Skin Cancer in Beverly Hills
SURGICAL INTERVENTION TO KEEP YOU SAFE
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 been 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 in Beverly Hills 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.
Options for Surgery
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 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
- 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.
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).
- 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.
Just a few of the treatment options we offer include:
- 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.
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 in 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, the 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.
Recovering from Your Procedure
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.