Skin Cancer Surgery

ABOUT THE PROCEDURE

Dr Haddad’s Surgical Approach to Aesthetic Skin Cancer Surgery

The overriding goals in skin cancer surgery will usually entail:

1. Appropriate cancer clearance

2. Achieving skin healing

3. Optimising the aesthetic result.

Dr Haddad’s extensive experience in plastic surgery takes into consideration different skin and tissue types, as well as requirements at special locations.

Applying plastic surgical principles to skin cancer surgery helps improve results. This involves careful planning, appropriate procedure selection, gentle tissue handling, and appropriate anaesthesia to reduce operative bleeding. Medical management of blood thinners perioperatively also needs to be tailored to each patient depending on their associated risk factors. Other factors include local anaesthetic injection techniques, minimising thermal injury to the skin and tissues during surgery, appropriate selection of sutures and careful suturing. Dressings to protect the repair site and of course careful aftercare.

While skin cancer surgery sometime sounds simple, it can be done with a higher level of finesse and attention to attain better results. Perfect results are not always guaranteed and are dependent often on the size and location of the lesion, as well as skin and genetic patient characteristics which can be outside of our control

Pre-surgical planning begins with a thorough assessment of the lesion, the anticipated repair, as well as your individual skin quality and preferences. Dr Haddad carefully maps out incision lines that follow natural skin creases and tension lines where possible, helping scars blend more naturally with your skin's architecture.

The excision is performed with appropriate margins as needed for complete cancer removal. This requires experience and judgement to determine the boundaries of the tumour, assess depth, and apply an appropriate margin. Dr Haddad operates using magnification and bright light to facilitate these markings. A similar marking is usually performed during your consultation to assist accurate planning and consider appropriate repair options, as well as your preferences.

Some lesions are more poorly demarcated and it can be difficult to judge the boundaries. Of course this can have implications for choice of repair. In this setting we may engage a pathologist to be present in the operating theatre, so that we can attain frozen sections from around the edges of the tumour. This increases our confidence of clearance before committing to a reconstruction. In some cases a two-stage approach, may be preferred, which will involve excision of a tumour in the first procedure. The wound is not repaired at this time, but temporised with a dressing while formal pathology is attained. A subsequent procedure is then required to repair the defect, usually a few days later, once formal confirmation of clearance is attained. The repair or reconstruction is performed at this second stage. This approach is called a slow Mohs technique. This is different to Mohs micrographic surgery which is a specific technique performed by some dermatology colleagues. Sometimes the latter approach is most favourable and Dr Haddad can provide guidance on this also.

Reconstruction and closure is where plastic surgical training makes the most significant difference. Rather than simply pulling skin edges together, Dr Haddad may employ:

• Direct closure using layered closure techniques that reduce tension on the skin surface, minimising scar widening.

• Local Flap reconstruction where skin is carefully repositioned from adjacent areas to fill the defect while maintaining natural contours. Local flaps are often preferred as they replace “like with like,” using skin from the immediately adjacent area.

• Skin grafts for larger defects, carefully matched where possible for colour and texture. A skin graft is detached from a suitable donor site on the body, and placed into the excision site. The skin is dependent on the recipient site for nutrition. We sometimes graft different tissues such as fat or cartilage if needed. Most skin grafts on the face and scalp involve full-thickness skin grafts. These can be taken from sites around the ears, or sometimes from the forehead, cheek fold, or base of the neck. For the legs we sometimes use split skin grafts, taking a shaving of skin from the outer thigh. Some patients are concerned about slow healing with skin grafts; “graft take” is usually very high if the surgery is performed thoroughly and appropriate after-care adhered to.

• Complex reconstructive methods if required. These move a block of skin or tissue from a more distant site in the body, and transplanting that tissue to the defect. Dr Haddad is proficient in microsurgical procedure, but details are beyond the scope of this page.

Most skin cancer surgeries are performed as day procedures under an assisted local anaesthetic (sedation), allowing you to return home the same day. For more complex procedures or higher risk patients, post surgical hospital admission may be required.

Your Recovery & Aftercare

Immediate Post-Operative Period

You'll leave with a dressing over the surgical site, which typically remains in place until your first follow-up visit. Some bruising and swelling around the area is normal and usually peaks within the first few days.

Pain management is usually straightforward, with most patients requiring only over-the-counter pain relief. Prescription pain medication may be provided for more extensive procedures.

Sutures are typically removed between 4-14 days post-surgery, depending on the location. Facial sutures are often removed earlier (4-5 days) while those on the body or limbs may stay in place longer (7-14 days).

During this time, you'll need to:

• Keep the dressings clean and dry as directed

• Elevate the operated area

• Avoid strenuous activity that might increase swelling or place tension on the wound

• Take any antibiotics if prescribed

• Attend follow-up appointments for wound checks and suture removal

Scars evolve significantly over time. Initially, scars may appear red or pink and slightly raised. Over the following 3-6 months, scars typically:

• Fade from red/pink to a pale colour closer to your natural skin tone

• Flatten and soften

• Become less noticeable as they mature

Scars will generally continue to improve and settle over 12 months.

Dr Haddad may recommend include:

• Taping for incision support and to prevent scar widening

• Silicone-based scar treatments to minimise scar thickening

• Sun protection to prevent pigmentation changes

• Gentle massage once the wound has fully healed

• Consideration of laser treatments for scar refinement if needed

Regular skin checks are essential following skin cancer treatment, as having one skin cancer increases your risk of developing others. Dr Haddad will usually advise continued surveillance with your dermatologist. Sometimes more frequent surveillance may be required and an appropriate schedule will be discussed if needed.