Basal Cell Carcinoma Surgery: Treating This Skin Cancer Surgically
Basal cell carcinoma is a type of non-melanoma skin cancer, and it is also the skin cancer that is the most common. This type of skin cancer is least likely to spread, is the most easily treated, and is rarely fatal. However, there is a high recurrence rate, and people who have had this cancer must often battle it again within five years. If this cancer is not removed, it can cause extensive damage to the tissue and bone that surrounds it. Various types of basal cell carcinoma surgery are the most common ways to remove this cancer.
Prepare For The Possibility Of Grafts
I have had several squamous cell cancers on my face, including 3 around and on my nose. You cant see scarring. The only time I had pain was when I had a large one removed from my forehead and down around my eye and nose with a skin graft on my nose. If I get anymore, I certainly wont hesitate to have them removed. So you can do this! – Bonnie
I had Mohs about the size of a dime At the end of my nose. Didnt feel a thing. Took graft from behind ear to fill hole. Only took Tylenol for pain. Bolster bandage the first week to hold graft in place was just annoying and thought I might pull off in sleep, but I didnt. You will be ok. If you are anxious tell them, usually the assistants will put you at ease. Good Luck! – Jeanne
I had basal on my nose. I can tell you it by far was the most painful surgery of all skin cancers that I have had. The nose is a VERY sensitive area and the anesthesia wears off very quickly. Had to be injected too many times to count. My cancer was there since childhood . The result: a dime-sized hole on top of my nose and the entire inside of nostril was filled with cancer. Had skin grafts and left with part of my nostril missing. No one knows unless I point it out. Doctors are amazing and the procedures they can do are as well. I hope I dont scare anyone, just want to share that if I had known so much earlier this wouldnt have been as invasive. Had it been squamous I dont think I would be here. Stay on top of your skin! – Vickie
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
Also Check: What Is The Main Cause Of Skin Cancer
After Skin Cancer Surgery Careful Reconstruction Around Eyes And Nose
Elizabeth Ann Badgett
For six months, Elizabeth Ann Badgett, of Clayton, NC, watched a painless, scaly spot appear and disappear on her nose. Each time the spot returned it was larger until it reached the corner of her left eye. Her primary care doctor referred her to a dermatologist, who diagnosed the spot as skin cancer.
There are three predominant types of skin cancer: basal cell skin carcinoma, which is the most common, squamous cell carcinoma and melanoma. Badgett, 62, was diagnosed with basal cell skin cancer. It had to be removed.
Duke dermatologic surgeon Dr. Jonathan Cook, MD, performed Mohs surgery, the most effective way to remove basal cell and squamous cell skin cancer. In the process, he had to remove a large area of tissue on her lower eyelid, cheek, and nose that extended to layers deep against the bones. Badgett needed reconstructive surgery to improve the function and appearance of her eye and face.
Skin Cancer Treatment at Duke
Closure With 2 Suture Layers
The scar on the cheek is nicely hidden along the nasolabial crease and is almost imperceptible after healing in many patients. There are two layers of stitches. The underlying stitches cannot be seen in this picture because they are deeper below the surface. They will dissolve on their own. The top layer of sutures are the visible blue sutures and they are removed in approximately 1 week. If sutures are left in the surface too long, a “railroad track” type of scarring can occur. If sutures are taken out too early then some scars can spread and widen. With strong supporting stitches in the deep layer, removing top stitches 1 week after surgery usually yields the optimal result. After top stitch removal we often reinforce the healing skin by placing steristrips across the surface. These are like small pieces of reinforced tape that usually stay on for about one week and provide a little more support for optimal scar healing. More
Basal Cell Carcinoma Of The Nose
BCC of the nose tip is common . Larger tumours will infiltrate and eventually destroy the neighbouring areas. Infiltration of the delicate muscles of the distal nasal part and later on the cartilaginous structures is characteristic for locally advanced tumours. BCCs of the lateral part of lateral sidewall do not necessarily respect the nasofacial groove. They may infiltrate the muscles including the orbicularis oculi in advanced stages. BCCs of the nasal root are less common than those of the bridge .c]. Since inner canthus is in close proximity this may cause a particular challenge for defect closure.
Clinical presentation of basal cell carcinoma of the nose. Small solid but ulcerated BCC of the nose tip. Large adenoid-cystic BCC of the nasal root. Patients with 3 lesions suspicious for BCC: Morpheic BCC, larger and smaller solid BCC Ill-defined morphoeic BCC with partial destruction of nostril
The ala nasi is a common place for BCC. Larger tumours will involve the nostrils and/or alarfacial and nasofacial grooves . Tumours of the nasal bridge often extend to the lateral sidewall.
Even small tumours of the columella and tend to invade cartilagenous structures, mucous membranes, and subcutaneous tissue. Some patients present with multiple nasal BCC .
Mohs Surgery Is Very Precise
During Mohs surgery, a dermatologic surgeon like Maher removes skin from a skin cancer site one stage at a time. First, a dermatologic surgeon outlines the lesion with ink to map the tumor. After a local anesthetic is injected, the doctor removes the thinnest possible layer of cancerous tissue. While the patient waits, that layer is processed in an onsite pathology lab. After processing, the dermatologic surgeon can then examine the entire margin of removed tissue under the microscope to determine whether any cancer remains. If skin cancer persists, the dermatologic surgeon can identify the precise location of the remaining cancerous cells. At that point, the patient returns to the operating room so that the surgeon can take another layerand the process is repeated until all cancerous tissue has been removed. Roughly 80 percent of patients only need a single layer of skin removed in order to remove all the cancerous tissue. This layer-by-layer approach keeps the incision as small as possible to reduce scarring and promote healing.
Because of the way we process these tissue samples, looking at 100 percent of the margin, we can know for certain when weve removed all of the cancer, Maher said.
What You Can Do
If youve already had a BCC, you have an increased chance of developing another, especially in the same sun-damaged area or nearby.
A BCC can recur even when it has been carefully removed the first time, because some cancer cells may remain undetectable after surgery and others can form roots that extend beyond whats visible. BCCs on the nose, ears and lips are more likely to recur, usually within the first two years after surgery.
Heres what you can do to detect a recurrence and safeguard yourself against further skin damage that can lead to cancer:
Treatment Of Facial Basal Cell Carcinoma: A Review
1Department of Dermatology, Hull Royal Infirmary, Hull and Hull York Medical School , Hull HU2 3JZ, UK
Basal cell carcinomas are locally destructive malignancies ofthe skin. They are the most common type of cancer in the westernworld. The lifetime incidence may be up to 39%. UV exposure is themost common risk factor. The majority of these tumours occur on thehead and neck. Despite BCCs being relatively indolent the highincidence means that their treatment now contributes a significant andincreasing workload for the health service. A good understanding ofthe options available is important. Management decisions may beinfluenced by various factors including the patient’s age andcomorbidities and the lesion subtype and location. Due to theimportance of a good cosmetic and curative outcome for facial BCCstreatment decisions may differ significantly to those that would bemade for BCCs arising elsewhere. There is little good randomizedcontrolled data available comparing treatment modalities. Althoughtraditionally standard excision has been the treatment of choicevarious other options are available including: Mohs micrographicsurgery, curettage and cautery, cryosurgery, radiotherapy, topicalimiquimod, photodynamic therapy and topical 5-fluorouracil. Wediscuss and review the literature and evidence base for the treatmentoptions that are currently available for facial BCCs.
2. Surgical Management
2.2. Mohs Micrographic Surgery
Ask The Expert: Why Am I Having Surgery To Remove A Small Basal Cell Carcinoma
Although the nonmelanoma skin cancer;basal cell carcinoma; is rarely life-threatening, it can be troublesome, especially because 80 percent of BCCs develop on highly visible areas of the head and neck. These BCCs can have a substantial impact on a persons appearance and can even cause significant disfigurement if not treated appropriately in a timely manner.
The fact is, BCCs can appear much smaller than they are. On critical areas of the face such as the eyes, nose, ears and lips, they are more likely to grow irregularly and extensively under the skins surface, and the surgery will have a greater impact on appearance than might have been guessed. Even a small BCC on the face can be deceptively large and deep; the extent of the cancer cannot be seen with the naked eye.
If such a BCC is treated nonsurgically , the chance of the cancer recurring is high. Unfortunately, treating a BCC that has returned is usually much more difficult than treating it precisely and completely when initially diagnosed.
BCCs on the trunk, arms and legs that cause concern are typically larger in size, but even a small BCC in these areas can have an irregular growth pattern under the skin if the initial biopsy shows the tumor is aggressive. In addition, a small BCC in an area previously treated with radiation may be much more aggressive;than it appears on the surface. Again, treating such a tumor nonsurgically is likely to leave cancer cells behind.
About the Expert:
What Are The Advantages Of Mohs Surgery
The technique offers the highest possible cure rate for the treatment of skin cancer, compared to other therapeutic modalities. ;Mohs surgery also allows the physician to remove as little normal tissue as possible around the tumor, and thus in many cases can provide a superior cosmetic result. Our doctors also offer a variety of laser treatments to improve the appearance of scars after Mohs surgery. Another advantage is that with many large skin cancers, hospitalization can be avoided by performing Mohs surgery on an out-patient basis.
Prepare For Pain & Anxiety
They stick a needle in your nose and shoot it up with a sedative. It hurts more than you will ever know! They then remove the cancer, have it tested and if the margins aren’t clear they do it again and again until it tests clear. The only other place I consider the pain from a needle is between the fingers. Both are super painful. I’m not looking forward to having mine removed at all. – Bliss
I have anxiety very bad from all my surgeries. Just had one removed from the bridge of my nose last Tuesday but this one I caught early and immediately went to my doctor. I had Mohs surgery – they got it on the first try. Now I hope I can get a break for a little while as the older I get the more anxiety I have. – Kathy
Is Mohs Right For Me
Mohs surgery is the gold standard for treating many basal cell carcinomas and squamous cell carcinomas , including those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for BCCs or SCCs that are large, aggressive or growing rapidly, that have indistinct edges, or have recurred after previous treatment. Some surgeons are also successfully using Mohs surgery on certain cases of melanoma.
The Pursuit Of False Perfection
So imagine my alarm years later when, in June 2015, my dermatologist, Patricia Mauro, MD, at the University of North Carolina , did a biopsy of a suspicious spot on my nose and informed me that I had basal cell carcinoma. My head started spinning, and it took me a few seconds to process. Dr. Mauro immediately escorted me to the Mohs Center at the university hospital to meet Brad Merritt, MD, who would soon become my Mohs surgeon and skin sculptor.
My thoughts drifted back to summer days as a teen, spent at the pool swimming and smearing iodine and baby oil on my skinny frame to amplify the suns effects.
In his office, my thoughts drifted back to summer days as a teen, spent at the pool swimming and smearing iodine and baby oil over my skinny frame to amplify the suns effects. Later, when I was a cheerleader at UNC, having bronzed limbs helped to set off the school colors, Carolina blue and white. A week before football season, we practiced cheers at the beach, and Who has the darkest legs? became our mantra. At the Tri Delta house, sunny days meant climbing onto our third-story roof to work on our tans without our greased bodies sliding into the gutters. All of this, it turns out, was sheer insanity for someone of Scotch-Irish descent like myself, with skin especially vulnerable to sun damage and prone to developing skin cancers.
Know That Surgery Sites Heal In Time
Had basal cell on the side of my nose going toward the corner of my eye. Couldn’t see anything on the skin, but thanks to the keen eye of my derm she saw it, and did a biopsy, and sent me to a Mohs specialist at UAB. He removed it along with surrounding tissue, sutured, sent me on my way looking, well, terrible! Within 1 year, the scare is completely gone & can’t tell anything was done. Thankful for those yearly scans. – Debbie
I had Mohs done on a very small spot on side of nose right by eye. They had to put me to sleep and did a flap on forehead. Also had Mohs on lip. It went about 2 inches outside of mouth and about an inch in mouth. Great results. Almost unnoticeable. – Joy
What Is The Treatment
Mohs micrographic surgery is a specialized technique for the removal of certain types of skin cancer. The skin cancer is removed one layer at a time and analyzed microscopically while you are in the office. Once the skin layer is removed, it is stained and carefully diagrammed. It is then processed immediately in the office by a specially trained technician who converts the tissue into micrographic slides. These slides are then reviewed by the physician to determine if all of the malignant cells have been removed. If there is residual tumor, it is possible to determine precisely where it is located since the tissue was previously diagrammed. The exact area where the tissue persists is then removed by taking another layer of tissue, and the process is repeated. The surgery itself takes only several minutes; however, the tissue processing takes anywhere from twenty minutes to one hour, and then upon examination of the slides, a decision is made as to whether or not further surgery is indicated. Each procedure where tissue is removed is referred to as a stage.;
Of Basal Cell Carcinoma
Basal cell carcinomas usually appear as the classic “sore that doesn’t heal.” A bleeding or scabbing sore that seems to get somewhat better, then recurs and starts to bleed, may be a basal cell carcinoma.
Most basal cell carcinomas are on the face and neck where the skin is exposed to sunlight. However, a fair number show up on parts of the body such as the abdomen, leg, and scalp exposed to little or no sunlight.
Basal cell carcinomas typically are locally invasive. They tend to burrow in locally and not metastasize to distant locations.
Small basal cell carcinomas can be removed by being scraped and burned . Larger basal cells can be removed by surgery. Basal cell carcinomas on the scalp, ears, and sides of the nose, as well as those which have come back after being treated, are treated best by Mohs surgery.
One basal cell carcinoma means an increased risk of developing another. Prudent sun precautions and annual skin checkups by the doctor are advisable.