Skin Cancer Surgery &
If you are on this site you have probably been diagnosed with skin cancer on your face. You are very likely concerned about this diagnosis and curious about treatment options. You may even have an appointment already scheduled in order to have the cancer resected and reconstructed by the same physician. Although reconstruction immediately after resection is routinely performed because of its convenience, it may not be the ideal approach to achieving the long term aesthetic results you are concerned about.
Dr. Hootan Zandifar, M.D. is double board certified in Facial Plastic and Reconstructive surgery and Otolaryngology – Head and Neck Surgery. As the director of the skin center he specializes on reconstructive surgeries of the head and neck and focuses mainly on aesthetically pleasing reconstruction after skin cancer surgical excision. He has run the resident skin cancer clinic at Indiana University and has honed his skill to incorporate aesthetic techniques in closure of skin cancer defects.
Hootan Zandifar, M.D., F.A.C.S
Skin Cancer Surgeon
Reconstruction of the skin of the face and the head and neck is more complicated than other parts of the body for several reasons. First because the face is not readily covered with clothing, unsightly scars can be easily noticeable and pose social challenges. Second, various structures of the face such as the eyes, nose, lip and ear have important functions that need to be considered during reconstruction. Therefore, proper pre-operative planning, meticulous cosmetic and functional techniques as well as appropriate post-operative care are essential to achieving a cosmetically and functionally appropriate reconstruction in the face and the head and neck region.
MOHS Surgery Repair
Basal Cell Carcinoma
“The experience with Dr. Zandifar and his team has been fantastic. I come in with this big hole in my face after basal cell tumor removed. Looked like a third nostril. Scary stuff. The doctor proceeded to put on some music while he closed the crater up. I have yet to understand how he got skin off of me to patch me up, but the result was amazing as has been all the follow up and post op care. So, if you have a hole in your face or anything else that requires a doctor, come see Dr. Z.”
Before & After
Frequently Asked Questions
Q: What are the different types of skin cancer?
A: Although there are many types of cancers arising from the skin, there are three major types of skin cancer that are encountered on a frequent basis.
Basal Cell Carcinoma (BCCA) – BCCA is the most common type of skin cancer. These types of cancers arise from the deepest cell layers of the epidermis (called basal cells). The lesions usually have a pearly appearance with small blood vessels coursing through them. These tumors usually do not spread to any other part of the body. However, they can destroy nearby structures and should be treated as soon as possible.
(Typical basal cell carcinoma has a raised edge with pearly appearance. Centrally there is a blood vessle. It can bleed or crust)
Squamous Cell Carcinoma (SCCA) – SCCA is the second most common type of skin cancer. These tumors arise from the keratinocyte cells of the skin. These tumors can be both locally destructive as well as metastatic meaning they can spread to other parts of the body via the lymphatic system or blood vessels. Therefore, they should be treated more aggressively.
(Squamous cell carcinoma typically has crusting that may or may not fall off and regrow again)
Malignant Melanoma – Although malignant melanomas are the least common type of skin cancers, they are the deadliest and therefore require urgent attention. These tumors are usually not locally destructive. However, there is a tendency for aggressive spread to distant organs and structures. Multimodality treatments (i.e., surgery, chemotherapy, radiation) are usually the preferred treatment of choice for these tumors.
(Malignant Melanoma is typically a pigmented asymmetric lesion of the skin that is not consistent in color or border)
Q: What are the different techniques to diagnose skin cancers?
A: There are several diagnostic techniques. Here are a few of them.
Shave biopsy – A shave biopsy is a procedure by which only a superficial layer of the skin is removed (shaved) in order to make a diagnosis. This is usually performed for lesions that are suspicious for actinic keratosis, BCCA or SCCA. The benefit to this method is that it leaves limited to no scarring. However, if a cancerous lesion is found this treatment would not be therapeutic and a definitive treatment would be required.
Excisional biopsy – Certain skin lesions should not undergo shave biopsy. For these lesions, an excisional biopsy is performed. This is when the lesion is removed in its entirety with a margin of healthy tissue. The wound is then closed using sutures. In most instances this method is both diagnostic (it can make the diagnosis) and therapeutic (it completes the treatment). However, in some cases, further surgery is needed to ensure complete removal of the tumor.
Q: What techniques can be used to remove the skin cancer?
A: There are several surgical techniques that can be used to treat skin cancers. For most locations on the head and neck, the cure rate for non-melanoma skin cancers, (Basal Cell Carcinoma and Squamous Cell Carcinoma) are very similar regardless of the technique used to remove the cancer. Here are the most common techniques:
Primary Excision – Primary excision is the procedure during which the entire tumor is removed with adequate surrounding tissue to ensure the complete removal of the tumor. This procedure is combined with some type of pathological evaluation of the specimen at the time of the surgery to ensure the complete removal of the tumor. This enables complete removal of tumor without need for repeat surgery. However, this does take longer because of the need for pathological evaluation.
Mohs surgery – Mohs surgery is a type of primary excision that is performed by a trained surgeon. The tumor is removed and divided into quadrants (sections). The Mohs surgeon then evaluates the pathological specimen of each quadrant to determine if tumor has been left behind in that specific area and can decide exactly where to take more specimens. The benefit of this procedure is not only the ability to determine if the entire tumor has been removed but also to limit the amount of extra (normal) tissue that is removed and thus decrease the necessary size of the defect to reconstruct. This results in a smaller defect that is simpler to reconstruct.
Q: Do I need to have my defect reconstructed the same day and by the same surgeon?
A: We understand that the diagnosis of skin cancer is both stressful and anxiety provoking. It is in no way our intention to minimize this diagnosis. However, remember that basal cell carcinoma and squamous cell carcinoma of the skin have a very high cure rate once fully resected and margins cleared. Once cancer removal is confirmed the most pressing issue that remains would be the cosmetic outcome of the closure. This is especially true if the defect is on your face. For this reason we recommend that your defect be closed by someone who can give you a more cosmetically appropriate closure with little to no scarring. To achieve this you may need to see a different surgeon to close your defect. This may delay your closure by a day or two but will likely result in a better over all outcome.
Q: What are some of the special considerations of the face?
A: Certain locations on the face pose challenges in reconstruction. Locations such as the lip, nose and eyelids have vital functions and as such careful attention needs to be paid during their reconstruction. Dr. Zandifar focuses solely on the reconstruction of the face. His training incorporates years of Head and Neck Surgery and Cosmetic and Reconstructive surgery of the Head and Neck, where all cosmetic and functional aspects of the facial structures are studied. This makes him the ideal surgeon for reconstruction of these regions.
Lip – For centuries full lips have been a sign of youth and beauty. But the lips have vital functions as well, which need to be maintained during their reconstruction. Damage to the function of the lips can lead to significant problems, including alteration of eating, drinking and speech. During reconstruction, the muscular function of the lip must be re-established and the volume must be maintained to achieve a functional, and aesthetic result. There are also other reconstructive and cosmetic options available to improve the appearance of the lips if you have already had surgery. With a background in Facial Plastic and Reconstructive surgery Dr. Zandifar would be more than happy to answer any questions or concerns you have.
Nose – Due to the projection of the nose from the face, defects and abnormalities of the nose become increasingly more noticeable than other parts of the face. More importantly, the nose plays a vital role in breathing. It is far too common for a procedure to be performed to reconstruct the nose with good-looking results that sacrifice function, leaving patients unable to breathe through their nose. Dr. Zandifar prides himself on his ability to comprehensively treat the nose internally and externally. This experience allows him to approach defects of the nose with a complete understanding of its function and anatomy, achieving excellent results.
Eyes – Skin cancer can affect the eyelid, and the defect that remains can be devastating. The eyelids function to open and close the eyes, as well as protect and moisturize the eyes. Retaining function during reconstruction of the eyelid is therefore of critical importance.
Adjunct procedures – In order to achieve optimal results both functionally and cosmetically, you may require adjunct procedures such as septoplasty, turbinectomy or rhinoplasty. For further detail you may click here.