Surgery is the most common treatment for skin cancers, however its purpose varies depending on how far the cancer has progressed.
For early skin cancers, a simple excision may be all that is required. An excision is a relatively simple procedure that involves the removal of the skin lesion. A local anesthetic injection is given to numb the area around the lesion and the wound is closed with stitches. The excised tissue is then sent to a pathologist who diagnoses the type of tumour, its depth, the risk of spreading, and whether the cancer has been completely removed.
For cosmetically sensitive areas on the face, Associate Professor Ch’ng can arrange to have the excised specimen assessed during the operation by a pathologist (frozen section) to confirm that adequate surgical margins have been obtained.
Wide local excision
A wide local excision is where the skin surrounding the skin cancer is removed to reduce the risk of recurrence of the cancer at that site. Even though an initial biopsy often removes the entire tumour, wide local excision may be recommended to further reduce the risk of the skin cancer recurring.
A wide local excision usually removes a 1-2cm margin around the site of the original skin cancer, however, this amount varies depending on the type of tumour and how deep it has spread into the lower layers of the skin. Most wide local excisions are closed with stitches, however larger excisions may require skin grafts or skin flaps.
As a specialist Plastic Surgeon, Dr Ch’ng is highly skilled in reconstructive surgery techniques, including skin grafts and flap repairs.
With melanoma, you may require a sentinel node biopsy during the same operation as your wide local excision to assess whether the melanoma has spread to your lymph nodes.
Skin grafts are used when the wide local excision leaves a wound area too big for stitches. The skin graft covers the wound and attaches itself to the cells beneath and begins to grow in its new location. If a skin graft were not performed, the area would be an open wound, and take much longer to heal.
Split skin grafts are taken by shaving the surface layers of the skin with a large knife called a dermatome. The shaved piece of skin is then applied to the wound. This type of skin graft is often taken from the thigh and is usually used to resurface larger areas.
A full-thickness skin graft is taken by removing all the layers of the skin with a scalpel. It is done in a similar way to skin excision. The piece of skin is cut into the correct shape, and then applied to the wound. This type of skin graft is often taken from the neck, behind the ear or arm. The donor site is usually sutured closed.
Local flap repair
A local skin flap consists of skin taken from an adjacent area and moved to fill the surgical defect. Where a wound is unable to be repaired using stitches, a flap provides the benefit of supplying tissue of a similar appearance and thickness to that of the tissue that has been removed. There are many different types of flap surgery. Examples include:
- Advancement flap – the flap slides directly into the defect from nearby
- Rotation flap – semicircular flap that rotates about a pivot point into an adjacent defect
- Transposition flap – the flap moves into the defect over intervening intact skin
- Interpolation flap – the flap rotates about a pivot point into a nearby but not adjacent defect, with the pedicle passing above or below a skin bridge