Skin Cancer Reconstruction

Skin cancer is the most common cancer worldwide, and according to the Cancer Association of South Africa (CANSA), South Africa has one of the highest monitored ultraviolet (UV) levels in the world, and as a result, also has one of the highest skin cancer rates.

Types of Skin Cancer:

Skin cancers are divided into two main groups- Melanoma and Non-melanoma skin cancers.

  • Melanoma is not as common as non-melanoma skin cancers; however, melanoma is the most dangerous skin cancer. Melanoma occurs in the cells that produce melanin and may occur in any region of the body, even in parts that are not exposed to the sun. The development of melanoma is associated with short bursts of excessive sun exposure such that even a singular incident of excessive UV exposure or bad sunburn (especially in childhood) can result in skin damage that will later develop into a melanoma.
  • Non-melanoma skin cancers include Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Basal cell carcinomas are the most common, and while they are considered the least dangerous, they can cause extensive local tissue damage if left to grow unchecked. BCC's occur as a result of long term additive exposure to the sun and commonly occur in people who spend a great deal of time outdoors for occupational or recreational reasons.

    Squamous cell carcinomas are also caused by long term excessive sun exposure and tend to occur on sun-exposed areas of the body such as the head, neck, back of the hands and lower legs. Squamous cell carcinomas can also occur on the lips, inside of the mouth or other areas of the body. The use of tanning beds is associated with an increased risk of developing squamous cell carcinomas.

Fast Facts:

Length of procedure: 30 - 60 minutes (Longer if multiple lesions or a very complex defect needing reconstruction).
Type of anaesthesia: Local or General anaesthetic
Length of stay: Day case (longer for large defects with complex reconstruction.)
What to expect post-op: Some tenderness at the site of the surgery. Avoid sun exposure. Use high-quality SPF-50+ sunscreen.
Recovery time: 1- 2 weeks for facial lesions. Social activities can usually resume after about one week, with a full return to normal activity around 2 weeks. Elsewhere on the body, healing can take longer. It may take up to 8 weeks for the treated area to settle, and in some instances, additional procedures may be required to further refine the result.

Surgery and Treatment for Skin Cancer:

Dr do Vale will take you through a full consultation and examination to assess your skin lesion/tumour. She will photograph the lesion and then discuss and answer any questions you may have regarding your skin cancer, all options available to you, and the expected results after surgery.

The procedure will depend on the type of cancerous lesion you need to have removed, as well as its size and location. Small lesions can often be removed by simply widely excising the lesion and suturing the wound closed in a manner that will heal with minimal scarring. This technique is usually used for worrisome skin moles, small growths and tumours.

In other cases, particularly when the cancerous cells affect a larger area, Dr do Vale may perform surgery to completely excise the cancerous skin with a surrounding margin of tissue (to try to ensure that there are no cancer cells left behind so as to reduce the risk of a recurrence of the cancerous lesion). The excised specimen will be analysed post-operatively, in a laboratory to confirm complete excision. In some instances, frozen section and examination of the excised specimen is performed by a histopathologist, in theatre, at the time of the surgery. Once the cancerous cells have been removed, reconstructive surgery is then performed to repair the skin defect.

Reconstructive surgery can be achieved in a variety of ways, including repositioning of healthy skin or tissue from nearby or further away (called local flaps, distant flaps or free flaps). Skin grafts can also be used where appropriate. The choice of reconstructive surgery depends on many factors such as the size of the lesion/resulting defect, proximity to important structures and potential functional impact of the defect or the reconstructive plastic surgery. Part of the reconstructive surgery considerations includes choosing tissue of the correct type, bulk and colour to best match the natural contour of the face or body area being repaired in order to provide a beautiful and well-camouflaged reconstruction.

Recovery from Skin Cancer Surgery:

Following the reconstructive plastic surgery, you may experience some tenderness at the site of surgery. Dr do Vale will explain appropriate wound care, and she will prescribe pain medications to help ease any discomfort.

The healing process can take several weeks or months, depending on the extent of the reconstructive surgery. It takes 12-18 months for scars to fully mature and settle. Incision lines will fade over time, although in some cases, follow-up procedures may be recommended to achieve optimal results. Dr do Vale will advise you on the most suitable scar management regimen to ensure that your scars are as inconspicuous as possible. Sun exposure should be avoided during the healing period as this may lead to pigmentation and darkening of scars. It is advisable to always wear a good quality sunscreen with SPF-50+ during the day, both to minimise poor scarring and to prevent future skin cancers. Anyone who has had one skin cancer is at increased risk of developing second skin cancer in the future. You will need to arrange ongoing follow-up consultations with your referring dermatologist to ensure that any new skin lesions are detected early.

Skin tone and Skin Cancer risk:

People with light skin tones, freckles, blonde/red hair, green/ blue eyes are more at risk for sunburn, skin damage and consequently skin cancers. If you fall into this group, it is essential that you take extra care when it comes to protecting your skin. Use a good quality sunscreen with a high SPF on a daily basis (SPF 30- 50+) and take additional precautions when outdoors, such as wearing a hat, appropriate clothing and avoiding excessive sun exposure.

People with darker skin are less susceptible to skin cancers due to higher amounts of melanin in the skin that help protect against sun damage. However, they can still develop skin cancers. Sun protection is important in preventing skin cancer in all individuals.

Prevention is better than cure:

Skin cancer might be the most common cancer worldwide, but it is likely also one of the most preventable. The CANSA association offers the following advice:

  1. Regular "Spot" Checks: Check your skin monthly and seek medical advice as soon as you notice a concerning spot that is asymmetrical, has an irregular border, changing colour, is enlarging or has scaling or crusting that won’t heal.
  2. Get screened: If you have any concerning spots or have had skin cancer before make sure you get screened by your doctor or dermatologist regularly.
  3. Use Sunscreen daily: Use at least SPF-20+ for daily protection and don’t use sunscreen which has expired.
  4. Apply sunscreen correctly and frequently: 20 minutes before going out into the sun and re-apply every 2 hours or after swimming or towel-drying.
  5. Wear protective clothing: Wide brim hats, UV400+ sunglasses and protective clothing and swimsuits.
  6. Avoid tanning beds.
  7. Protect & Educate Children: Protect your children from the sun. Educate them regarding the importance of sun protection and be a good example to them by following your own advice. It is important to note that just 2 blistering sunburns before the age of 18 can dramatically increase their risk of developing skin cancer later in life.

For more information on Skin Cancer, request a consultation below or call 0109003999 to schedule your detailed consultation with Dr do Vale.