skin has not returned to normal in 2 weeks, call your primary care doctor, dermatologist or our office.
WARNING SIGNS:
1.) An open sore that bleeds, oozes or crusts and remains open for a few weeks. A persistent, non-healing sore is a very common sign of an early skin cancer.
2.) A reddish patch or irritated area which may also itch or hurt. But you do not have to feel any discomfort.
o A shiny bump that has a raised, smooth surface like a pearl. Its color can be pink, red, white or translucent.
o Other colors. The bump can also be tan, black or brown, especially in dark-haired people, and can be confused with a mole.
o A pink growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.
o A scar-like area which is white, yellow or waxy, and often has poorly defined borders. The skin itself appears shiny and taut. This warning sign can indicate the presence of small roots, which make the tumor larger than it appears on the surface.
Treatment
Biopsy: The first step is often to obtain a small sample of a suspicious skin lesion. This can be done by shaving off a small piece of the tissue or using a biopsy tool that may require a small stitch. A local anesthetic is used and the pathology report is usually available in one week.
Non-surgical treatments: It may be enough to treat a precancerous skin lesions with a laser, liquid nitrogen, phototherapy or 5-FU cream (usually under the care of a dermatologist), but skin cancers must be removed entirely and with proper checking of the tissue by a pathologist.
Excision: We recommend avoiding certain medicines before any surgery. Avoid aspirin, certain herbal medicines and alcohol (beer, wine, etc.) because these drugs make your blood thin (you will bleed and bruise more). Your doctor will start by numbing the area with Xylocaine. This involves inserting a small needle into the area to be removed and then injecting the medication. The medicine stings when it is injected and this is usually the worst part of the whole procedure.
The doctor will then remove the growth. This will be done by cutting it out with a scalpel. You should not feel any pain when the doctor is cutting. If you do, tell him right away and he will inject more Xylocaine. The doctor will cut an oval of skin around the growth. This leaves a longer scar, but avoids the formation of "dog ears" which are bunches of skin or folds of skin left over when a growth is cut out in a circular fashion.
The doctor will then remove the growth. This will be done by cutting it out with a scalpel. You should not feel any pain when the doctor is cutting. If you do, tell him right away and he will inject more Xylocaine. The doctor will cut an oval of skin around the growth. This leaves a longer scar, but avoids the formation of "dog ears" which are bunches of skin or folds of skin left over when a growth is cut out in a circular fashion.
Figure - An oval excision makes a longer, but smoother, scar.
The tissue removed will then be sent to a pathologist. In some cases, at the time of surgery, the pathologist will look at the edges to make sure the growth is all out. If the pathologist finds cancer in the removed skin, your ENT surgeon will remove more tissue. But in most cases, this technique is not needed. The wound will be immediately repaired and the pathology report will be available about one week after the surgery.
Moh’s Surgery: This type of surgery is used when a skin cancer is large, located in a difficult area, such as the nose, or the edges of the cancer are ill-defined. Skin cancer can spread beyond the obvious edges of the lesion by growing along blood vessels and nerves. With this surgical technique, the skin cancer is removed in pieces by a specialized dermatologist and immediately analyzed for complete removal of the cancer. The surgery is performed under local anesthesia and may take longer, but it is the most precise method for removing the cancer and preserving as much of the normal surrounding tissue as possible.
For larger repairs after Moh’s surgery, the wound is carefully covered and the patient will be seen later that day by the ENT surgeon for closure of the wound with either a skin flap or skin graft.