‘Let’s Take Care Of This’

Skin cancer procedure discovers larger tumor than expected, requires repair by specialist.

For his 70th birthday last year, Kenneth Wells received the thrill of his life – a ride across the sky in a P-51 Mustang, the long-range single-seat fighter plane that helped the United States win control of the skies during World War II.

“It was a gift from my kids, and I could not have been more thrilled,’’ Kenneth says of his flight. “I’ve always been fascinated by World War II planes. I love them. I used to tell my kids,

‘It’s one of the best flyers ever made.

“And that flight was everything I hoped it would be. We did all the air show loops and dives and everything. That’s something I brag about, because I used to be in the Air Force, but I was in munitions and weapons. I never got a chance to fly in a plane like that.”

Kenneth’s tour of military duty preceded a 28-year career as a manager, salesman and dispatcher for a concrete company and a relatively successful stint as an amateur 15K distance runner that fed his insatiable desire to be outside as much as possible.

“I never stay in the house,’’ Kenneth says. “I’m always out doing something, whether it’s biking, fishing. I surfed a lot when I was younger and for some reason I’ve always wanted to be out in the sun.”

Unfortunately for Kenneth, that desire to be outdoors has come with consequences.

Last November, during a routine trip to his dermatologist, Kenneth learned of a skin cancer growing between his right cheek and lower right eye lid. The surgery Kenneth had to remove the cancer was anything but routine.

Performed in February, the surgical procedure is called . It’s a process during which microscopic layers of cancerous skin tissue are repeatedly removed and examined until the tissue removed no longer contains cancerous cells.

Kenneth’s surgery was scheduled for 8 a.m. He rode his bike to the dermatologist’s office, thinking the surgery wouldn’t take long and he could take a bike ride afterward. That never happened. The surgery took six hours and could not be completed by the dermatologist.

“She told me that closing the wound was beyond her expertise, and this is a very good dermatologist I’m talking about here,’’ Kenneth says. “She told me I needed to see a plastic surgeon and recommended I go see this gentleman, Dr. Blandford. So I went to see Dr. Blandford, who doesn’t know me from Adam. It was 4 o’clock in the afternoon on a Thursday by the time I got there, but they took me right in, which was incredible.”

Day Turns Into Night

Alexander D. Blandford, MD, is a board-certified oculofacial plastic surgeon with the Center for Advanced Eye Care in Vero Beach, where he specializes in cosmetic and reconstructive surgery around the eyes and face.

In addition to performing upper eyelid (eyelid lift), lower eyelid (lower bag removal) surgery and brow lifts, Dr. Blandford also specializes in skin cancer removal/reconstruction, orbital surgery and tear drainage system surgery.

“When Mr. Wells presented to our practice it was at the end of the day and he was obviously anxious about the next step. Although he was new to our practice, I was able to add him on for same-day reconstructive surgery.’’ Dr. Blandford says.

“What immediately came to mind for me was the situation he was in. First of all, it’s very anxiety-provoking to have skin cancer on your face. But then, to have the cancer removed and have that be more involved than you thought makes it even harder.

“On top of that, to learn that day that you would need to meet a different doctor for reconstructive surgery after the skin cancer removal, well, I just put myself in his position and thought, What would I want someone to do? So, we got the staff together and said, Let’s take care of this today.

Dr. Blandford’s decision prompted his staff to make a sudden flurry of phone calls home saying they’d be working late, which they did. It wasn’t until 9 p.m. that they completed Kenneth’s reconstruction. Because of the nature of the defect, however, Dr. Blandford believed it was necessary to do that reconstruction immediately.

“The Mohs surgery had taken most of the skin on Mr. Wells’ right lower eyelid, a significant portion of the skin on the right side of his nose and a large portion of his cheek,” Dr. Blandford reports.

“Mr. Wells certainly wasn’t expecting the skin cancer removal to be that involved, but that is why it is important to ensure all the skin cancer is removed with techniques such as those used by his dermatologist.

“Although rare, the extent of a skin cancer can sometimes surprise the dermatologic surgeon performing the removal, but the first step is still getting cancer free with clear margins.

“And while it’s not unusual for me to see someone the day after Mohs surgery or even that same day, Mr. Wells’ presentation was a surprise for both of us. Thankfully he came on a day when I was already in the OR, so we all pulled together to get the job done.”

That job required Dr. Blandford to reconstruct Kenneth’s lower right eyelid, most of his right cheek down to his upper lip and the right side of his nose. As a result, it was a complex defect requiring specialized reconstruction.

“Repairing a defect of that size required a large rotational flap to repair the eyelid and cheek components of the defect and then a skin graft to repair the nose defect. I began by making an incision that is similar to a traditional face-lift incision that went down along the lateral aspect of the defect in front of his hairline and ear, and then back behind the ear.

“I then elevated all of his remaining cheek tissue and a lot of his neck tissue to fill in the defect in the cheek and lower eyelid area. That left us with the residual defect that was on his nose, which we repaired with a skin graft.

“The graft came from his arm, which was intentional because in reconstruction of the face it’s important to respect the different aesthetic regions of the face. So a big cheek flap shouldn’t go all the way on to the side of the nose. It should only go to where the nose and cheek meet, so the flap stopped at that point.
“The nose was then looked at as a separate subunit of the defect that was repaired independently to have the best cosmetic and functional outcome.”

Speedy Recovery

To ensure an optimal outcome, the flap that covered the cheek and lower eyelid was supported by the cheekbone. That support not only ensures the skin covering the lower eyelid does not get pulled down, it also allows for normal function of the eyelid.

Kenneth says friends and family
members can’t even tell he had surgery.

In addition, Dr. Blandford made his other incisions in the junction between the nose and cheek and in the junction of the eyelid. That ensures that the incision is less noticeable following the healing process, which went remarkably fast, according to Kenneth.

“I had the surgery on a Thursday, went back to see Dr. Blandford to have the bandages taken off the following Wednesday, then went back to work the following Sunday,’’ says Kenneth, who now works part time as a security guard to stay busy.q

“By the time I went back to work, which was 10 days after the surgery, nobody could tell I’d had anything done. And a lot of my clients are doctors. They couldn’t believe it. They all said Dr. Blandford did a marvelous job.”

Dr. Blandford refuses to take all the praise. He gives a great deal of credit to his staff for sticking around and putting in an extra-long day to ensure Kenneth’s outcome was the best it could be.

“I definitely have to applaud the nursing team, the technicians and the anesthesia provider for all they did to keep the patient as comfortable as possible and for making his experience as pleasant or reasonable as possible,” he says. “They did an exceptional job.”

So exceptional that Kenneth says he will refer Dr. Blandford to anyone who needs reconstructive surgery. Unfortunately, he fears he may need to have such a surgery again himself on the left side of his face.

“We’ll see what that is, but I already told my dermatologist to send the results of whatever it may be to Dr. Blandford,’’ Kenneth says. “He’s incredible and so extremely nice. And the same goes for his staff.

“Like I said, I had no idea what I was in for when I first went to see him. And to then learn that so much had to be done and that he took that on right away, it’s amazing.

Dr. Blandford said right from the start, You’re going to be happy when this is all done, and I definitely am.”

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