SKIN CANCER

Early Intervention & Prevention

SKIN CANCER

Early Intervention & Prevention

Risk Factors

The number one factor that increases the risk of skin cancer is sun exposure. Ultraviolet rays from the sun cause mutations in skin cells that can lead to pre-cancer and eventual cancer formation. The best ways to decrease this risk is wearing protective clothing, avoiding the sun at peak hours and wearing sunscreen that blocks both UVA and UVB rays with SPF of at least 30.

Skin cancer is more common in men and elderly patients. Other factors that increase risk of skin cancer are fairness of skin, living closer to the equator, radiation exposure, smoking, and immunosuppression.

Signs and Symptoms of Skin Cancer

Most commonly, a skin cancer presents itself as an abnormal lesion on the skin.  The following is a list of common signs and symptoms that can warrant an evaluation by a head and neck surgeon.

  • Lesion on the skin
    • Discoloration
    • Raised area
    • Bleeding from lesion
    • Change in size of lesion
  • Pain
  • Numbness
  • Weakness of face
  • Odor from lesion
  • Mass in neck
Diagnosis and Staging of Skin Cancer

The first step to diagnosis is a detailed evaluation from a head and neck surgeon or dermatologist, which includes a history and physical exam. A biopsy should be done if the physician finds the lesion concerning for cancer. The type of cancer will be determined leading to any other imaging or laboratory studies.

If a cancer has been identified, a complete work up will include different radiological tests to determine metastasis or spread to the regional lymph nodes in the neck or other distant organs including the lungs or liver. The following are the most common tests used:

  • CT (computerized tomography) scan
  • Ultrasound
  • MRI (magnetic resonance imaging) scan
  • PET (positron emission tomography) scan
  • CXR (chest x-ray)

Laboratory tests may also be ordered depending on the medical status of patients. We will also obtain all medical records pertaining to your diagnosis.

After obtaining all tests, we follow the most up to date AJCC (American Joint Committee on Cancer) Cancer Staging System to stage your cancer. Staging describes the primary tumor, spread to regional lymph nodes and spread to other organs. We discuss and finalize recommendations for treatment at our Multidisciplinary Head and Neck Tumor Conference.

Treatment of Skin Cancer

Surgery is the preferred treatment for skin cancers. Earlier stage skin cancers can be excised with simple excision of the lesion with a good cuff of normal tissue to ensure total removal. The edges of the tissue removed will be checked by a pathologist to ensure all the cancer is removed at the microscopic level. Bigger surgeries may be needed for more advanced skin cancers including melanoma, merkel cell cancer as well as squamous cell carcinomas that have spread to lymph nodes.

For melanoma, sentinel lymph node biopsies may be performed if the tumor invades pasts a certain depth of skin based on the pathologist’s report.  This is a surgery that is meant to be diagnostic. Before the surgery, a radiologist will inject a radioactive tracer around the lesion. After a certain amount of time has passed, the radiologist will take images to see where the radioactive tracer has traveled to. Using this information, the surgeon will remove the lymph node(s) that the tracer has traveled to. The surgeon uses a gamma probe that can detect radiation during the surgery. These “sentinel” lymph nodes will be studied extensively by the pathologist for staging and prognostic purposes. After the results are collected, a decision will be made for more extensive lymph node removal, radiation therapy, immunotherapy, or no other therapies needing to be administered.

Radiation therapy can be an alternative to surgery for certain types of skin cancers in selected patients. Radiation therapy with or without chemotherapy may also be recommended after surgery if indicated. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Radiation Therapy

Radiation therapy can be an alternative to surgery for certain types of skin cancers in selected patients. Radiation therapy with or without chemotherapy may also be recommended after surgery if indicated. All cases will be discussed at our Multidisciplinary Head and Neck Tumor Conference with radiation oncologists, medical oncologists, along with other specialties to determine the best modality of treatment.

Reconstructive Facial Surgery

Overview

One of the more common defects reconstructed is the skin and underlying soft tissue. Skin cancer is the most common form of cancer. While smaller skin cancers can be closed without much reconstruction, Dr. Son considers all aesthetics of the face when treating skin cancers and subsequent defects. Incisions are made in skin creases and skin tension lines that help camouflage scars. Dr. Son also has extensive experience with reconstructing skin cancer defects that require larger transplants of tissue. The wide range of experience allows him to be comfortable with any type of defect of the facial skin.

Being a head and neck surgery specialist, Dr. Son sees cancers and resulting defects from the lips, nose, eyelids, and ears. These are very unique structures in the body that have very specific shapes and functions.

Proceedures

The following is a list of procedures commonly done to repair facial skin defects. Dr. Son can use an individual procedure, a combination of procedures, or a custom reconstruction to the specific defect for patients.

  • Advancement flaps
  • Bilobed flaps
  • Interpositional flaps
  • Pivotal flaps
  • Rotational flaps
  • Rhombic flaps
  • Transposition flaps
  • O to T / O to Z flaps
  • V to Y / Y to V flaps
  • Z-plasties
  • Cervicofacial advancement flap
  • Supraclavicular artery island flap
  • Radial forearm free flap
  • Anterolateral thigh free flap
  • Latissimus dorsi free flap
  • Skin grafts
  • Biologic (i.e. dermal grafts) implants
  • Scar revisions

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