Skin Cancer Surgery Beverly Hills

Conveniently located to serve the areas of Beverly Hills and Los Angeles

Description

A surprise to many people, the skin is actually the largest organ of your body, and plays a crucial role in the health and proper functioning of the body.  The skin’s primary role is to act as the first line of defense for the body – protecting it from damaging chemicals, harmful bacteria, biological contaminants, dehydration, physical trauma, overheating, and ultraviolet radiation.  Although the skin is vital to the body’s health, it is also a vulnerable organ, and can sustain significant damage from unprotected exposure to the harmful effects of the sun.

Skin cancer is the most common form of cancer in the United States, with over one million cases of skin cancer diagnosed each year. According to the American Cancer Society (ACS), one in five people will develop skin cancer at some time in their life. These statistics highlight the importance of skin cancer awareness and taking preventative measures to protect yourself from damaging UV rays. However, prevention is not always enough – if you have are noted to have a skin cancer, surgical intervention may be necessary to remove the lesion.  When undergoing treatment for skin cancer, it is reassuring to be in a safe, comforting environment, and to have complete faith in the skills and abilities of your plastic surgeon. Dr. Joubin Gabbay M.D., and the entire team of compassionate and professional individuals at Gabbay Plastic Surgery, will guide you and be by your side throughout your skin cancer treatment—from your first initial consultation, to your post-recovery healing.  Dr. Gabbay has years of extensive training and experience performing various skin cancer procedures, and implements the most cutting edge surgical techniques and advanced technology in order to preserve both your health and your appearance.

Surgery Options

There are a wide variety of methods and treatments for skin cancer, depending upon the particular type and degree of skin cancer the patient is suffering from. During your initial consultation, Dr. Gabbay will conduct a thorough medical evaluation and will create a customized treatment plan for you, taking into consideration factors such as the degree to which your skin cancer has grown, whether your skin cancer has metastasized, and your overall physical and emotional health.

One of the main benefits of having a highly skilled plastic surgeon perform your skin cancer surgery, is that Dr. Gabbay understands the importance of both physical and emotional healing.   To this end, Dr. Gabbay will take every possible measure not only to restore you to complete physical health, but also to ensure that your post-surgical scarring is as minimal as possible. Dr. Gabbay focuses on the complete eradication of your skin cancer, while simultaneously providing the best possible cosmetic outcome, and to creating a compassionate, caring environment for your treatment. If you are concerned that you may have skin cancer, or if you have been previously diagnosed with the condition, please call Gabbay Plastic Surgery today and let us schedule your initial, complimentary consultation with Dr. Gabbay.

Anatomy of The Skin

Human skin is made up of three primary layers: the epidermis, the dermis, and the subcutaneous layer. The epidermis is the outermost layer of the skin, and is primarily made up of cells called keratinocytes, melanocytes and dendritic cells. Melanocyte cells produce a dark pigment called melanin, which contributes to skin color and provides UV protection from the sun.  These cells are located at the bottom of the epidermis and have the potential to turn into melanoma skin cancer.

The dermis consists mostly of connective tissue (structural tissue), and is much thicker than the epidermis. The dermis is responsible for the skin’s strength, pliability, and resistance, for regulating the body’s temperature, and for providing the epidermis with nutrients through its vascular network. The subcutaneous layer is below the dermis, consists of a network of connective tissue and fat, and acts as a protective cushion for the body.

Risk Factors

Risk factors for both melanoma and non-melanoma skin cancer include:

  • Ultraviolet (UV) Radiation – Sun exposure is a significant contributing factor to the development of skin cancer.
  • Skin Tone—people with lighter skin tones area at greater the risk for getting skin cancer because of their increased sensitivity to UV rays
  • Gender—men are more likely to get skin cancers than women, although it is not known why this is the case
  • Previous Skin Cancer—people who have previously had skin cancer are at a heightened risk for getting skin cancer again
  • Immune System Suppression—the immune system helps the body fight off cancer, which means that people with weakened immune systems have a higher risk for developing skin cancer
  • Xeroderma Pigmentosum—an inherited disease that affects the body’s ability to repair damaged DNA skin cells.  People who have xeroderma pigmentosum are at a higher risk for getting skin cancer and must be especially careful about exposure to UV radiation.

Risk factors specific to melanoma skin cancers include:

  • Moles—moles are essentially benign (non-cancerous) tumors and are generally not a cause for concern; however, certain types do pose an increased risk of developing into melanoma cancer.
  • Family Background—individuals with relatives who have developed melanoma skin cancer are at a greater risk for developing the melanoma skin cancer themselves
  • Age—the risk for developing melanoma increases with age

Risk factors specific to non-melanoma skin cancers include:

  • Exposure to Non-UV Radiation (ie. radiation therapy)
  • Basal Cell Nevus Syndrome
  • Chemical Exposure
  • Smoking
  • Permanent Skin Injury
  • Actinic Keratosis
  • Bowen’s Disease

Types of Skin Cancer

The types of skin cancers include:

  • Basal Cell Carcinoma: Ninety percent of all skin cancers in the United States are basal cell carcinoma.  This type of cancer grows slowly and rarely spreads to other areas. Basal skin cancer can often be removed completely during a biopsy with no further treatment required.
  • Squamous Cell Carcinoma: this common type of skin cancer has an extremely low fatality rate (less than 1%).
  • Melanoma: Melanoma skin cancer is less common than basal and squamous cell cancers, but is more likely to spread throughout the body.  Melanoma is the most deadly type of skin cancer and if left unmonitored, it will spread to the lymph nodes and to other sites within the body, making it very difficult to contain and treat.  Melanoma typically arises from pigmented (brown) moles on the body and causes them to change shape and/or color.

It is important to check your moles regularly for any changes in shape/color using the ABCDE’s of melanoma warning signs:

  • A—Asymmetry: the mole is not symmetric.
  • B—Borders: the borders of the mole are irregular.
  • C—Color: there is variation in the color within the mole.
  • D—Diameter: diameter is usually greater than ¼ inch
  • E—Evolution: changes within a mole.

If you suspect that you may have skin cancer, or are concerned about a particular mole, it is always a good idea to see a physician for a skin cancer screening.

Evaluation

At your initial consultation, Dr. Gabbay will ask you questions about when your irregular growths first appeared and how they have changed since you first noticed them. During your medical evaluation, Dr. Gabbay will look for the following signs of skin cancer:

  • A reddish or irritated patch of skin.
  • A new, smooth skin bump (nodule) with a raised border and indented center.
  • A raising or thickening of a previously flat mole.
  • Scaling, erosion, oozing, bleeding, or crusting.
  • Change in the surrounding skin tissue, such as redness, swelling, or small new patches of color around a larger lesion (satellite pigmentations).
  • Change in sensation, such as itching, tingling, or burning.
  • A shiny area of tight-looking skin (especially on the face) that looks like a scar with poorly defined edges.
  • Change in skin consistency, such as softening or small pieces that break off easily (friability).
  • Telangiectasias
  • A persistent red bump on sun-exposed skin.
  • A sore or an area of thickened skin on the lower lip

If Dr. Gabbay finds a suspicious or troublesome, he may perform a biopsy to determine if the lesion is cancerous.

Treatment Options

Simple Excision: the melanoma or non-melanoma skin cancer tumor is removed with a surgical knife.

Curettage with Electrodessication: the tumor is scraped off using an instrument called a curette.  After most of the tumor is scraped away, an electrode is used to kill any remaining cancer cells.

Cryosurgery: nitrogen or argon gas is applied to the cancerous tissue to freeze and destroy it.  Cryosurgery is less invasive than conventional surgery and involves only a small incision for the insertion of the cryoprobe through the skin. Typically, cryosurgery can be performed using only local anesthesia, and because cryosurgical treatment can target a limited area, the destruction of nearby healthy tissue can be avoided.

Laser Surgery: an intense, focused beam of light (laser) is used to destroy the skin cancer tissue layer by layer

Immunotherapy: immunotherapy medications are injected into the skin to stimulate the body’s immune response to destroy cancerous tissue

Dermabrasion: the removal of the top layer of skin using a rotating wheel or small particles to exfoliate cancerous skin cells.

Radiation therapy:  uses high-energy photons (X-rays) to destroy cancerous tissue. Radiation therapy can be adjusted to treat superficial or deeply penetrating tumors and may be performed in conjunction with chemotherapy for advanced tumors

Topical Therapy: used for skin cancer that is confined to only the top layers of the skin (epidermis)

Photodynamic Therapy: uses drugs that become active when exposed to light to eliminate cancerous cells

Mohs Surgery: Mohs Micrographic Surgery (MMS) is the most exact and precise method of skin cancer removal. During this procedure, very thin individual layers of cancerous tissue are removed one at a time until all cancerous tissue has been removed. With Mohs surgery, cure rates are extremely high and there is a low incidence of cancerous cell re-growth.

Surgery Reconstruction

Skin cancer surgery can result in a loss of skin that is significant and does not allow for the skin to simply be sutured back together.  For this reason, it is ideal to have a plastic surgeon reconstruct changes from skin cancer surgery.  Plastic surgeons are specialists trained in the art and science of reconstructing changes to the body after disease, trauma, or surgery.  Dr. Gabbay has extensive experience and training on complex reconstruction techniques after skin cancer surgery.

Specialized reconstruction after skin cancer surgery can help optimize cosmetic and functional results.  Often, after proper skin cancer reconstruction, there are minimal obvious signs of prior surgery and patients are able to resume normal daily life without a hint of their prior operation.

Techniques used by Dr. Gabbay for skin cancer reconstruction include:

  • Multi-layered skin closure – Closing multiple layers of skin helps reduce tension from a wound and results in substantially less visible scarring
  • Skin grafts – for larger defects, skin may be excised from one area of the body and transplanted onto the affected area.
  • Skin flaps – Special techniques are used to transfer local skin into the area of skin cancer removal using advanced geometry and planning.  These local skin flaps can transfer skin and tissue that is most similar to the tissue taken as part of the skin cancer surgery and result in the most natural looking reconstruction.
  • Skin / muscle / fascial flaps – Very large defects sometimes require the transfer of large amounts of tissue from other parts of the body.  Sometimes the muscle, skin or fascia (deep supportive tissue under the skin) may be attached to its local blood supply, and sometimes the transferred tissue must be removed from its blood supply and re-implanted to the body using the surgical microscope.
  • Advanced Biological Technologies – (Integra, ACell Alloderm, etc.) There are a number of advanced biologically based products that are used to aid many of the surgical techniques used by Dr. Gabbay.  These products have the advantage of allowing much less invasive or aggressive surgery in many cases, or expediting the healing or recovery phase.

Recovery

Each patient’s recovery process will depend on the specific treatment techniques that were utilized. Potential (although rare) skin cancer treatment complications include: infection, excessive bleeding, wound dehiscence, seromas, nerve dysfunction, hematoma and post-surgical scarring. If you are concerned about post-surgical scarring, you can rest easy knowing that Dr. Gabbay is a skillful plastic surgeon who will incorporate specific techniques to minimize visible scarring during your procedure, and he can also perform scar-reduction treatments at a later date to further improve your skin’s appearance.

Frequently Asked Questions (FAQs)

How common is skin cancer?

If you have been diagnosed with skin cancer, you are not alone, because skin cancer is the most common form of cancer in the United States; with over one million people being diagnosed every year.  Anyone can get skin cancer, no matter what your skin type, race, age, where you live, or what you do. Although skin cancers can be found on any part of the body, over 90 percent appear on the face, head, neck, hands, or arms where they may be disfiguring, as well as dangerous.

How often do plastic surgeons remove skin cancer?

Fortunately, most skin cancers can be removed by plastic surgeons, and if the cancer is small, the procedure can usually be performed quickly in an office or an outpatient facility.  When a plastic surgeon performs the skin cancer removal, the resulting scar is less visible, or it will be concealed within the natural folds and contours of your face.

What types of skin cancers can be removed by plastic surgeons?

Although most skin cancers can be removed surgically by plastic surgeons, your specific treatment will depend on the type of cancer you have, its stage of growth, and its location on your body.

What are the most common types of skin cancer?

The most common types of skin cancer that plastic surgeons treat include:

  • Basal Cell Carcinoma—This is the most common and least dangerous form of skin cancer and it tends to grow slowly, and rarely spreads beyond its original site.
  • Squamous Cell Carcinoma—This is the second most-common type of skin cancer and squamous cell carcinoma frequently appears on the lips, face, or ears.  Though rare, if left untreated it can spread to distant sites, including the lymph nodes and the internal organs.
  • Malignant Melanoma—This is the least common, but most dangerous, form of skin cancer and if discovered early enough, it can be completely cured.  If it is not treated quickly however, malignant melanoma may spread through the body and become life threatening.

What other types of skin growths can a plastic surgeon treat?

The other types of skin growths Dr. Gabbay can treat include:

  • Moles—A mole is a growth that appears as a cluster of heavily pigmented skin cells that may be flat or raised above the skin’s surface.  While most are harmless and pose no danger, some may develop into malignant melanoma, particularly those that have mottled colors or irregular edges.  Often, moles are removed for cosmetic reasons, or because they are constantly irritated from rubbing against clothing and jewelry.
  • Keratoses—These rough red or brown patches on the skin are usually found on areas exposed to the sun, and they sometimes develop into squamous cell cancer.

What will I talk about with Dr. Gabbay during my consultation?

A personal consultation is the first step for every patient who either has been diagnosed with skin cancer or who suspects that they may have it, and during this meeting, Dr. Gabbay will examine your skin and evaluate your general physical health.  You should arrive at the consultation prepared to provide complete information about:

  • Previous skin cancers or other abnormal skin conditions that have been diagnosed or previously treated
  • Skin allergies or facial injuries you have had and how they have been treated
  • Any family history of skin cancer or personal history of blistering sunburn
  • Your use of tobacco and alcohol
  • Medications you are taking or have taken previously including vitamins, aspirin products, dietary and herbal supplements
  • Acne treatments you may have had as an adolescent (especially if you received therapeutic radiation treatments)

What are the warning signs Dr. Gabbay will look for on my skin?

During your physical examination, Dr. Gabbay will evaluate the affected area. Basal cell and squamous cell carcinomas can vary widely in appearance.

The cancer may first appear as:

  • A small, white, or pink bump, lump, or nodule
  • A red spot that is scaly, rough, or very dry
  • A firm, red bump
  • A crusted group of nodules or bumps
  • A sore that bleeds and does not heal after 2-4 weeks
  • A sore that appears to heal then recurs again
  • A white patch that looks like scar tissue
  • Malignant melanoma is usually signaled by a change in the size, shape, or color of an existing mole or a new growth on normal skin

How will Dr. Gabbay remove my skin cancer?

The method used to remove your skin cancer depends largely on the type of cancer you have, its stage of growth, and its location on your body.  Dr. Gabbay’s goal is to remove the growth in a way that maintains function, and offers the most pleasing cosmetic appearance. This is especially important if the cancer is in a highly visible area.  If the cancer is small, Dr. Gabbay may remove it with a simple excision that may leave a barely visible scar.  In some cases, the cancer may be treated with curettage and desiccation, and in this procedure the cancer is removed with a sharp instrument. The area is treated with an electric current to control bleeding and to eliminate any remaining cancer cells. Other methods of treatment may include radiation therapy, cryosurgery (freezing the cancer cells), topical chemotherapy (anti-cancer drugs are applied to the skin), or Moh’s surgery, which is a procedure in which the cancer is shaved off one layer at a time.  If the cancer is larger in size, or if it has spread to the lymph nodes, more complex surgery may be required.

Can anything be done if I have a horrible scar after my cancer is removed?

If removing the cancer leaves a cosmetic defect, Dr. Gabbay can use reconstructive techniques that range from simple scar revision; to a more complex transfer of skin and tissue, to repair damaged areas, rebuild structures, and help restore appearance and function.

Is skin cancer removal safe?

Each year thousands of men and women undergo skin cancer removal surgery, and experience no major complications, although with any surgery, risks are involved.   During your consultation at Gabbay Plastic Surgery, you will be informed of all of the risks and complications, as well as the benefits of the treatment you choose.

Is healing after skin cancer removal difficult?

By carefully following Dr. Gabbay’s instructions after your skin cancer treatment, your recovery will progress much smoother and some of the instructions may include:

  • You should avoid certain medications that may complicate your recovery
  • Do not smoke or drink alcohol until Dr. Gabbay allows you to after your treatment
  • You should arrange for someone to take you home and care for you after your procedure until you are ready to care for yourself
  • You should arrange your post-operative work and social schedule with the understanding that you will not be looking or feeling your best
  • You should be patient with your healing process and realize you have survived a life-altering experience and patience is necessary

Will I go home the same day as my skin cancer treatment?

Most small skin cancers can be removed in an office or outpatient surgery center, under local anesthesia.  If your cancer is larger or if you are having a more complex reconstructive procedure to restore a normal appearance however, you may be admitted to a hospital.

What type of anesthesia will be used?

In most cases local anesthesia with IV sedation is used, but for larger cancer removals or surgical repairs, you may be given general anesthesia, so that you will sleep through the entire procedure.   During your consultation, Dr. Gabbay will recommend the best and safest anesthesia option for keeping you relaxed and comfortable.

What can I do to minimize the look of my scar?

After your procedure, the scar may be red or pink in color, and if you had a more complex tissue-transfer procedure, your recovery time will be longer than if you had a simple excision.  With any kind of cancer-removal surgery, it is crucial that you follow Dr. Gabbay’s instructions to help the treated area heal properly.  As you heal, keep in mind that a scar, however large or small, is the tradeoff for removing the cancer from your body. How quickly the scar heals depends on the size of the wound, the nature and quality of your skin, and how well you care for the wound after the procedure.

Will I see Dr. Gabbay after my skin cancer removal?

After you have been treated for skin cancer, you will return to Dr. Gabbay’s office for regular follow-up visits to make sure the cancer has not recurred.  It is important that you keep these appointments so that he can assess your long-term results, and address any questions or concerns you may have.  You should also follow his instructions to reduce your risk of skin cancer recurrence.

What precautions will Dr. Gabbay give me?

Since the sun is primary cause of skin cancer, Dr. Gabbay will advise you to:

  • Avoid prolonged exposure to the sun (especially between the hours of 10:00 a.m. and 4:00 p.m.)
  • Be especially cautious with sun exposure during the summer months.
  • Remember that ultraviolet rays pass right through clouds and reflect off sand, snow, and water.
  • When you go outdoors for an extended period of time, wear protective clothing such as wide-brimmed hats and long sleeves.
  • On any exposed skin, use a sunscreen with an SPF (sun-protection factor) of at least 35.
  • Apply your sunscreen at least 30 minutes before you go outside and reapply it frequently, especially after swimming or sweating.
  • Examine your skin at least monthly and if you find anything suspicious, see Dr. Gabbay as soon as possible.
  • Schedule regular exams with Dr. Gabbay

Do I only need to protect myself from the sun when it is hot and sunny?

Ultraviolet rays cause sunburn and skin damage and they cannot be felt or seen.  They are not related to or indicated by heat, high temperatures, or light. Therefore, they are present on days when it is cloudy, hazy, breezy, as well as hot, sunny days.

Can the sun only harm me during the middle of the day?

You can be harmed by the sun anytime during the day, although, the most dangerous time in the sun is between 10am – 4pm when the UVR level is at its highest.

Is it possible to develop skin cancer if my skin does not burn?

Anyone can develop skin cancer regardless of whether or not his or her skin burns.  Although people with fair skin are at a greater risk of developing skin cancer, people with tanned skin are also at risk of developing skin cancer if they do not protect their skin when going outdoors.

Does a tan provide better protection from getting skin cancer?

Any form of a tan obtained from exposure to UVR (natural or artificial sources) increases your chances of premature aging and skin cancer. People with naturally tanned or darker skin have very limited protection to UVR and they still need to protect their skin when going outdoors.   Some fake tanning products do contain sunscreen, but this will only protect for a few hours after application, and you will still have the same risk of obtaining skin cancer.

Is there anyway to get a safe tan from the sun?

Any form of a tan from UVR, whether from direct sun or artificial devices, will damage your skin and increase your risk of developing skin cancer.