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Physicians Update

 
Fall 2006: Plastic Surgery

Reconstructive Plastic Surgery Can Be A Key to Recovery after Skin Cancer

More than a million new cases of skin cancer are reported each year, making it the most prevalent form of cancer in the United States. Although a potentially fatal condition, even the most dangerous form of skin cancer can, if detected early enough, be treated and cured.
A variety of techniques for removing a skin cancer exist—surgical excision, cryosurgery, topical chemotherapy,Mohs surgery, curettage and electrodessication. Depending on the location and severity of the cancer, the consequences of treatment may range from a small scar to permanent changes in facial structures such as the nose, ear or lip.
Thus, reconstructive plastic surgery can play an important role in helping patients who have been treated for skin cancer. “Restoring form and function is our primary goal,” says UCLA plastic and reconstructive surgeon George H. Rudkin, M.D. “In some areas of the face it may be more of an issue of form—appearance—but certainly it can be functional also.”
As an example, Dr. Rudkin cites a patient who requires reconstruction of the nose following removal of a cancerous lesion. “In a case like that we want to make sure that the nostril is open for breathing,” he says. “If, in another case, we are reconstructing the eyelid, we want to provide adequate mobility so the eyelid can close and lubricate the eye. In reconstruction of the lip area, we have to consider the aperture of the mouth; if a lot of the lip is taken away, we can’t just simply close the incision because that will leave the person with microstomia, small mouth, which will not function well.”

The most common and least dangerous skin cancer, basal cell carcinoma, grows slowly and rarely spreads beyond its original site, but can, if untreated, grow deep beneath the skin and into underlying tissue and bone. Squamous cell carcinoma frequently appears on the lips, face or ears, and can spread to distant sites such as lymph nodes and internal organs and become life threatening if not treated. Malignant melanoma is the least common but deadliest skin cancer. It can be completely cured if discovered early, but if untreated can spread through the body. Once discovered, a lesion must be removed. Some simple reconstruction techniques can be performed once the cancer has been excised.
In the case of a small cancer, for example, the post-operative defect often can be repaired with a layered closure and fine suture technique. But larger skin cancers, as well as skin cancers in visually critical areas of the face, can require more extensive reconstructive surgery involving techniques such as skin grafting and complex facial flaps.
“We often work closely with the plastic surgeons when more extensive reconstruction is required,” says UCLA dermatologist and Mohs specialist Teresa Soriano, M.D. “We have an ocular plastic specialist for eyelid tumors, and head and neck and plastic surgeons for tumors on the nose and ears. Through this collaboration, we are able to provide our patients with the best possible cosmetic outcome.”

In some cases, it may be the plastic surgeon who performs both the tumor excision and the subsequent reconstruction. “If the dermatologist feels that the tumor is inappropriate for a procedure like Mohs (in which the cancer is removed one skin layer at a time) or is too large, or the patient is too ill to have the procedure done under a local anesthetic, then we will do both the extirpation and the reconstruction,” explains Dr. Rudkin. Reconstructive plastic surgery can be invaluable to a patient with a large tumor excision. “
In certain cases, and when dealing with tumors of a certain size, the reconstructive plastic surgeon can be very aggressive in making sure that the tumor is completely removed, while also giving the patient a better cosmetic result,” says Timothy A. Miller, M.D., chief of the Division of Plastic and Reconstructive Surgery at UCLA. “Take, for example, a tumor on the side of the nose that is about the size of a dime. Chances are in a case like that it is better to take off a good part, if not all, of one side of the nose, and then reconstruct it.”




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