Skin Cancer Treatment and Face
Hundreds of thousands of people will get skin cancer this year. It's the most common form of cancer. Often, people get skin cancers on a part of the body frequently exposed to sunlight: the face.
People may worry that their appearance will be damaged by removal of skin cancer. But a number of techniques, both old and new, allow surgeons to help restore the face to its original appearance, says Dr. Sam Most, assistant professor and chief of the Division of Facial Plastic and Reconstructive Surgery at the University of Washington.
Patients come to Most after they have had a lesion or cancer removed from their face and would like a reconstructive procedure. The patient may be missing a piece of the nose, a piece of the cheek or, sometimes, the top of the ear.
"The idea is that when some part of the skin has to be removed because of cancer, we want to replace that area with something of the same shape and color as what is missing. So you have to replace like with like," Most says. "The idea is to use skin from nearby, so it looks similar, and then to get it to heal properly, so its appearance does not catch the eye."
That's why reconstructive surgeons replace tissue with like tissue. If the skin has to be removed from the nose, the surgeon can place nearby skin on the remaining cartilage. In cases of a small section, the surgeon will remove skin from a nearby location: the back of the neck or behind the ear. New blood vessels can grow into the graft within a few days.
Sometimes, tissue still attached to its own blood supply can be shifted onto the area in question. So, for example, a surgeon can graft this tissue from the forehead onto the nose, and leave it attached in one spot at the forehead. At the original location, there is still enough skin thickness to re-grow.
The reason the skin flap stays attached to the forehead is to assure there is a blood supply while the graft grows onto the nose. It's as if the graft had an umbilical cord. New blood vessels at the nose will grow into the graft. At the end of three weeks, the surgeon can detach the graft from the forehead, and the graft will live on its own.
Surgeons can also attach skin from the cheek onto the nose, the same way.
Reconstruction of the ear seems, at least, more complicated. The ear consists of skin sandwiched around a thin layer of cartilage. To reconstruct the ear, a surgeon must reconstruct the cartilage. That usually involves "borrowing" cartilage from the other ear. Fortunately, there is a small sheet of cartilage in the base of the ear that sits against the skull that is handy for this purpose: you'd never miss it.
Once the cartilage is obtained as a base, the surgeons can take a flap of skin from the head above the ear and move it onto the ear. Again, the surgeon will leave the skin attached to the head for three weeks to guarantee a blood supply until the graft grows permanently into place.
Some people have difficulties with grafting. For example, people who smoke may have trouble with grafts. The nicotine in cigarettes causes blood vessel constriction, so the graft may not get the blood it needs to survive.
Insurance generally pays for reconstructive surgery related to cancer. Sometimes, people who are having reconstructive work also choose at the same time to have other cosmetic work done. People who have melanomas removed sometimes have skin peels via chemicals, or even laser. These peels remove the very top layers of skin, offering a fresher look to the face. Often, however, these procedures are not covered by insurance.
Needless to say, the smaller the amount of skin removed, the easier the reconstruction. This is yet another reason to be watchful of potential cancers. If you have new, irregularly shaped skin marks that do not heal after several weeks, ask your healthcare provider to take a look at the spot.
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