Questions To Ask Before Reconstructive Surgery
- What are my options for repairing the wound after the cancer is removed?
- Will you do the repair immediately? Will I need to return for a second surgery?
- What do you expect the area to look like after the repair?
- What should I expect for the recovery?
- When can I resume my normal activity?
- How long will it take to heal? How will I need to care for the wound and donor sites?
- How often should I have follow-up exams with my dermatologist to check for cancer recurrence or a second skin cancer?
What Happens If Squamous Cell Carcinoma Is Left Untreated
Untreated squamous cell carcinoma of the skin can destroy nearby healthy tissue, spread to the lymph nodes or other organs, and may be fatal, although this is uncommon. The risk of aggressive squamous cell carcinoma of the skin may be increased in cases where the cancer: Is particularly large or deep.
What Happens The Day Of Surgery
The procedure is begun after the area to be removed has been anesthetized with a local anesthetic. The surgeon then removes a thin layer of skin consisting of the visible tumor and a narrow rim of normal skin. A temporary bandage is placed over the site and the patient waits in the waiting room while the tissue is processed. The surgeon examines the slides prepared from the tissue with a microscope. A map is created of all tissue removed and any areas with remaining cancer are plotted on the map. The surgeon then returns to the patient to remove any remaining areas of cancer in the skin. This process is repeated until all of the cancer is removed.
One to two hours are needed each time a layer of skin is processed and examined with the microscope. Skin cancers may have extensions or roots beneath the skin that are invisible to the naked eye. No one can predict how many layers will be necessary to completely remove the cancer. For this reason it is impossible to predict how large the final wound will be or how long the procedure will take.
We would like to make the time you spend with us as pleasant and comfortable as possible. You should come prepared to spend the entire day with us. You should bring a bag lunch, a sweater, and perhaps some reading material to occupy your time while the slides are being processed. It is also necessary that you arrange for someone other than yourself to transport you to and from the doctor’s office.
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Can Skin Cancer Come Back After Mohs Surgery And Reconstruction
There is a risk for skin cancer recurrence depending on certain factors such as the size, border, growth rate and location of the tumor. However, skin cancer is less likely to come back after excision and least probable after Mohs surgery. An evaluation of the five-year recurrence rate among post-op patients who had skin cancer excision or Mohs surgery found the recurrence rate for basal cell carcinoma was 2% for excisions and 1% for Mohs surgery.
In cases where the skin tumor returns, Mohs surgery is still the preferred option. In squamous cell carcinoma, the five-year recurrence rate was 3% for Mohs and 8% for excisions. Some forms of skin cancer require additional treatment, such as radiation therapy. Follow-up appointments after Mohs surgery and skin cancer reconstruction are crucial for the early detection of new skin lesions.
Recommendations For After Mohs Surgery
You can expect minimal discomfort after Mohs surgery pain can usually be managed well with acetaminophen . Significant discomfort should be reported to us.
You may experience some localized swelling and bruising, which may not be at its worst until three to four days after surgery. Some swelling and bruising is normal and should improve within a week.
If you have surgery on your forehead or nose, you may experience some swelling of your eyelids, which, at times, may nearly close them due to swelling and bruising settling in that area. Similarly, swelling and bruising may occur down the neck, and rarely the chest, when surgery is performed on the chin or jawline area. To help reduce swelling and bruising, apply an ice pack for 20 minutes each hour while awake for the first 48 hours following Mohs surgery.
While bleeding rarely occurs after Mohs surgery, a little blood or seepage on the dressing is normal. If you notice active bleeding , remove the bandage and apply firm pressure over the area with dry gauze or a dry cloth for 20 minutes.
If bleeding continues, contact our office or the on-call dermatologist . On rare occasions, it may be necessary to have the bleeding stopped by cauterization.
We recommend you limit vigorous physical activity, excessive bending over or exercise for seven days after your Mohs surgery to allow your wound to heal and prevent bleeding or damage to your stitches.
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Recurrent Basal Cell Carcinoma
Recurrent basal cell carcinoma refers to cancer that has come back after treatment and a period of time during which there is no trace of the cancer. Although basal cell carcinoma has an excellent cure rate, it is not uncommon for patients to develop multiple lesions during their lifetimes. People who have already had one skin cancer have a higher risk of developing additional skin cancers in the future, so anyone who has been diagnosed with one basal cell carcinoma should be especially watchful for signs of recurrence.
Most recurrences happen within three to five years of a patients original diagnosis. Although anyone can experience a basal cell carcinoma recurrence, several studies have shown recurrence is more likely in:
- People who had a history of eczema
- People who were exposed to high doses of UV light in their teens, 20s and 30s
- People whose original carcinomas were larger than 2 centimeters
- People whose original carcinomas were several layers deep in the skin
Although its impossible to predict whether basal cell carcinoma will come back, people who have undergone treatment for one lesion are often advised to schedule regular follow-up visits with their oncologists and/or dermatologists. These people should also consistently check for unusual changes in their skin and report any abnormalities to their physician right away.
Bring A Family Member Or Friend
Even though youre not undergoing general anesthesia, its still possible that you still may feel tired after surgery. If you are undergoing a procedure near your eyes, the effects of the surgery may temporarily make it difficult to operate a vehicle, so it may be necessary to have your friend or family member drive you home. Either way, having a loved one there for you following surgery is helpful for support.
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Recurrence Of Basal Cell Skin Cancer
Basal cell skin cancer is the most common type. It’s also the most treatable. Almost all basal cell cancers can be cured. If a basal cell cancer recurs, it usually happens within five years. If you have a basal cell cancer removed, you will probably need to see your doctor once every 6 to 12 months to check for recurrence.
It’s rare for basal cell cancer to return. One study, published in the Archives of Dermatology, followed almost 500 people with basal or squamous cell skin cancer for about seven years after treatment. They found that the recurrence rate of these skin cancers was just 3.5%. According to the National Cancer Institute, 85 to 95% of basal cell skin cancers do not come back after treatment.
If basal cell cancer does return, doctors often recommend to treat it. The procedure involves removing all of the skin cancer and using a microscope to make sure there are no cancer cells left in any tissue on the edge of where the cancer was.
Insurance And Referral Information
We participate with most insurance plans. We will submit all claims to your insurance company. Expenses not covered include cosmetic procedures, deductibles, co-insurance, co-pay amounts and occasionally office visits. These fees will be collected at the time of service. Payments may be made by cash, check, or credit card.
Please check with your insurance company if you have any questions about coverage or preauthorization. If prior authorization is required, please contact your insurance company before surgery. It is important you tell them the following code information so that your referral is correct. You are having Mohs surgery for skin cancer and it will be performed in the office.
We would not want anyone to be denied medical care because of an inability to pay. If you have difficulties understanding or paying our bill, we encourage you to discuss your problem with our billing office at 346-5033.
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Skin Cancer Can Come Back
For this reason, regular follow up with your dermatologist is recommended after any type of skin cancer. Your doctor will probably recommend that you perform regular skin self-examinations between visits. Skin cancer survivors do not need to spend their days inside. = But they should protect their skin whenever they are going to be outside.
Recurrence is different than having a second skin cancer in a different location. Having one skin cancer puts you at higher risk of having another skin cancer. Between 30% and 50% of people with a non-melanoma skin cancer develop a second non-melanoma skin cancer within 5 years.1 Between 2% and 10% of melanoma survivors develop a second primary melanoma.2 Regular follow-up, skin self-examination, and sun protection is important for catching or preventing second skin cancers, too.
Will I Need To Come Back
Follow-up visits largely depend on the type of repair or sutures used to close your surgical wound. Periodic visits to your referring physician at least once a year are advisable to monitor for new skin cancers or signs of recurrence from previous procedures. Statistics show that a patient with skin cancer has a higher chance of developing another one, so follow-up skin exams are very important.
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Avoid Wearing Makeup And Facial Lotions
The vast majority of Mohs surgery procedures take place on facial skin. When going into the clinic on the day of your surgery, avoid putting on makeup and facial lotions if possible. Makeup and lotions will need to be removed at the clinic, in order to ensure that the surgical site is as sterile as possible.
How Do They Remove Skin Cancer From Face
Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue. Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue.
Why Does Melanoma Return
Like any cancer, melanoma returns when some cancer cells survive treatment. Your dermatologist or oncologist does everything possible to prevent this. Sometimes, however, cancer cells survive.
If cancer cells survive, they may multiply and grow into a melanoma. The medical term for this is recurrence.
Its Normal To Feel Anxious
Knowing that you may get another melanoma can leave anyone feeling anxious or worried. In the beginning, any change to your body may convince you that you have another melanoma.
Taking action can help ease your mind. Examining your own skin and keeping all follow-up appointments can help you find signs of skin cancer as early as possible. Protecting yourself from harmful UV rays helps to reduce your risk of getting another skin cancer, including melanoma.
In time, these healthy habits should begin to feel normal and help reassure you that if melanoma returns or you get another one, it will be found early.
Related AAD resources
ReferencesBenvenuto-Andrade, Oseitutu A, et al. Cutaneous melanoma: Surveillance of patients for recurrence and new primary melanomas. Dermatol Ther. 2005 Nov-Dec 18:423-35.
Faries MB, Steen S, et al. Late recurrence in melanoma: clinical implications of lost dormancy. J Am Coll Surg. 2013 Jul 217:27-34.
Francken AB, Shaw HM, et al. Detection of first relapse in cutaneous melanoma patients: implications for the formulation of evidence-based follow-up guidelines. Ann Surg Oncol. 2007 Jun 14:1924-33.
Paek SC, Sober AJ, et al. Cutaneous melanoma. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008: 1156-7.
Uliasz A and Lebwohl M. Patient education and regular surveillance results in earlier diagnosis of second primary melanoma. Int J Dermatol. 2007 Jun 46:575-7.
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What’s The Difference Between Skin Grafts And Flaps For Skin Cancer
A flap is a section of healthy skin that is partially detached and moved to cover a nearby wound.1 The flap has its own blood supply. The blood supply may be a single, larger artery or multiple smaller blood vessels. The medical term for the blood supply is the pedicle. The skin used for the flap is chosen for its similarity to the wounded area in appearance and thickness.2 Flaps usually heal faster than grafts.2
A graft is a piece of healthy skin that is removed from one part of the body and used to cover a wound elsewhere. Unlike a skin flap, a graft does not have its own blood supply.1 At first, the graft survives because nutrients pass from the wound site into the graft. Soon, blood vessels grow into the graft. The blood vessels supply the graft with nutrients.3
The tissue is taken from a donor site. The tissue is used in the recipient site. 3,4 You will have two woundsthe donor site and the recipient siteto care for after surgery.
Request An Appointment At Moffitt Cancer Center
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NEW PATIENTS To request a new patient appointment, please fill out the online form or call 1-888-663-3488.
REFERRING PHYSICIANS Providers and medical staff can refer patients by submitting our online referral form.
Moffit now offers Virtual Visits for patients. If you are eligible for a virtual appointment, our scheduling team will discuss this option further with you.
Moffitt Cancer Center is committed to the health and safety of our patients and their families. For more information on how were protecting our new and existing patients, visit our COVID-19 Info Hub
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Living As A Basal Or Squamous Cell Skin Cancer Survivor
For most people with basal or squamous cell skin cancers, treatment will remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer growing or coming back. This is very common if youve had cancer.
For a small number of people with more advanced skin cancers, the cancer may never go away completely. These people may get regular treatment with radiation therapy, chemotherapy, or other treatments to help keep the cancer in check for as long as possible. Learning to live with cancer that does not go away can be difficult and very stressful.
Basal Cell Carcinoma Recurrence
Recommended follow-up. After treatment for basal cell carcinoma , national guidelines recommend having a complete skin examination by your dermatologist every 6 to 12 months for the first 5 years.3 Recurrence may occur more than 5 years after treatment, too. Therefore, the guidelines call for yearly skin examinations for the rest of your life. Ask your doctor what she or he recommends for you.
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How To Prepare For Mohs Surgery
In preparation for your Mohs surgery, consult with your doctor about any allergies you may have, as well as any supplements or medications you may be taking. Dress comfortably for the procedure as it can last several hours. Finally, ask your doctor if you should refrain from consuming alcohol or smoking before the procedure. If the surgery will be near the eyes or mouth, make sure that any contact lenses, glasses or dentures are removed prior to the procedure.
What Happens During Mohs Surgery
The procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain.
Step 1: Examination and prep
Depending on the location of your skin cancer, you may be able to wear your street clothes, or you may need to put on a hospital gown. The Mohs surgeon examines the spot where you had your biopsy and may mark it with a pen for reference. The doctor positions you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you cant see whats happening, but the doctor talks you through it. The surgeon then injects a local anesthesia, which numbs the area completely. You stay awake throughout the procedure.
Step 2: Top layer removal
Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may be the tip of the iceberg, meaning they have roots or extensions that arent visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily and you can relax while the lab work begins.
Step 3: Lab analysis
Step 4: Microscopic examination
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