Dr. Pacella releases the definitive textbook on treatment of skin cancer: AESTHETIC RECONSTRUCTION AFTER MOHS SURGERY
After years of caring for patients diagnosed with skin cancer, I have heard this story too many times:
A patient sits in my exam room with a large bandage over their nose. What started as a small spot biopsied by their dermatologist has progressed into a large open defect requiring major plastic surgery. The patient sits anxiously, waiting for the final procedure to make them whole again. The patient’s emotions fluctuate rapidly: they may experience guilt about spending too much time in the sun, disbelief in the deformity that they have suffered, and fear of the possibility of permanent scarring. They are in shock…How I can possibly restore their cosmetic appearance to a time before they were diagnosed with skin cancer?
In the United States alone, about 5.4 million non-melanoma skin cancers are diagnosed each year. According to the American Cancer Society, these lesions will be discovered multiple times in over 3.3 million Americans. Worldwide, the increasing number of patients diagnosed each year is even greater. Mohs surgery is the most common way to remove a skin cancer of the face, but it often requires plastic surgery expertise to repair the defect. Make no mistake; skin cancer is a terrible disease. It is visible and obvious. At times, the surgical treatment can lead to disfigurement.
Together with my friend and colleague Dr. Mark Codner (Atlanta, GA), we have catalogued our combined 30 plus year of experience in Aesthetic Facial Reconstruction after Mohs Surgery. We have placed ourselves in the shoes of a skin cancer patient. Our focus lies not only on the techniques to close facial defects, but on how to achieve a perfect closure – by balancing facial symmetry, restoring facial contour and creating imperceptible scars which are barely visible at conversational distance. In support of this goal, we discuss the philosophies of facial aesthetics, the basics of surgical techniques and instruments, as well as the intricacies of scar revision and aftercare.
From East to West, we have collaborated with the leading multidisciplinary experts on the treatment of skin cancer through a combined approach of Mohs surgery and plastic surgery. Each chapter dives deep into the nuances of creating a perfect reconstruction based on the anatomic zones of the forehead, ears, nose, eyelids, cheeks and mouth. The text contains over 5 hours of video, hundreds of photos and over 40 hand drawn illustrations (which I personally created!). Throughout our discussions, we advance many of our own well-described techniques of aesthetic surgery and oculoplastic surgery to adapt to the reconstructive patient suffering from skin cancer.
There is one underlying theme to the book: The outcome for a patient who requires an advanced reconstructive procedure for skin cancer is held to exactly the same standard as the outcome for a patient with a blepharoplasty or facelift: perfect aesthetics with minimal scarring. This is the essence of success in aesthetic facial reconstruction. Cosmetic Surgery is Reconstructive Surgery: Reconstructive Surgery is Cosmetic Surgery . They are one and the same.
Salvatore J. Pacella