The Oculoplastics Centre | Adult and Paediatric Lid, Lacrimal and Orbit Surgery Sydney

Contact

Phone: +61 2 9525 8669
Email:  

Skin Cancer Excision & Repair

Unfortunately up to 50% of Australians will develop a skin cancer at some point in their life. Most of these skin cancers occur on the head, face and neck.

Dr Wilcsek specialises in treating the "mask area" area around the eyes. This area includes the upper and lower eyelids and extends over the eyebrows onto the forehead, the temples and cheeks.

The eyelids are complicated structures having seven separate layers each with its own function. The eyelids must have a soft inner lining and a skin surface as well as the ability to open to allow vision and closure to protect the eye.

When dealing with skin cancers in the periorbital region not only must all of the cancer cells be removed but the lid must be repaired or reconstructed to maintain its function of keeping the eyes comfortable and seeing well.

Dr Wilcsek takes particular pride in the level of care he gives to ensure the cosmetic outcome is as pleasing as possible.

What are skin cancers?

Cancer is the abnormal growth of cells. The cancer tissue usually grows and destroys the surrounding tissue. The most common types of cancers that occur in the skin are basal cell carcinoma and squamous cell carcinoma.

Basal Cell Carcinoma (BCC) is the most common type of skin cancer affecting this area. This type of skin cancer will not travel to other parts of the body, but will continue to grow deeper and destroy surrounding tissue if not treated.

The next most common type of skin cancer is Squamous Cell Carcinoma (SCC). These usually grow more rapidly than BCC’s and have the potential to spread to other parts of the body.

Melanoma is the most serious but fortunately the least common skin cancer to affect this area. They usually occur as a new mole or pigmented spot but can potentially occur in an existing mole.

What are the symptoms of Skin Cancer?

Skin cancers generally are painless. They may appear as a new thickening of the skin, which may ulcerate, bleed or develop a surface crust. Skin cancers can cause eyelash loss.

When should it Skin Cancer be treated?

All skin cancers or suspicious skin lesions need assessment. Often Dr Wilcsek will take a biopsy to diagnose the particular sub-type of skin cancer and this informs the timeframe and extent of treatment required.

What does the treatment involve?

There are several treatments for skin cancer all of which are highly successful in the majority of patients. The type, location and size of your skin cancer will affect the choice of treatment. A biopsy will give important information about the type and depth of the skin cancer, some forms of skin cancer if only superficial, may be treated with specific creams or freezing with liquid nitrogen. If surgery is chosen there are two parts to treatment:

  • The surgical removal of the skin cancer
  • The surgical repair of the area

Reconstructing eyelids is very specialised and intricate surgery. It is important to ensure all cancer cells have been removed before reconstructing the area. There are two methods that Dr Wilcsek uses when dealing with basal cell carcinoma and squamous cell carcinoma:

  • Frozen section pathology
  • MOHs surgery (see separate section on MOHs surgery)

When frozen section is used, a pathologist sets up a mobile laboratory at the day surgery. During surgery the area that appears to be involved with the skin cancer is removed. This specimen is given to the pathologist who will "snap-freeze", and examine the edges of the specimen to ensure that the skin cancer has been removed entirely.

When the pathologist is happy that the skin cancer is removed, Dr Wilcsek will reconstruct the area. The reconstruction techniques required will vary depending on the amount of tissue loss and specific location of tissue loss.

How will I look immediately after surgery?

A bandage may be required for 1-3 days. Usually the defect is closed by rotating areas of available neighbouring skin laxity (“skin flap”), this tends to settle within days to weeks. If skin grafting is required depending on the availability of similar skin, the “settling in” time varies from weeks to months.

What is the recovery time?

Most patients will take 3 – 5 days off work. Physical activity in the first week should be minimal and then building up to a normal level over the following two weeks.

What are the risks?

Any surgery carries risk, however the risks for this procedure are low and will be discussed fully at the time of your consultation. Overall the risks of not treating the skin cancer far outweigh the risk of the operation.

Is there a risk of the cancer returning?

By checking the margins of excision (edges of the specimen taken) by MOHs or frozen section the recurrence rate is made as low as possible. Skin cancers develop in areas of sun damage and these areas are also prone to developing new skin cancers. The area involved needs to be monitored and Dr Wilcsek does this in the postoperative period, however follow-up with your referring doctor is very important to monitor for any recurrence, or the onset of new skin cancers in the area. As a rule a 5 year period of follow-up is advocated.

Is there anyone who shouldn't have this surgery?

All skin cancers require treatment. Some types of skin cancer when caught early can be treated with creams or liquid nitrogen “freezing therapy”. In other cases surgery will be required.