Head & Neck Skin Cancer Surgery
Skin cancer is the most common cancer diagnosed in Australia. A small percentage of these cancers present at an advanced stage and require extensive surgery and reconstruction, as well as other forms of treatment including radiotherapy and immunotherapy. Surgical treatment for skin cancers in the head and neck requires specialist care to preserve or reconstruct the important functions of nerves, muscles and tissues in this area and to help you look and feel most like yourself after surgery.
What is head and neck skin cancer?
Cancer occurs when normal cells change and start growing in uncontrolled ways, potentially spreading abnormal cells to other parts of the body. Skin cancers can be found anywhere on the body but are common on the head and neck as we get older due to prolonged sun exposure. In later stages, skin cancers can spread to the lymph nodes and other structures inside the head and neck, particularly nerves. Surgery is often the first line of treatment for skin cancers to reduce the likelihood of cancer coming back.
Surgery for advanced skin cancer
Dr Wykes specialises in the surgical treatment of advanced skin cancers of the head and neck, including reconstructive surgery. This includes local skin grafts and other more advanced reconstructive techniques. He also specialises in removing skin cancers that have spread to lymph nodes or nerves in the head and neck that require major surgery, and which is often followed by other treatments like radiotherapy or immunotherapy.
Dr Wykes specialises in surgical treatment for:
Advanced basal cell carcinoma (BCC)
BCCs are the most common type of skin cancer that usually develop in sun-exposed areas of the head and face.
In later stages, BCCs can grow larger and may spread beyond the skin to nearby structures such as muscle or deeper tissues. They very rarely spread to lymph nodes or other parts of the body.
Most BCCs are highly curable with surgery to remove the cancer and a surrounding rim of normal tissue.
Advanced squamous cell carcinoma (SCC)
SCCs are more common in people with fair skin and with a history of sun exposure and sun-damaged skin.
SCCs respond well to surgery, especially when treated promptly.
In later stages, SCCs can invade nearby structures such as nerves and bone, spread to nearby lymph nodes in the neck or other distant organs.
In some cases, advanced SCCs are considered ‘high-risk’ and may require additional treatment with radiation or immunotherapy to reduce the chance of recurrence.
Melanoma
Cancer arising from the cells that produce pigment (colour) in your skin is called melanoma.
Having surgery to completely remove early melanomas is often enough to cure the cancer.
Advanced melanoma is more likely than SCC to spread to lymph nodes or remote parts of the body.
A sentinel lymph node biopsy is frequently utilised to indicate whether a more advanced melanoma has spread to the lymph nodes and may determine the need for further treatment.
Merkel cell carcinoma
Merkel cell carcinoma is a rare and aggressive type of skin cancer that grows quickly and can spread to lymph nodes and other distant organs.
Surgical treatment often involves removing the merkel cell carcinoma and a rim of normal tissue around it as well as a sentinel lymph node biopsy.
Merkel cell carcinomas also respond well to radiotherapy and immunotherapy, and these treatments often follow surgery.
What happens during skin cancer surgery?
Surgery for advanced skin cancer is a highly specialised area. As head and neck surgeons, we must consider the complexity of your facial appearance and the underlying structures in this part of the body. Our goal is to protect vital nerves, organs and major blood vessels and preserve important functions like talking, eating, hearing and facial movements. How your face looks and moves following surgery is vitally important and consideration of this is a key aspect when planning any surgery.
Dr Wykes has advanced training in reconstructive surgery and is experienced in various surgical techniques used to help rebuild facial structures and tissues that have been damaged by cancer or other conditions. Depending on the size of a tumour and how far it has spread, Dr Wykes may perform surgery that involves:
Local excision – removing the skin cancer and a margin of healthy tissue
Skin grafts – taking layers of skin from another part of your body (eg thigh) to cover the wound
Local flap repair – moving tissue with its own blood supply from a nearby area to cover the wound
Regional flaps – moving tissue from somewhere near the head and neck (eg chest) on a stalk containing blood vessels to regenerate new tissue in the wound area
Free flaps – moving either soft tissue (with its own blood vessels) and/or bone from elsewhere in the body to cover the wound
Sentinel node biopsy – finding and performing a biopsy of the first lymph node or nodes (the sentinel node) that is most likely to have cancer cells spread to it to gauge if cancer has spread
Neck dissection – removing the lymph nodes in the neck (between 20-50 lymph nodes) when cancer is suspected of spreading
Parotidectomy – removing the major salivary gland in front of the ear (parotid gland) and the surrounding tissue where cancer is found in the gland or nearby lymph nodes
Reconstructive surgery may be done at the same time as the surgery to remove your cancer or be scheduled as a separate operation for a later date. Dr Wykes will discuss the plan for your reconstructive surgery at your consultation.
Will I need to have lymph nodes removed?
Lymph nodes are small bean shaped glands that filter and process lymph fluid from other organs. There are around 50 of them in each side of the neck. Some people will need to have some lymph nodes in a predefined region removed where cancer is suspected to have spread. This is called a neck dissection. While some lymph nodes are obviously enlarged with cancer, Dr Wykes may not be able to tell during your operation if a lymph node is clean or contains cancer cells. The lymph nodes must be processed and tested, which takes time.
Where will I have my surgery?
Dr Wykes works as part of the head and neck cancer multidisciplinary team at Chris O'Brien Lifehouse in Sydney and operates at Chris O’Brien Lifehouse and Bankstown Hospital. He is also part of the head and neck cancer multidisciplinary team at Wollongong Hospital and works at the Wollongong Hospital and Wollongong Private Hospital.
Dr Wykes will plan your surgery alongside other experts in your cancer care team. Small lesions may be removed as day surgery procedures while surgery for larger tumours or more complex cases will be scheduled for treatment in hospital with at least an overnight stay or longer.