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Skin Cancer Removal on the Ear by Dr. Nikko

One of the many benefits of having your dermatologist double as a cosmetic surgeon is the beautiful results patients see after an excision as shown. Here Dr. Nikko performs an excision of skin cancer on his patients ear, and explains the importance of careful cosmetic care so he is not left with a noticeable imperfection.

Transcription

Dr. Nikko:          Hey, everyone. Today, we're going to show how we remove skin cancer on top of the ear and put it back together. Okay.

Dr. Nikko:          This gentleman has a ... Sorry, forgot the gauze ... Has a squamous cell carcinoma, and it happens to be in a bad spot on top of the ear. It's already been removed with margins, so this is what we have. As you can see, it looked like he got a little dog bite on the top of the ear, so obviously we can't ... Then there's cartilage exposed so, obviously, we have to do something to make it look good and then to put it back together nicely. That's what we're going to do next, all right?

Dr. Nikko:          All right, so the first thing we're going to do is we have to excise, and now we got to put it back together. We have to excise a little wedge from the ear. Okay, and ... Okay. There we go. There you go. The reason why we have to do this is that's the only way we're going to get it together nicely, without any defect. Okay. All right. And then, so you can see there's cartilage right there. Take that for me, and now we're going to use a little cautery for a couple of small blood vessels. Okay.

Speaker 2:          You doing okay?

Dr. Nikko:          Just fine. Yeah, we usually basically use local anesthetic. The patient is comfortable. He's actually daydreaming, he said. So, all right. Okay. So, now we're gonna put it together nicely so it'll look like ... Comes together nicely. I'm gonna put what's called subcutaneous sutures and this will go underneath the ear. And these are dissolvable sutures. Takes about three months to dissolve and that's what's gonna hold it together for the next several months.

Dr. Nikko:          The idea is to get the ear to come closely together so that way he doesn't have that little notch on the ear, that you can tell ... And although we took a slice from his ear, after it's all said and done, it's still very difficult to notice a difference in size from one ear to another. Gauze. You can see you have it back together nicely, so now we gotta put the skin together. I do the front first. Blot that for me. Doing all right? Hold this for me while I do this and just tilt this back for me. There we go. So, the important part is to align the rim of the ear perfectly so that way there's no notching, and that's the part that you can see the most.

Dr. Nikko:          And you see we're lining the rim of the ear just ... perfectly. Just like that. All right. Back this way. Dry gauze. Okay. Probably be good to ... We'll put patient on some prophylactic antibiotics to make sure we don't have an infection. Scissors. Since the cartilage is exposed, we're gonna give him some antibiotics just to minimize the chance of getting an infection. He's gonna take Tylenol for pain, and if he has any more pain than that then the patient will call us and we may call in a little bit more. The ear can be a little bit more tender than other areas. We do pin back the ear, so for people with prominent ears, they tend to have discomfort for a couple weeks. So he's probably gonna be taking Tylenol for about a week.

Dr. Nikko:          Okay. Hold this for me. We are gonna clean this up, show everybody. Just gonna clean it up with hydrogen peroxide. Dry gauze. Thank you.

Speaker 2:          I don't need to send the wedge off, right?

Dr. Nikko:          Huh?

Speaker 2:          The wedge?

Dr. Nikko:          No. So, as you can see ... Once the swelling goes down, from the lidocaine, as you can see, the patient will have his normal ear anatomy back, and when that becomes faint, that scar becomes faint, can't really tell anything's been done. And you had a large squamous cell, so it should look good.