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skin tumours
Skin cancer is a common problem in New Zealand. The three most
commonly treated tumours are;
Basal Cell Carcinoma
BCCs rarely metastasize and grow slowly. However if left
they will slowly erode through adjacent tissue leaving a fungating
ulcer. They are related to sun exposure over time. There are several
clinical types of BCC and treatment varies accordingly.
Squamous Cell Carcinoma
SCCs may metastasize and those on the lower lip are particularly
dangerous. They are also related to sun exposure but also to various
chemicals and chronic trauma. They require a wider margin of excision
than BCCs.
Melanoma
Melanoma has a high mortality in New Zealand. It may occur
on any part of the body including non sun-exposed regions. Prognosis
is related to depth of the tumour. The margin of excision depends
on the tumour depth. Once a melanoma is diagnosed, the Plastic Surgeon
will perform a wide local excision which involves a wider margin
and greater depth of excision. In some cases a sentinel node biopsy
is performed to examine the draining lymph nodes. Regular periodic
examination of the draining lymph nodes is important for up to ten
years following a melanoma.
The role of the plastic surgeon is diagnosis of the tumour and
appropriate treatment which may include surgery. Plastic Surgeons
are especially involved in excision and reconstruction of difficult
defects particularly in cosmetically sensitive areas.
EXAMPLES OF CASES
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AFTER |
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Forehead flap for BCC medial canthus
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A multiple recurrent BCC on the lateral nasal sidewall and medial
canthal region is marked for excision. It involved the eyelids and
canthal apparatus. Excision removed the medial orbital wall and
nasolacrimal duct. A transnasal canthopexy was used to hold the
eyelids in position along with a flap from the forehead to reconstruct
the defect following excision.
Cheek advancement flap for BCC face
BCC beside the nasal alar. The resultant defect is closed with a
cheek advancement flap similar to a reverse facelift.
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