“The good news about skin cancer,” says Dr. Laura Briley, of Southern Dermatology & Skin Cancer Center in Raleigh, “is that it is treatable. (see box) Virtually all skin cancers are curable if treated promptly, and even melanoma—the most dangerous—has an over 90 percent cure rate when found early.

“Nonetheless, even when cured, skin cancer leaves scars—physical and emotional—and attention to skin care post-cancer is of special importance. While it’s a survivable disease, many cancer survivors find themselves worried about recurrence, or with skin in need of rejuvenation following surgery that produces scars.”

Rehabilitation: Repairing, Protecting, Rejuvenating

Cancer treatment begins, of course, with the removal of skin cancers. “Complete rehabilitation, however,” says Dr. Briley, “also entails repairing the damaged skin, and taking steps to prevent recurrence.

“Among the foremost concerns of cancer patients—especially when the cancer is on the face—is about what this will mean going forward. They’re scared; they’re worried that every year there will be another cancer; they wonder if they’re going to lose their nose or if the scars will be prominent and permanent.

“Happily, thanks to advanced surgical techniques and the many options we have for treating scars, we are able to repair and restore skin damage and reduce scarring. Mohs surgery is the procedure of choice for cancers located in areas such as the nose, eyelids, lips, or hairline—cases requiring major reconstruction. The Mohs procedure allows us to complete all aspects of the procedure—from removing the tumor and all cancerous cells, to reconstruction—often, in the same session. (see photos)

“Concerns about scars,” says Dr. Briley, “are addressed right at the time of the surgery. Often there are stitches involved, so keeping the area immobilized is of highest priority to ensure a good scar. So, both in the treatment and in patient instructions, we do all we can to minimize the tension on the stitches to avoid a poorly healed scar. Later, there are lasers we can use to lighten the scar, and resurfacing lasers we can use if the scar hasn’t healed appropriately or if there’s excessive scar tissue.

“This is a process and takes time. So, I often need to reassure patients who worry, especially three months out, that this is what their scar will look like permanently, and whether the cancer will recur. I can reassure them that: even though it’s been three months, this isn’t going to be the permanent scar. It’s going to get better and better.”

Preventing Recurrence

“Preventive care of our skin is important for everyone,” observes Dr. Briley. “Sun exposure is the primary reason we develop visible signs of aging of the skin—causing wrinkles, pigmentation issues, degrading the texture, and eroding skin elasticity. And, as a cause of skin cancer, it’s hard to overstate its impact.

“For those who have had skin cancer, prevention is even more important. If you’ve developed a cancer, your risk of another is always going to be higher,” she explains. “It’s not that the treatment of the skin cancer weakened the skin, it’s that you’ve proven that your sun exposure caused one skin cancer; which means it could cause another.”

For this reason, says Dr. Briley, measures to prevent recurrence are an essential part of the rehabilitation process. “Behavioral changes are the cornerstone for preventing the recurrence of skin cancer. In other words: sun protection!

“Also important is to be vigilant about identifying and removing any and all pre-cancers as early as possible. Anyone with a history of skin cancer or pre-cancer needs to schedule routine, full body examinations by a trained provider,” she emphasizes. “For example, actinic keratosis—patches of dry, scaly skin caused by years of sun damage—are pre-cancerous lesions that often go unrecognized by the untrained eye, and are a huge risk factor for the development of squamous cell carcinoma. These are important to find and remove, so the skin can heal and strengthen before cancer develops.”

A number of different treatments are used for precancers. “How aggressive we are,” says Dr. Briley, “depends, in part, on how much damage we see. We might treat a single precancer by lightly freezing it, or—if there’s a lot of damage—we might use more aggressive treatments such as chemotherapy or photodynamic therapy. The goal is to remove the risk of future skin cancers.”

Rejuvenation

“There are so many options today for rejuvenating skin—whether it’s damaged by cancer or just by sun and age,” says Dr. Briley. “With a lot of my patients, I encourage them to use a product such as Tretinoin or Retin A—because we have plenty of clinical trials that have shown that it increases collagen and helps slow down the aging process. These products also work on brown spots and can prevent pre-cancers.

“Beyond that,” she says, “the medical aesthetic procedures at the Skin Renewal Center run the full gamut of non-to-minimally-invasive solutions for skin rejuvenation. These include fillers, chemical peels, microneedling, lasers, and more. The treatments reduce wrinkles, age spots and freckles, skin laxity, unsightly veins, and other signs of aging. They can repair acne and post-traumatic scars, stretch marks, and hyperpigmentation. We work with each patient to identify their goals and to determine the appropriate treatment to meet those goals.”