Northern New Jersey Plastic Surgery – Skin Cancer Treatment
At the Parker Center in Paramus, New Jersey
Our Approach in Treating Skin Cancer and Tumors at the Parker Center
Scheduling a Consultation
Patients wishing to see Dr. Parker for an in office consultation may schedule an appointment by calling our office between 9 AM and 5 PM. Or, if more convenient, by filling out our online contact form. Our front office staff makes every effort to schedule these appointments in a timely manner.
Initial Consultation
A careful history and physical examination are performed by Dr. Parker on all patients presenting with skin lesions.
Benign lesions
If the lesion clearly appears to be benign, based on this evaluation, observation is usually recommended. If the patient and/ or family are bothered by the appearance of the lesion, Dr. Parker provides a detailed discussion about removal options. Consideration may be given to shave removal by a dermatologist, and if elected, an appropriate referral made.
Surgical excision by Dr. Parker and careful soft tissue repair are discussed as well. An anatomic diagram is drawn for the patient, demonstrating how the lesion is to be completely removed. In addition, diagrams are used to demonstrate the use of cosmetic surgical techniques employed by Dr. Parker in his cosmetic surgeries to try to make the resultant scarring as inconspicuous as possible.
Precancerous lesions
Lesions suspicious for being pre-cancerous or cancerous are treated with a full-thickness skin biopsy, either incisional or excisional, as discussed by Dr. Parker with the patient.
Precancerous lesions are referred to a dermatologist if topical treatment is appropriate. If not, surgical excision by Dr. Parker and careful soft tissue repair are discussed. An anatomic diagram is drawn for the patient demonstrating a more aggressive surgical removal than for benign lesions. In addition, diagrams are used to demonstrate the use of cosmetic surgical techniques employed by Dr. Parker in his cosmetic surgeries to try to make the resultant scarring as inconspicuous as possible.
All of these lesions are reviewed by a pathologist to verify the histology of the lesion and for the completeness of removal.
Malignant lesions
Lesions suspicious for being cancerous are treated with a full-thickness skin biopsy, either incisional or excisional, as discussed by Dr. Parker with the patient. Once the diagnosis is known, options for treatment are discussed with the patient.
Moh’s surgery
Moh’s micrographic surgery is performed by a specially trained dermatologist under local anesthesia. The treatment involves the progressive excision of the cancer using serial frozen section analysis and precise mapping of the excised tissue until no evidence of remaining tumor exists. Moh’s surgery is recommended by Dr. Parker in the following circumstances: for difficult and high-risk basal and squamous cell carcinomas including tumors greater than 2 cm in diameter, located in areas where deep invasion is more likely, rapidly-growing, recurrent or ill-defined tumors, and those located in an area of previous radiation or where perineural invasion is likely.
Coordinated reconstruction of the patient undergoing Moh’s surgery is performed by Dr. Parker later that same day or the following day. The resultant size and extent of the soft tissue defect determines the type of reconstruction to be done. Some defects are best repaired with a skin graft (skin removed and transferred from a distant area); others are better suited for a skin flap (the sliding of adjacent skin into the defect). In either case, Dr. Parker utilizes techniques borrowed from his cosmetic surgeries to make the resultant scarring as inconspicuous as possible.
Surgical excision with frozen section margin control (non-melanomas)
Patients who do not need Moh’s surgery for their basal or squamous cell skin cancers are treated entirely by Dr. Parker. He surgically excises the skin cancer with an appropriate margin of skin. With the patient still on the operating table, a pathologist microscopically evaluates the removed tissue to be sure all peripheral and deep margins are free of tumor. In the great majority of patients, the margins are negative for residual tumor. Occasionally, the pathologist asks Dr. Parker to remove more tissue from a certain area. Once the tumor has been completely excised, the soft tissue defect is repaired.
The resultant size and extent of the soft tissue defect determines the type of reconstruction to be done. Some defects are best repaired with a skin graft (skin removed and transferred from a distant area); others are better suited for a skin flap (the sliding of adjacent skin into the defect). In either case, Dr. Parker utilizes techniques borrowed from his cosmetic surgeries to make the resultant scarring as inconspicuous as possible.
Surgical excision of malignant melanomas
Based on the Breslow thickness (in mm) of the biopsied melanoma, the appropriate surgical excision will be performed. The following peripheral surgical margins are obtained: in situ: 0.5 cm margin, less than 1 mm: 1 cm margin, 1-4mm: 2 cm margin, greater than 4 mm: 2-3 cm margin. The depth of excision extends completely through the skin and subcutaneous layer to the underlying fascia. For tumors greater than 1 mm thick and with non-palpable lymph nodes, sentinel lymph node biopsies are discussed.
The resultant size and extent of the soft tissue defect determines the type of reconstruction to be done. Some defects are best repaired with a skin graft (skin removed and transferred from a distant area); others are better suited for a skin flap (the sliding of adjacent skin into the defect). In either case, Dr. Parker utilizes techniques borrowed from his cosmetic surgeries to make the resultant scarring as inconspicuous as possible.
Scheduling Surgery
If after reviewing options for treatment, Dr. Parker recommends surgery, arrangements will be made by our staff to schedule the procedure in a timely manner.
All surgeries performed by Dr. Parker are done so in Surgiplex, our on-site fully certified ambulatory surgical facility. Patient safety is of the utmost importance to Dr. Parker and our staff. Many procedures can be performed under local anesthesia. Our team of board-certified anesthesiologists is available to provide general anesthesia or conscious sedation if requested by Dr. Parker and/or the patient.
Our Surgical Coordinator will obtain pre-certification of the proposed surgical procedure with your insurance carrier prior to your date of surgery. She will communicate the details of the process to you ahead of time in order to make sure everything goes smoothly.
Dr. Parker will communicate with your referring doctor and/or dermatologist by a customized “referral letter”, with a telephone call if necessary. He will also be sure that they receive a copy of your pathology report for your files in the office.
Following surgery, our highly trained nursing staff will review written postoperative instructions with you in detail. They will call you the next day to check on you and answer any questions you might have.
Our goal at the Parker Center for Plastic Surgery is to deliver the highest level of service to you before and after your procedure.
