Skin cancer surgery – complex

ear-skin-cancer ear-skin-cancer-1 ear-skin-cancer-2 ear-skin-cancer-4 rambo-flap rambo-flap-1 rambo-flap-2 skin-graft-ear-4 skin-graft-ear-3 skin-graft-ear-2 skin-graft-ear-1 transposition-nasal-flap-1 transposition-nasal-flap-2 transposition-nasal-flap-3 nasal-vy-flap nasal-vy-flap-1 nasal-vy-flap-2 nasal-vy-flap-3 nasal-vy-flap-4 rhomboid-flap-on-temple rhomboid-flap-on-temple-1 rhomboid-flap-on-temple-2 nasal-tip-skin-flap-1 nasal-tip-skin-flap-2 myocutaneous-vy-flap-repair-tip-of-nose-4 nasal myocutaneous skin flap
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If you don't smoke, the patched on skin will look like this. It will be look completely normal in another few weeks

Surgery is still the gold standard in treating skin cancer. To us skin and skin cancer Surgery is simple and straight forward. Removing the cancer completely is more important. Making your scar looking nice and neat is important too.

We haven’t yet found any magic smooth talk, potions, lotions and snake oils that will improve surgical scars. Just let your body do its work  and it’s free !

Some patients will heal faster than others; It’s just a matter of your genetic make up. If you have made it past 90 years of age,  your skin tends to heal very well – That’s why you can live to 90 !

 What is skin flap surgery ?

 As the name suggests, a flap of skin is dissected and pulled over to cover the open wound. It takes experience to judge what type of skin flap and how much dissection is required for  successful wound closure. The risk of flap dying is higher with poor handling and smoking.

skin-flap-on-temple

Skin flap on the temple. Excising large tumors in this location can be a real challenge. The doctor must be a able to deal with significant bleeding, nerve injury and distorted anatomy.  Timid, conservative—minimalist approach will risk incomplete excision of the cancer. Recurrence of cancer in this area can be quite problematic. In this example, misguided dissection will result in severing of the temporal artery and nerve damage resulting in permanent facial droop.

facial paralysis from injuring to facial temporal nerve
facial paralysis. Injuring to the facial temporal nerve will occur if the nerve is cut either by choice or by accident.

Full thickness skin graft.

skin-graft-nose
The cancer is removed. Matching skin is taken from a suitable site e.g. behind the ear.

The skin is stitched onto the surgical defect. Cotton dressing  (bolster) is tied over the skin graft to press it onto the wound base.

Selecting the right donor skin and good suturing will result in a well healed wound.

Avoid smoking, strenuous activities and keep the dressing dry to allow the skin graft to heal. Stitches and dressing are removed in 7 to 14 days.

Notice: first set of photos, the cancer was removed from the lower eye lid, skin was taken from behind the ear ( 2nd set of photos) and stitched on. Bolster dressing must be kept dry and must not be disturbed. Having said that, we don’t bolster that often !

The resulting scar will nice and neat in the majority of cases. Scar should only be judged 3-6 months post-operatively.

 More examples of full thickness skin grafts

ala nasi excision ala-nasi-excision-1 ala-nasi-excision--2 ear scc ear scc full thickness skin graft ear scc full thickness skin graft 1 wk
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Observe the cleanliness of excision. Note the muscles below. Cancer rarely penetrate the muscles - unless you've left it too long.

Split thickness skin grafts surgery

Split thickness skin grafts surgery are normally reserved for large cancers and on the lower leg or scalp.  If on the leg,  you will require bed rest at home ( with toilet and shower privileges ). The affected leg must be kept elevated, above the shoulders ,for 2 weeks. We therefore, like to keep the graft to 3cm or less.  NO SMOKING or the skin graft will die you will be back again for more skin surgery.

Radiation therapyradiation therapy to nose

Radiation therapy for skin cancer, is available at various hospitals, Usually reserved for multi-focal cancer, Cancer in awkward areas and for the elderly. The patient will usually be 60 or older. We will prepare your skin ready for Radiation therapy.

Radiation therapy is like going for multiple repeated x-rays. The resulting scar will be fantastic in the short term.  Long term the scar will be pale, discoloured and slightly crinkly.

Examples of the common daily routine surgeries.

skin cancer on the nose
Observe the cleanliness of excision. Note the muscles below. Cancer rarely penetrate the muscles – unless you’ve left it too long- then you have to see the surgeon 🙁

full thickness skin graft
full thickness skin graft is sutured in place

full thickness skin graft to the nose
The graft survives at 7th day. After 3 months- will it will be barely visible.

Skin cancer on the nose is very common and so too are recurrences of cancer following skin cancer surgery. Here the infiltrating cancer was excised widely and deeply to cartilage and a full thickness skin graft was used to close the resulting defect.