Skin Cancer Surgery

Key Highlights

• The most common skin cancers are basal cell carcinoma and squamous cell carcinoma.
• Most of these cancers occur on sun-exposed skin: the scalp, face, nose, ears, lower lip, forearms, hands and lower legs.
• Skin cancers are more frequent in light-skinned individuals who have significant sun damage.
• Malignant melanoma is less common but generally more aggressive, and requires a wider skin excision. Melanoma is also related to sun exposure, but it can occur on unexposed skin as well.
• Skin cancer surgery is usually performed by removing the lesion with a rim of normal skin, then examining the tissue after the procedure to make sure no cancer was left behind.
• Mohs surgery is a technique that removes the cancer in concentric layers, examining each layer under a microscope until it is clear of tumor.
• The Mohs technique is used for cancers close to the eyes, lips, nose and ears. In these locations it is essential to preserve as much of these vital structures as possible while making sure the cancer is completely removed, so that it cannot penetrate further into them.
• Removing a skin cancer leaves a skin “defect.” Reconstructive surgery is then needed to restore a normal appearance.

When Is Mohs Surgery Indicated?

Mohs surgery is used for cancers close to vital structures such as the eyes, lips, nose and ears. Many types of skin cancer can be treated with the Mohs procedure; the most common are basal cell carcinoma and squamous cell carcinoma.

What Is Reconstructive Surgery?

Reconstructive surgery closes the defect left behind after a skin cancer has been successfully removed. Its aim is to restore a normal appearance. A good reconstruction should:

• Replace missing tissue with tissue of similar thickness and color.
• Avoid pulling on or distorting a nearby structure, such as the lower eyelid or the rim of the nostril.
• Place scars within or parallel to the natural skin creases of the face or body.

In the simplest cases, this is achieved by stitching the edges of the defect together. In more complex cases, a skin “flap” is used to move tissue into the defect. Surgery is usually performed in the office under local anesthesia. More complex procedures can be performed in the hospital under sedation or general anesthesia.

When to Consider Reconstructive Surgery

Mohs surgery is performed by physicians with advanced training in the procedure. Some Mohs surgeons close the defect themselves after removing the skin cancer; alternatively, a Plastic Surgeon performs the closure. This is especially true when the tissue loss is significant and restoring a normal appearance presents technical and aesthetic challenges, as is often the case on the scalp and face. Particularly challenging areas are the scalp, cheeks, eyelids, nose, ears and lips.

What If Reconstruction Fails to Restore a Normal Appearance?

A defect that is not correctly reconstructed can cause an abnormal appearance and impaired function. For example:

• A scarred, retracted eyelid may make it impossible to close the eyes, which can lead to a corneal ulcer, scarring and blindness.
• A constricted nostril may obstruct breathing.
• Distorted lips may cause drooling, difficulty eating and dental disease.
• A distorted ear not only looks unsightly but may impair your ability to wear glasses.

Looking normal is a function. Facial and limb deformities affect our ability to look normal, our social interactions and our general quality of life. Poorly planned reconstructive surgery and its complications can lead to problems that are difficult, or even impossible, to correct. Prevention is the best solution.

What If I Want a Plastic Surgeon to Perform My Reconstruction?

Speak with your Mohs surgeon or dermatologist about having a Plastic Surgeon perform the reconstruction. Alternatively, Dr. Kirwan can refer you to a Mohs surgeon for the Mohs excision. A Plastic Surgeon’s skills are especially important when the cancer is in a critical area, particularly on the face and especially around the eyes, lips, nose or ears.

The Mohs surgeon or dermatologist will remove the skin cancer and apply a sterile dressing, and you will then be seen by Dr. Kirwan for the reconstruction, either on the same day or on a separate day. It is important to know your options for both removing the skin cancer and repairing the defect.

Does the Surgeon I Choose Make a Difference?

Yes, it does. Plastic Surgery requires a rigorous training program in both the art and science of the specialty. Plastic Surgeons treat every age, from birth to old age, and every part of the body, from the scalp to the soles of the feet. A Plastic Surgery residency lasts a minimum of five years after medical school. Many Plastic Surgeons are also Board Certified in General Surgery or Otolaryngology, and most complete a fellowship in a specialized area of Plastic Surgery after their initial training.

Not only did Dr. Kirwan complete General Surgery training (becoming a Fellow of the Royal College of Surgeons of England) before starting his Plastic Surgery residency, he also completed a Fellowship in Hand Surgery and Microsurgery and was ultimately appointed to the university faculty as an Instructor in Hand Surgery at the University of Colorado Health Sciences Center in Denver, Colorado. Dr. Kirwan is Board Certified by the American Board of Plastic Surgery.

There is only one kind of Plastic Surgeon and only one American Board of Plastic Surgery (ABPS). Some surgeons advertise themselves as “Plastic Surgeons” even though they are not certified by the ABPS. You can verify Dr. Kirwan’s ABPS certification on the American Board of Medical Specialties website: www.certificationmatters.org.

Information for Kirwan Plastic Surgery Patients

The best decisions are informed decisions. Dr. Kirwan can help you learn more about skin cancer reconstruction, discuss other treatment options and provide personalized answers based on your individual needs. You can schedule a consultation with Dr. Kirwan in Norwalk.