Living in a sun-drenched area such as San Diego has one disadvantage: sun exposure. The single biggest risk of developing skin cancer is related to the cumulative effects of sun damage. While avoidance of sun exposure and the use of sunscreen are very effective preventative measures, early diagnosis and treatment is the key to improving the survival rate for this disease. The most common types of skin cancers are basal cell carcinoma, squamous cell carcinoma and melanoma. If caught early, most cancers can be surgically removed. Techniques such as Moh’s micrographic surgery can be used to minimize the total amount of tissue that needs to be removed. Dr. Pacella specializes in repairing defects of the face and body resulting from skin cancer removal. His exceptional talent and vast experience in plastic surgery led him to write a leading textbook, which was recently awarded a “Highly Commendable Award” by the British Medical Association. Dr. Pacella is regularly invited domestically and internationally to teach other surgeons these techniques. His textbook can be purchased here.
Squamous cell and basal cell carcinomas can be treated more easily with standard treatments, particularly when they are localized and detected early. Standard treatments are safe and effective and cause few side effects. When utilizing the special technique of Moh’s surgery to remove the tumor, the amount of skin removal needed can be quite minimal. Melanoma can be a much more aggressive skin cancer, requiring the surgeon to remove a much larger area (i.e. surgical margin) and possibly remove lymph nodes near the anatomical area. In cases of advanced melanoma, radiotherapy or chemotherapy or a combination of the two may be used to slow the effects of the cancer.
Reconstruction Following Skin Cancer
When skin cancers are removed, unfortunately a resulting defect of the skin occurs where the cancer was removed. On the face, these areas are often found in regions where sun exposure is the greatest. Dr. Pacella has worked extensively with dermatologists and Moh’s surgeons around San Diego in an effort to minimize the damage created by skin cancer removal. Utilizing advanced techniques of skin rearrangement and reconstruction, Dr. Pacella approaches every patient with the primary intention of preventing distortion of normal anatomic structures while repairing the skin defect, thus preventing extensive scarring. Carefully considered design of the reconstruction is critical. By placing skin incisions along the natural skin wrinkles, defects created by skin cancer can often be repaired to optimize the long term appearance.
Scarring and Secondary Deformities
Scarring is unfortunately a necessary evil with any reconstructive surgery. Nonetheless, the best chance of creating an unnoticeable scar is to plan the correct reconstructive procedure from the beginning of treatment. Sometimes, long-term scarring from skin cancer surgery can create secondary deformities. Large, poorly planned incisions across the middle of the cheek can distort the natural architecture of the lower eyelid, leading to a “pulling-down” or tethering effect on the lower eyelid. Sub-optimally designed incisions for skin cancer removal around the nose can lead to distortion and contour deformities that can be quite noticeable. Techniques such as scar revision, z-plasty, fat transfer or tissue rearrangement can be employed to minimize the unsightly appearance of unsightly scars. Dr. Pacella has a specialized interest in correcting these secondary deformities with a goal to create a result that is both natural and inconspicuous.