Skin cancer is one of the most common forms
of cancer in this country. There are three major types including
basal cell carcinoma, squamous cell carcinoma, and melanoma.
Dermatologists trained in Mohs surgery can excise the skin
cancer with both precision and accuracy. Plastic surgeons
usually take a standard margin for each type of skin cancer
and check the margins with a “frozen section” where a pathologist
looks at the excised skin cancer under the microscope to check
for clear margins at the time of the surgery. Both Mohs surgery
and the plastic surgeons’s excision techniques using standard
margins have excellent cure rates for skin cancer. In cases
where the Mohs surgeon performs the cancer excision, reconstruction
is performed on the same day at a surgery center by a plastic
surgeon. There are various techniques for reconstruction including
primary closure, skin graft, and local flaps.
Primary closure is performed in cases where the defect
or the wound left by the excision of the skin cancer is
relatively small. If the defect is a circular wound, the
circle is fashioned into an oval to achieve a linear closure.
A skin graft is used to cover defects which are relatively
large in size. The skin is taken from an area of the body
where there is enough laxity and the skin is expendable.
The skin graft is applied to the defect and sutured into
place. There is a “cushion”-type dressing placed over the
skin graft which is sutured on for 5-7 days.
A flap is the process of covering defects with local tissue
around the defect, based upon the use of geometric patterns
and intrinsic skin laxity. It is more often performed than
skin grafts or even primary closures, because it tends to
heal in the most inconspicuous manner where the scars are
not readily noticeable.
In Mohs surgery, the extent of the skin cancer defect will
not be known until after the skin cancer is excised. So,
at your initial consultation, Dr. Dimitrijevic will go over with
you the various surgical techniques which may be used to
reconstruct the defect. Once the Mohs surgery is done, and
Dr. Dimitrijevic has a chance to examine the actual defect, he will
be better able to discuss the exact procedure which will
be performed. This discussion will take place just before
you go off to the operating room at the surgery center.
Dr. Dimitrijevic's postoperative instructions for skin cancer &
reconstruction
1. When you awake from surgery, you will have surgical
tape dressed directly over the suture line, and you may
also have a gauze bandage over this surgical tape. Leave
the bandage on for 48 hours. The outer bandage can be removed
after 48 hours, but the surgical tape should remain over
the suture line.
2. You may shower 48 hours after the surgery. You can
sponge bathe before this 48-hour period, but keep the surgical
area clean and dry. The surgical tape can get wet. If the
surgical tape peels off after getting wet, this is ok. Just
leave your suture line open to air and start applying Neosporin
over the area twice daily. No baths or swimming. Showers
are ok.
3. Call to make an appointment 7 days after your surgery.
The sutures will be taken out at this appointment.
4. You can place cold-packs (or frozen peas) over the
surgical area to keep the swelling down. If the surgery
was over your face or scalp, keep your head elevated at
all times. Use at least 2 pillows for sleep.
5. Do not lift objects over 5 pounds (heavier than a phone
book) for 1 week.
6. Do not smoke or drink alcohol or take aspirin for at
least 3 weeks before and after surgery.
7. Do not drive a car while you are on narcotic medication
for pain.
8. Take medications as directed. Do not take aspirin,
anti-inflammatory medications (Motrin, Ibuprofen, Alleve)
or Vitamin E supplements for 2 weeks after surgery.
9. Keep your incisions out of the sun. Sun exposure will
make your scars red, raised, and persistently irritated
for a long period of time. Make every effort ot avoid the
sun for up to 1 year following surgery. You can cover up
the incision with sun screen (SPF 15 or above) or clothing.
10. Call with any questions or concerns. Dr. Dimitrijevic is available
through the office phone number 24/7. Don’t ever feel badly
about calling
