Innovative reconstructive surgery improves appearance, outcomes for skin cancer patients
OHSU study finds patients with massive skin cancers improve overall quality of life after free tissue transfer surgery
Dorothy Fahland says she was as a typical blue-eyed blonde with freckles growing up on Long Island, N.Y. She spent her days playing on the beach and sailing with friends. “No one ever thought to wear sunscreen back then,” she said. “As a teenager, the goal was to get as tan as possible, so I was in the sun a lot.”
Today Fahland, 72, of Olympia, Wash., regrets having spent her youth basking unprotected in the suns harmful rays. She is one of 250,000 Americans each year who develop a form of skin cancer called squamous cell carcinoma. If caught early, squamous cell carcinoma typically doesnt spread, but if neglected or undiscovered for years, it can spread to other parts of the body, causing significant disfigurement and even death.
Fahlands battle with skin cancer began in 1997 with a cancerous lesion above her eye. Her cancer was removed and treated, and Dorothy underwent annual CT scans for the next four years. It was during her July 2001 scan that a tumor was discovered behind her eye. “Unbeknownst to me the cancer had traveled along the optic nerve,” Dorothy said. “I was told from the beginning I would lose my eye.”
“Most head and neck cancers can easily be removed and treated by a facial plastic surgeon,” Mark Wax, M.D., professor of otolaryngology/head and neck surgery in the Oregon Health & Science University School of Medicine. “But some skin cancers that have recurred after multiple treatments, or that have grown to great size due to neglect require removal of massive amounts of tissue, leaving the patient with a large defect that is difficult to reconstruct with surrounding tissue.”
After being told she would lose her eye, Fahland searched the Internet for a “surgical team that would provide the best chance of survival and the best appearance.” Her efforts led her to Wax and his colleague Peter Andersen, M.D., who proposed she undergo skin cancer free tissue transfer.
“Free tissue transfer has revolutionized the care of the patient with massive skin cancer,” said Wax. “A few years ago, patients with massive skin cancers were left with huge holes and told thats as good as it gets. Now, with this technique, patients are once again able to talk, eat and breathe easier. More importantly, their quality of life is better. Theyre willing to go out and do things with their families.”
Free tissue transfer for skin cancer involves transferring muscle and blood vessels from one part of the body to another to reconstruct damaged or missing tissue. Although free tissue transfer surgery has been around since 1991, only a few surgeons perform this type of reconstruction. OHSU is the only center in Oregon to offer this expertise.
Wax and his colleagues recently published a study showing that patients requiring major removal of head and neck tissue — skin, eye, ear, lip, nose and cheek tissue — experienced significant improvement in function, appearance and quality of life, as well as excellent survival rates following surgery using free tissue transfer.
The researchers reviewed the charts of 43 patients (38 men and five women) who were treated for massive neglected skin cancers of the cheek, ear, forehead, neck, scalp and nose at OHSU, Vanderbilt University or West Virginia University from January 1992 through October 2001. The study was published in the Archives of Facial Plastic Surgery.
According to Wax, principal investigator for the study, the only option previously available to these patients were prostheses. “Facial prosthetics can be excellent, but not all patients have access or can afford the time and expense involved in getting them,” he explained.
Andersen, an associate professor of otolaryngology/head and neck surgery in the OHSU School of Medicine, removed Fahlands eye and surrounding tissue in 2001, and Wax replaced them with muscle and blood vessels from her abdomen. Today she is living an active, cancer-free life.
“I was told I would be left with a good appearance, and Im pleased with the results. Ive adjusted to having one eye very well, although I do have to be careful with steps, stairs and curbs. Six months after the surgery, I passed a driving test with one eye. I remain healthy with good nutrition and exercise and the support of my husband, Frank.”
SQUAMOUS CELL CARCINOMA FACTS
Squamous cell carcinoma is the second most common form of skin cancer. Middle-aged and elderly people who have experienced excessive, chronic sun exposure for many years, and people with white skin, especially those with blonde or red hair, are particularly susceptible, according to the American Academy of Dermatology.
To prevent squamous cell carcinoma, dermatologists recommend wearing suncreen with SPF 15 or higher and a wide-brimmed hat whenever spending time, even briefly, in the sun.
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