Skin Cancer Surgery in Sydney, Penrith and Orange

Skin cancer surgery removes the cancer and then rebuilds what has been taken away. Dr Rohit Kumar is an Australian-trained specialist plastic surgeon (FRACS) who performs excision and reconstruction for skin cancers of the face, scalp, trunk and limbs, with consultations in Sydney, Penrith and Orange.

• Why a plastic surgeon
• What is treated
• The operation
• Recovery
• Scars
• Risks
• Cost and Medicare
• Where
• Questions

Why see a plastic surgeon for skin cancer

Many skin cancers are straightforward and are well managed by a GP or skin cancer doctor. Referral to a plastic surgeon is usually about the reconstruction rather than the removal: what happens to the defect once the cancer is out.

That matters most where skin is tight, mobile or visible — the nose, eyelid, ear, lip and scalp — where a simple closure can distort a feature, and where a flap or graft designed around the local anatomy gives a better structural and cosmetic result. It also matters for large lesions, recurrent lesions, and lesions over bone or cartilage.

Dr Kumar is a Fellow of the Royal Australasian College of Surgeons with specialist registration in surgery (plastic surgery). Reconstruction after tumour removal is core plastic surgical training.

What Dr Kumar treats

Non-melanoma skin cancer

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common skin cancers in Australia. Both are usually treated by excision with a margin, confirmed on pathology.

Melanoma

Melanoma is managed according to the depth of the lesion on the initial biopsy, which determines the width of the excision margin and whether further investigation is appropriate. Management is coordinated with your GP, dermatologist and, where indicated, a melanoma unit.

Other lesions

Moles, cysts, lipomas and other benign skin and soft-tissue lesions can be removed at the same time or on their own, particularly where the site is cosmetically sensitive.

How the surgery works

Excision

The lesion is marked with a margin of normal-looking skin around it. The margin depends on the type of cancer and, for melanoma, on its depth. The specimen goes to pathology, and the report confirms both the diagnosis and whether the margins are clear.

Closing the defect

There are three broad options, chosen for the site rather than for speed.

Direct closure

The edges are brought together in layers. Suitable where there is enough loose skin and where the line of closure can be hidden in a natural crease or skin tension line.

Skin graft

Skin is taken from another site — commonly in front of or behind the ear, the collarbone area, or the thigh — and laid into the defect. Grafts are useful where there is not enough local tissue, but the colour and texture match is rarely perfect.

Local flap

Adjacent skin, with its own blood supply, is moved into the defect. Flaps generally give the best colour and contour match on the face, at the cost of a longer, more geometric scar line that is planned to follow natural creases.

If the margins are not clear

Pathology occasionally shows cancer extending to the edge of the specimen. Where that happens, a further excision is planned. This is a recognised part of skin cancer treatment rather than a complication, and it is discussed before surgery so it is not a surprise.

Recovery

When	What to expect
Day 0	Dressing applied. Most patients go home the same day. Keep the area dry.
Days 1–3	Swelling and bruising, most noticeable around the eyes if the lesion is on the face. Simple analgesia is usually enough.
Days 5–7	Facial sutures removed. Graft dressings reviewed.
Days 10–14	Sutures removed from trunk and limbs. Pathology results discussed.
Weeks 2–6	Scar is pink and firm. Sun protection and scar care begin.
3–12 months	Scar settles and fades. Ongoing skin checks continue with your GP or dermatologist.

Time off work depends on the site and your occupation. Most people with a small excision return within a few days; facial flaps and grafts usually warrant a week.

Scars

Every excision leaves a scar. The aim of reconstruction is to place and orient that scar where it is least conspicuous, not to avoid it. Scars are at their most obvious between six weeks and three months and continue to improve for a year or more. Sun protection over a healing scar makes a material difference.

Where an older scar has healed poorly, scar revision surgery can sometimes improve it once it has fully matured.

Risks

All surgery carries risk. For skin cancer excision and reconstruction these include bleeding, bruising, infection, wound breakdown, partial or complete graft or flap loss, altered or reduced sensation around the scar, visible or thickened scarring, distortion of a nearby feature such as the eyelid or lip, incomplete excision requiring further surgery, recurrence of the cancer, and risks related to anaesthesia.

Dr Kumar discusses the risks relevant to your lesion and the proposed reconstruction at consultation. Read more about the risks of surgery here.

Cost and Medicare

Excision of a skin cancer and the reconstruction that follows are recognised medical procedures. Where the clinical criteria are met, Medicare item numbers apply to the excision, to any flap or graft, and to the pathology. A current referral from your GP or dermatologist is required, and is also what allows you to claim the Medicare rebate on your consultation.

Out-of-pocket costs depend on the site, the size of the lesion, the type of reconstruction, the anaesthetic and the facility. Private health insurance may cover part of the hospital and theatre costs where an admission is required. You are given a written estimate before booking.

Costs and payment  |  Medicare rebates and plastic surgery

Where Dr Kumar consults and operates

Consultations are available at Westmead, Penrith and Orange. Day-case skin surgery is performed at Somerset Private Hospital in Kingswood, and larger or more complex reconstructions at Westmead Private Hospital.

For patients in the Central West, this means the consultation, the planning and the follow-up can happen in Orange, with the procedure itself scheduled at one of the two hospitals.

Common questions