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James Thornton, M.D. Answers Questions On Skin Cancer

James Thornton, M.D. Answers Questions On: Skin Cancer

How do plastic surgeons and dermatologists work together after someone is diagnosed with melanoma or another form of skin cancer?

Typically, plastic surgeons and dermatologists don’t work together. The patient will see a dermatologist specializing in Mohs surgery to remove the lesion and then have to find their own plastic surgeon to close the skin cancer wound.

However, at UT Southwestern our integrated approach to care benefits the patient. I work closely with the dermatologist in planning the reconstruction and ensuring a smooth day for the patient in our single-day resection and reconstruction.

So patients can receive same-day reconstructive surgery? Why is this beneficial?

The majority of our patients are able to receive same-day reconstruction. This minimizes the inconvenience to the patient, and they’re able to return home with a reconstruction on the same day as their resection.

What are specific issues that patients need to be aware of when being treated for skin cancer – after Mohs surgery?

The single biggest recommendation is to identify a plastic surgeon with a tremendous amount of experience in Mohs reconstruction. This offers the best possible results for the patient.

What types of closure techniques do you use for skin cancer patients? What are the unique surgical techniques you offer related to these?

Our closure techniques are based on the size and location of the defect. I tend to use the simplest techniques possible. Many of the patients I treat after Mohs surgery require simple wound closures. However, we have the full availability of both skin grafts and flaps if the defect requires it. Whatever the severity of the reconstruction, we have the expertise to treat any size closure.

Is it more difficult to work with someone who has been diagnosed with cancer on their face or body?

From the shoulders down, the body is much more forgiving and has more laxity in noncritical areas. We’re able to close these wounds much easier than facial defects. We tend to work with smaller flaps on the neck and face when performing reconstruction after skin cancer.

What types of surgical treatment for skin cancer typically leave a significant permanent scar and/or some sort of disfigurement?

Even though our goal from the beginning is to “return the patient to normal,” all surgery leaves some sort of scar. Our job as plastic surgeons is to minimize the scar deformity.

Why is nutrition such an important part of wound healing? Do you offer specific guidance to patients about how to enhance their healing process?

Nutrition is just one segment of overall wellness. Often, we will provide specific counseling on health and wellness if needed to optimize a patient’s wound healing. Personally, I have a great interest in nutrition and overall fitness and will apply some of these concepts to patient care if needed.

Do you treat patients who have had skin cancer reconstruction and are unhappy with their results?

Yes. This type of reconstruction is complicated, and I’ve consulted plenty of people who aren't happy with their results, or the repair is insufficient. As a plastic and reconstructive surgeon specializing in soft tissue facial reconstruction for the past 20 years, I have the expertise to perform secondary reconstruction or revisions for these patients to provide desired results.

What are some of the latest advancements regarding reconstruction and Mohs surgery to treat skin cancer?

From a surgical standpoint, there have been continued refinements of nasal reconstruction, and many of these refinements have been pioneered here at UT Southwestern. Few people in the country specialize in nasal reconstruction, and our team of doctors has become experts and leaders in this procedure.