Yes, plastic surgeons remove skin cancer, but their involvement goes beyond simple excision. They play a dual role, performing the necessary oncologic removal while simultaneously focusing on the immediate or delayed reconstruction of the resulting defect. This approach ensures the cancer is completely cleared while aiming for the best possible functional and aesthetic outcome for the patient.
The Dual Role of Plastic Surgeons in Excision
Plastic surgeons are uniquely trained to handle both the removal of the cancerous tissue and the complex repair that follows. Their training includes detailed knowledge of tissue dynamics, wound healing, and advanced reconstructive techniques. They are highly sought after when a skin cancer is situated in an area where the resulting defect is anticipated to be large or complex, such as the eyelids, nose, or lips.
The involvement of a plastic surgeon is often sought when functional preservation is just as important as cancer clearance. For example, a defect near the eye requires a surgeon who can ensure the eyelid maintains proper function to protect vision. Their skill set allows them to plan the excision in a way that maximizes the chance of a successful, aesthetically pleasing reconstruction. They are equipped to handle a wide range of skin malignancies, from basal cell carcinoma to more advanced melanomas.
Standard Excision Procedures and Margin Goals
When a plastic surgeon removes skin cancer, they typically perform standard surgical excision. This involves cutting out the visible tumor along with a predetermined ring of surrounding healthy tissue, known as the surgical margin. The goal of this margin is to ensure that no cancerous cells are left behind, achieving a “clear margin” and minimizing the risk of recurrence.
The width of this margin is a precise, scientific decision based on the type and size of the cancer. For a low-risk basal cell carcinoma, a margin of 3 to 4 millimeters (mm) is often accepted, while a high-risk squamous cell carcinoma may require a margin of 6 to 10 mm. Melanoma, a more aggressive form of skin cancer, necessitates even wider margins, ranging from 5 mm for in situ lesions to 20 mm for thicker tumors. The excised tissue is immediately sent to a pathologist for microscopic analysis to confirm the margins are clear of cancer cells.
Reconstructive Techniques After Tumor Removal
Reconstruction is a primary expertise of the plastic surgeon in skin cancer management. The technique chosen depends on the size, depth, and location of the defect created by the tumor removal. The simplest method is primary closure, which involves stitching the edges of the wound together, often used for smaller defects in areas with loose skin. When the resulting defect is too large for primary closure, the surgeon must utilize more advanced techniques.
Skin Grafts and Flaps
Skin grafts involve transplanting a thin layer of skin from a donor site elsewhere on the body to cover the wound. A split-thickness graft includes only the epidermis and a portion of the dermis, while a full-thickness graft includes all layers of the skin. Full-thickness grafts offer a better color and texture match, especially for facial defects.
For larger or deeper defects, especially on the face, local or regional flaps are often employed. This technique involves moving nearby healthy skin and underlying tissue, which remains attached to its original blood supply, to cover the wound. Flaps provide bulk and a superior match in color and texture compared to grafts, helping to preserve the natural contour and function of structures like the nose or ear.
When Collaboration with Specialists is Key
The treatment of skin cancer often involves a multidisciplinary effort. Plastic surgeons frequently collaborate with dermatologists, particularly those who specialize in Mohs micrographic surgery. Mohs surgery is a precise technique often used for cancers in cosmetically sensitive areas, where the surgeon removes the cancer layer by layer, microscopically examining each slice until all cancer is cleared. This preserves the maximum amount of healthy tissue.
Once the Mohs surgeon confirms the cancer is completely removed, the patient is often referred to the plastic surgeon for reconstruction of the resulting defect. This collaboration ensures the highest possible cure rate with specialized skills for complex aesthetic and functional repair. A plastic surgeon may also perform both the excision and the reconstruction for larger, more complex skin cancers, such as advanced melanomas, or when Mohs surgery is not the indicated treatment.