Skin Cancer Removal

Dr. Casso often sees patients who are diagnosed with skin cancer (basal cell carcinoma, squamous cell carcinoma, and melanoma).

Generally, patients with a suspicious lesion are seen by their dermatologist, who performs a biopsy. If the biopsy shows a skin cancer, the dermatologist may refer the patient to Dr. Casso for removal of the skin cancer and reconstruction of the resulting defect, or the patient may self-refer.

Dr. Casso sees the patient in consultation and examines the patient, and discusses the pathology report relating to the recent biopsy, if available. Dr. Casso then makes a recommendation regarding removal of the skin cancer, and about reconstructive options.

The patient then returns on the day selected for the procedure. A light sedative may be prescribed, if desired, in which case the patient is driven to the office and back home by a friend or relative.

Dr. Casso again discusses the procedure with the patient. Local anesthetic is injected into the area of the tumor. After assuring anesthesia, the body area is prepped with a topical antiseptic, and draped in a sterile fashion. The tumor is surgically removed and often sent immediately to the pathology department at nearby Houston Methodist St. John Hospital, where a frozen section is performed, allowing a pathologist assessment confirming the diagnosis, and commenting on the adequacy of tissue margins around the tumor. If there is tumor found at a surgical margin, additional tissue is removed for clearance of the tumor.

Most wounds are closed directly with sutures. Some wounds, however, require creation of a local flap, or application of a full thickness skin graft, which is often performed at the same procedure in the office.

On rare occasions, reconstruction of the defect is deferred to a later date in the operating room under general anesthesia.

In some cases, patients see a Mohs surgeon for treatment of their skin cancer. If the patient or Mohs surgeon seek Dr. Casso for reconstruction, the patient is seen by Dr. Casso before the tumor is removed, and recommendations are made to the patient and surgical options discussed. The final determination awaits the actual tumor removal and the size of the defect which results. The patient, Dr. Casso, and the Mohs surgeon then coordinate to select a day to do the procedures.

The patient is then seen by Dr. Casso after the tumor has been removed, and the reconstruction is typically performed in the office under local anesthesia.

Patients and family are given post-operative instructions regarding wound care. Pain medication is prescribed, if desired. The patient is typically seen again 4-7 days later for suture removal.

These procedures are typically covered by health insurance.

Prior to the surgery, patients are apprised of out-of-pocket expenses they may expect relating to the surgical component of the procedure.

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