When looking into the treatment of skin cancer many patients go to their "regular doctor." We have been asked at times: "Why would I want to go to a Plastic Surgeon for a skin cancer?" Maybe you are concerned about how the treated area might look later. If not, then by all means go to a dermatologist or your family doctor. If you want treatment without surgery, you should certainly go elsewhere. A plastic surgeon is for surgery.

What might you look like if operated upon by a non-plastic surgeon? Here's an example:

Skin Cancer Removal by a non-plastic surgeon - Not by Dr Di Saia

Plastic surgeons are trained to take into account your post-operative appearance much more carefully than other specialists. This scar would be deemed unacceptable to most plastic surgeons as it has several problems:

• It is Uneven.
• It has "Frankenstein Marks" Cross Hatching from too many external sutures.
• It is a bit Thick at the center.

We see a few problems like these on occasion, but very rarely do we see all of them in one wound. We use sutures underneath the skin to hold tension, so we get much less Cross Hatching. We design our incisions to be more curved and even.

This kind of scarring is that which you often observe after surgery by non-plastic surgeons. These other doctors have as their focus to cure the cancer and there is nothing wrong with that unless you'd like to look better afterward.

Dr Di Saia performs reconstructive as well as cosmetic surgery. As skin cancer is very common (especially in Southern California), it is reasonable to at least mention it briefly here.

Skin cancers vary in severity from the relatively minor Basal Cell Cancer all the way to the potentially fatal Melanoma. There are two main aspects of skin cancer treatment:

• Removal - obviously removal of the skin cancer is advisable as the tendency is for the lesion to grow or spread. Dr Di Saia does remove some skin cancers in the office, but prefers to do complicated cases in the local hospital operating room. The removal of many cancers of the face is becoming more frequently accomplished by first sending the patient to a dermatologist for the excision and then having the patient return for the reconstruction.
• Reconstruction - This is the repair of the defect created by the removal of the cancer. This can involve layered closure, skin grafting or local flaps. Local flaps involve the rearrangement of the nearby skin to allow coverage of the defect with similar tissue. Local flaps are most commonly used on the face, nose and ear and are considered "complicated reconstructive maneuvers" by your insurance company. We cannot guarantee that your insurance company will cover all of the costs of reconstructive surgery. Insurers often try to discount bills severely. Plastic surgeons are not cheap.

Take into account that skin cancer reconstruction is not cosmetic surgery. It is repair after cancer removal. In cancer reconstruction, patients more frequently end up with scarring and distortion than in cosmetic cases. A goal in plastic surgery is to try to minimize this disfigurement. This is why some patients will consider involving a plastic surgeon even if they end up paying more for it. Your dermatologist is more often than not focussed upon cure....as he/she should be.

A Few of Dr Di Saia's Skin Cancer Patients

BEFORE Large Skin Cancer at Temple	Weeks AFTER Removal With Local Flaps
BEFORE Open Wound Nasal Tip After Cancer Excision	AFTER Local Flap Reconstruction

On Medical Insurance

Over the past few years we have learned to be very non-committal on the issue of medical insurance. In the case of skin cancer, it is far more likely than in the cosmetic procedures seen on this site that insurance will "cover" the procedure. Dr Di Saia sees a fair number of skin cancer cases some referred by Dermatologists (large cancers and cancers in sensitive areas (nose, face, ears)). Recently we have seen more patients refer themselves opting for a better appearance after surgery.

Most insurance plans tend to restrict your access to plastic surgeons. At this point, Dr Di Saia takes no HMO plans. We still treat Medicare as well as insurance patients with "Out-of-Network" benefits, however our availability varies quite a bit for this type of work. Please call ahead for availability.