Skin Cancer Treatment and Aesthetic Reconstruction
Skin cancer is one of the most common types of cancer worldwide. Its incidence increases especially in individuals exposed to intense sunlight. When the DNA structure of skin cells is damaged by environmental factors such as ultraviolet (UV) rays or harmful chemicals, these cells begin to multiply uncontrollably, and skin cancer can develop.
[Image of skin cancer types: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma]
Other Types of Skin Cancer
Skin cancer is generally seen in sun-exposed areas such as the face, nose, lips, ears, and hands. However, in some cases, it can also appear in non-exposed areas such as the back, scalp, or genital area. This shows that skin cancer should not be associated solely with the sun.
1. Melanoma
Although melanoma is less common than other skin cancer types, it is the most dangerous. It can manifest itself especially with rapid changes in moles. When noticed early, it can be treated successfully; in the late stage, the risk of metastasis is very high.
2. Basal Cell Carcinoma (BCC)
Basal cell carcinoma is the most common but least invasive form among all skin cancer types. It usually grows slowly, rarely metastasizes, and complete treatment is possible with early diagnosis.
Characteristics:
•Yüz, burun, kulak ve alın gibi güneşe maruz kalan bölgelerde sık görülür.
•It may appear as a shiny, pearly bump or a crusty, non-healing wound on the skin.
Treatment:
•Surgical removal of the cancerous tissue is the most effective method.
•Plastic surgery reconstruction may be required after removal in esthetically important areas.
3. Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma can follow a more aggressive course than BCC. It carries a risk of spreading to lymph nodes or other organs, especially in advanced stages. Therefore, early diagnosis is of critical importance.
Characteristics:
•It usually forms in areas with long-term sun exposure (face, lips, hands, scalp).
•It appears as a rough, crusty, hard-surfaced lesion prone to bleeding.
Treatment:
•Surgical excision is the most effective method.
•Repair methods such as flaps or grafts may be required after wide excision.
Causes of Skin Cancer
•Long-term and unprotected sun exposure
•Artificial UV sources such as solariums
•Weak skin defense in fair-skinned individuals
•Genetic predisposition and immune system disorders
Symptoms of Skin Cancer
•Asymmetrical moles that change shape over time
•Skin spots that show color change or darken
•Irregularly bordered formations with a diameter larger than 5 mm
•Non-healing wounds, bleeding or crusting areas
Skin Cancer Diagnosis and Treatment Process
1. Diagnosis
Examination of skin lesions is generally performed through dermatological examination followed by biopsy. A definitive diagnosis is made as a result of pathological examination.
2. Surgical Treatment
In skin cancers detected at an early stage, surgical removal of only the cancerous tissue is usually sufficient. In necessary cases, removal of larger areas may be required.
Aesthetic and Functional Reconstruction After Skin Cancer
After the removal of cancerous tissue, new tissue transfer may be required, especially in aesthetically and functionally important areas such as the face, nose, lips, eyelids, ears, and scalp. In such cases, plastic surgery reconstruction techniques are applied.
[Image of skin reconstruction using flap and graft techniques]
Applied Repair Methods
•Flap (Flap) Method: It is a repair made by transferring a living piece of tissue from a nearby part of the body, whose blood circulation is preserved. It provides a natural result in both aesthetic and functional terms.
•Graft (Skin Graft) Method: A thin layer of skin, usually taken from areas such as the thigh, arm, or abdomen, is transplanted to the damaged area. It is frequently used for small and superficial tissue defects.
These techniques ensure not only cancer treatment but also the preservation of the natural appearance, the reduction of scars, and the continuation of the function of the affected area.
Each patient is planned individually, and the most appropriate method is chosen by considering the location, size of the lesion, and the general condition of the patient.
Information Regarding Sentinel Lymph Node Biopsy (SLNB) and Lymph Node Dissection (LND)
This page summarizes evaluation and treatment options for lymph nodes in the armpit and groin area for skin and soft tissue cancers (melanoma, skin SCC/BCC, Merkel cell carcinoma, soft tissue sarcomas, etc.). The information is for general purposes; personal medical decisions are made via examination and multidisciplinary evaluation.
Why are lymph nodes important?
Skin and soft tissue cancers may first spread to regional lymph nodes where the tumor drains.
•Upper extremity (arm, shoulder, part of the back) and upper part of the trunk: mostly drains to the axillary (armpit) lymph nodes.
•Lower extremity (leg, hip, perineum/lower part of the trunk): mostly drains to the inguinal (groin) lymph nodes.
Diagnostic Roadmap
1. Clinical examination and imaging: The relevant side armpit or groin area is carefully evaluated; ultrasound, advanced imaging, and/or needle biopsies are performed when necessary.
2. If no clinical growth/spread is detected:
•Sentinel Lymph Node Biopsy (SLNB) is performed.
3. If cancer is clinically suspected in the lymph nodes or if SLNB is positive:
•Regional lymph node dissection (LND) may be planned according to the situation and tumor characteristics, or an individualized approach with close follow-up / systemic-radiation therapies may be preferred according to modern guidelines. (The decision is made in the oncology council.)
What is Sentinel Lymph Node Biopsy (SLNB)?
It is the process of finding and removing the "sentinel" lymph node that drains first from the tumor area.
•The sentinel node is detected with special markers and/or blue dye accompanied by nuclear medicine.
•For the armpit: the sentinel node is sought in the arm/bust areas.
•For the groin: the sentinel node is sought in the thigh/hip-perineum drainage areas.
•If the pathology result is negative, no additional surgery is required in most cases. If positive, additional treatment options are discussed.
What is Lymph Node Dissection (LND)?
If there is proven involvement in the lymph nodes or if the SLNB result indicates this, it is the surgical removal of the risky lymph nodes in the relevant area.
Axillary (Armpit) Dissection
•Indication: Suspicion or proof of axillary spread in skin-soft tissue cancers originating from the upper extremity/upper trunk.
•Purpose: To control regional disease, clarify staging, and contribute to treatment in selected cases.
Inguinal (Groin) Dissection
•Indication: Suspicion or proof of spread in the groin lymph nodes in skin-soft tissue cancers originating from the lower extremity/perineum.
•Purpose: Regional control and correct staging. If necessary, femoral vessels can be protected and plastic surgery techniques (e.g., sartorius/flap shifts) can be used for soft tissue coverage.
How is the Surgery Performed?
•Anesthesia: Performed under general anesthesia.
•Incisions: Performed in a position suitable for regional anatomy, preserving nerve-vessel structures.
•Drain: Temporary drains can be placed to reduce fluid accumulation.
•Duration and stay: Varies per case; usually a short-term hospital stay may be required.
Possible Risks and Side Effects
As with every surgical intervention, risks are individual; they are shared with you in detail before surgery.
•Early period: Bleeding, infection, seroma/lymphocele, wound healing problems, sensory changes, shoulder movement limitation (axilla), skin edge circulation problems.
•Late period: Lymphedema (swelling in the arm or leg), long-term sensory or movement limitations, recurrence.
•Lymphedema risk: Varies with tumor type, history of radiotherapy, body mass index, the scope of dissection, and individual factors. It can be managed with early precaution and physiotherapy.
Post-Surgery Period and Rehabilitation
•Drain follow-up: The drain is removed when output decreases.
•Wound care: Keeping the suture line dry and clean, performing dressings according to instructions.
•Pain control and movement: Controlled shoulder/hip-leg exercises are recommended in the early period.
•Protection from lymphedema:
•Keeping the affected arm/leg elevated, avoiding excessive loading.
•Skin care (protection from cuts-injuries, moisturizing).
•In case of need, compression sleeves/stockings and manual lymph drainage.
•Avoiding situations that may force lymph flow such as blood collection/blood pressure measurement at the extremities, tight jewelry, and long-term hot contact (according to your physician's recommendation).