Unlike cosmetic surgery, a referral from your General Practitioner is required as this condition potentially has implications for your health. 

Your surgeon deals mostly with skin cancers involving the head and neck where reconstructions are more complex than elsewhere on the body. Most commonly, a biopsy of the lesion is obtained to ensure that it is a cancer so that surgery is not undertaken unnecessarily.  At this stage a description of the surgery and reconstruction will be discussed.

Commonly, a “staged excision and reconstruction” is undertaken as this ensures that a tumour is completely excised prior to any attempt at reconstruction. If this course is not followed it is difficult to ascertain where residual tumour lies if a complex reconstruction is undertaken at the time of the excision.  The time span between the excision and reconstruction is a day or two.

This can take place under local anaesthetic with or without sedation depending on a patients’ wishes.

With sedation, patients have no recollection of the procedure and this avoids the recollection of pain when injecting tender areas such as the tip of the nose or lips. Following surgery you will be allowed to recover adequately before going home.  If it is to be a staged excision and reconstruction procedure, you will be given an appointment within a day or two.

It is important to avoid anything too active in the immediate postoperative days.  You will be instructed as to the postoperative wound care. 

As stated already, smoking worsens all wound healing and should be avoided. If you are on anticoagulants, these can be started the day following surgery.  Sutures on the head and neck are generally removed in 5-7 days following surgery at which stage the results of histology (if not already available) will be given do you. Steristrips are frequently applied to keep tension off the wound.  It is advisable to avoid sun exposure on any new scar for several weeks to months depending on the season of the year.

1. Incomplete Excision
Some tumours extend under the normal skin beyond the cuff of apparently normal tissue. Occasionally this can result in an incomplete excision if a staged excision and reconstruction is not planned. This will warrant a re-excision.

2. Bleeding
If it is appropriate, medication which prolongs bleeding (such as aspirin or warfarin) may need to be stopped up to one week prior to surgery. Many herbal remedies have anticoagulant properties so should be avoided. Your medication can be started again on the day following surgery. Slight oozing of blood is expected after surgery but anything more than this warrants medical attention. Immediate treatment consists of applying pressure directly over the wound for ten minutes. If this does not stop the bleeding, you will need to notify your surgeon.

3. Flap Failure
It is important to note that smoking causes all wounds to heal poorly. When reconstructing defects, skin is sometimes "borrowed" from adjacent sites of your head and neck. As the skin is usually under tension, there is a small risk of the skin not surviving. If the flap does fail, the wound is usually allowed to heal by itself. This prolongs the recovery but the resulting scar is usually very acceptable.

4. Infection
Sometimes lesions are infected prior to surgery, in which case you may be given antibiotics following surgery. If you do have increasing pain after surgery, infection is likely and you should seek medical advice as soon as possible.

5. Unsightly Scarring
The most important part of your surgery for skin cancer is removing it completely. On rare occasions there can be unsightly scarring as a result. It may be necessary to perform revision surgery for cosmetic reasons in these cases.

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