Head and Neck Skin Cancer Surgery

Many causes play a part in skin cancer of the head, neck, face and ears. The most important cause is exposure to sunlight. Skin cancer is one of the most common tumours. It develops on parts of the body that get a lot of sun, such as the scalp, face, lips, ears and neck.

Signs and diagnosis

The main signs of skin cancer are a new sore or a sore that does not heal, pain that does not go, and a change in how the skin looks. Skin cancer can be a small, smooth, shiny or pale lump. It can also be hard and dark. Sometimes the lump bleeds or forms a crust. The lump can also be dry, scaly and rough.

Not every skin change is a sign of cancer. If a change lasts more than 2 weeks, see a doctor. The doctor takes a biopsy (a small tissue sample) from the skin that looks abnormal. A pathologist examines the tissue under a microscope (histopathology). The biopsy confirms the diagnosis of cancer.

Skin cancer usually stays in one place (local disease). Apart from malignant melanoma (a cancer of the pigment cells), skin cancers very rarely spread under the skin. For large cancers and cancers that have been present for a long time, the doctor checks for spread near the tumour and to distant organs, and decides the stage of the disease.

Risk factors and protection

The known risk factors for skin cancer are fair skin, skin cancer in the family, a previous skin cancer, blue or green eyes, blond, red or light hair, and frequent exposure to sunlight.

The most common known cause of skin cancer is ultraviolet (UV) light. UVA and UVB light cause skin cancer. The most important way to prevent skin cancer is to protect yourself from the sun. Follow these four rules:

• Stay in the shade between 10:00 and 16:00, when sunlight is strongest and most harmful.
• Protect the parts of your body that get a lot of sun.
• Wear a wide hat that protects your face, ears, head and neck.
• Use a cream that protects against UVA and UVB, with a protection factor of 15 or more.

Types of skin cancer

The epidermis is the top layer of the skin. It is as thin as a pencil line. It makes a protective layer of skin cells that multiply fast and fall off. It has three types of cell:

• Squamous cells, the flat cells on the outside
• Basal cells, under the squamous cells, which make new cells
• Melanocytes, in the lowest layer of the epidermis, which give the skin its normal colour

Skin cancer can develop when the controlled growth of these cells goes wrong for different reasons. There are three main types of skin cancer:

• Basal cell cancer: This is about 70 to 75% of skin cancers. It usually damages the tissue where it is and grows very slowly.
• Squamous cell cancer: This is about 25% of skin cancers. It can be aggressive. It rarely spreads to the nearby lymph nodes.
• Malignant melanoma: This is 1 to 5% of skin cancers. It is an aggressive tumour. It very often spreads to the area around it and to distant organs (metastasis).

Treatment

The main aim of treatment is to remove the cancer completely. The method depends on where the cancer is and how large it is, and on your age, general health and medical history. The main treatments are:

• Mohs surgery: This is a special surgical technique for skin cancer. Its aim is to remove the cancer with as little healthy tissue as possible. It helps most with tumours whose size and depth are not clear. Experienced surgeons must do this technique. Fewer than 10% of skin cancer cases need it.
• Cryosurgery (freezing treatment): Doctors use it for actinic keratosis (a rough skin patch caused by the sun) and some small skin cancers. Liquid nitrogen freezes and destroys the abnormal cells. After the area thaws, the dead tissue comes away. The treatment sometimes needs to be repeated to destroy all of the tissue. The procedure is usually painless. After it, the wound can be painful and swollen. A white scar can stay on the treated area.
• Laser: A laser beam destroys the cancer cells. Doctors usually use this method for cancers in the outer layer of the skin. In photodynamic therapy, a medicine makes the cells sensitive to light, and a laser beam then destroys them.
• Surgery: This is the main treatment for skin cancer. The surgeon removes the tumour with a margin of healthy tissue around it. The width of this safe margin depends on the size and position of the tumour. The wound can be left to heal on its own. It can also be closed by joining or moving the skin around it, or with a skin graft from another part of the body. In the head and neck, the surgeon closes the gap (defect) with a flap (a piece of nearby tissue moved into place) or a graft (tissue moved from another area), chosen for the position of the tumour, with the aim of an acceptable appearance.

Follow-up and repair

As with all cancers, skin cancer needs regular follow-up. A person who has had skin cancer has a 50% chance of a new skin cancer in the next 3 years. For this reason, patients come for check-ups at regular times for at least 3 to 5 years. If you see a change on your skin that is new, grows fast or looks suspicious to you, see a doctor.

These changes (lesions) are usually not very large, so the surgeon cuts out the lesion itself. This procedure gives the diagnosis, and it is often enough as treatment too. If the lesion is very large, or if the type of cancer can spread, a larger operation can be necessary. On parts of the body that people see, such as the face, where no tissue can be lost, the surgeon must repair the skin that was removed. The repair usually uses skin from the area around the wound. This skin is similar, so these operations take care of both appearance and function.