Skin Cancer/Reconstruction & Skin Conditions

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More than just removing a spot

Skin cancer is the most common cancer in the United States, and surgical excision remains the definitive treatment for most types. But the surgery itself and what happens to the wound afterward varies enormously depending on the type of cancer, its size and location, and the surgeon performing the procedure.

Basal Cell Carcinoma (BCC)
The most common skin cancer. Rarely metastasizes but can cause significant local tissue destruction if left untreated or inadequately excised. Surgical excision with clear margins is the standard treatment for most BCCs, particularly those that are large, recurrent, or in anatomically sensitive locations.

Squamous Cell Carcinoma (SCC)
The second most common skin cancer and more aggressive than BCC. SCC carries a meaningful risk of metastasis — particularly in immunocompromised patients, high-risk anatomic locations, or tumors with aggressive histologic features. Excision with adequate margins is critical, and sentinel lymph node biopsy may be indicated for high-risk lesions.

Melanoma
The most serious form of skin cancer due to its propensity for metastasis. Surgical excision with defined margins based on tumor depth is the cornerstone of treatment. Sentinel lymph node biopsy is performed concurrently with wide local excision for most invasive melanomas to assess regional nodal spread — a staging procedure that directly informs prognosis and guides further treatment.

Merkel Cell Carcinoma
A rare but aggressive neuroendocrine skin cancer requiring wide excision and sentinel lymph node evaluation. Management involves close coordination between surgery, radiation oncology, and medical oncology.

Why the surgeon you choose matters for skin cancer

Skin cancer surgery is often perceived as straightforward  remove the lesion, close the wound, done. For small, low-risk tumors in forgiving anatomic locations, that perception is roughly accurate. For everything else, it is not.

A large or poorly located tumor on the face, the nose, the ear, the scalp, the hand requires a surgeon who understands not just how to achieve clear margins, but how to close the resulting defect in a way that preserves function, minimizes scarring, and produces a result the patient can live with. A general surgeon without cosmetic training can remove the cancer. What they leave behind is a different matter.

For melanoma and high-risk SCC, there is an additional dimension: staging. Sentinel lymph node biopsy requires specialized training and adds meaningful prognostic information that shapes the entire subsequent treatment plan. When the surgeon performing your excision cannot also perform your sentinel node biopsy, you face a second operation, second anesthesia, and a gap between your oncologic team members. When they can do both you don't.

General surgical oncology. Cosmetic reconstruction. Sentinel node. One surgeon.

Dr. Palakodeti's dual board certification in general surgery and cosmetic surgery creates a capability that neither a general surgeon nor a dermatologist alone can offer:

Oncologic excision to surgical standards
Board-certified in general surgery with fellowship training and active oncologic practice. Skin cancer excisions are performed to oncologic margins — not cosmetic convenience. Clear margins are the non-negotiable foundation of every case.

Cosmetic reconstruction beyond standard closure
Because Dr. Palakodeti is specifically trained in facial cosmetic surgery, he can offer reconstructive options that general surgeons cannot skin grafts, local flaps, advancement flaps, and layered closure techniques designed not just to close a wound, but to restore natural contour, minimize scar visibility, and preserve the anatomic landmarks that define appearance. This is particularly meaningful for defects on the face, nose, ears, and other aesthetically sensitive areas where standard primary closure is insufficient.

Sentinel lymph node biopsy at the time of excision
For melanoma and high-risk SCC, Dr. Palakodeti performs sentinel lymph node biopsy concurrently with wide local excision and reconstruction all in a single operation. This eliminates the need for a staged procedure, reduces the total number of anesthesia exposures, and ensures that staging information is obtained as efficiently as possible. The patient goes to surgery once and comes out with their cancer excised, their wound reconstructed, and their nodes assessed.

Coordination with Mohs surgery
For tumors where Mohs micrographic surgery is the preferred excision technique — particularly BCCs and SCCs in high-risk anatomic locations where margin control is best achieved layer by layer Dr. Palakodeti works collaboratively with dermatology colleagues. When Mohs surgery produces a complex defect requiring advanced reconstruction, he is available as the reconstructive surgeon to close the wound with the same cosmetic rigor applied to his own excision cases. This is a particularly valuable coordination pathway for dermatologists managing complex facial skin cancers.

A Note on Ear Reconstruction — A Special Surgical Interest

The ear is one of the most technically demanding areas of the body to reconstruct. Its complex three-dimensional cartilage framework, thin overlying skin, and high aesthetic visibility mean that defects from skin cancer excision, trauma, or structural deformity require a surgeon with specific technical experience not just general reconstructive capability.

Dr. Palakodeti has a particular surgical interest in ear reconstruction and regularly manages cases that other surgeons decline or refer away, including:

Skin Cancer of the Ear
The ear is a common site for BCC, SCC, and melanoma — and a particularly challenging one to reconstruct following excision. Depending on the size and location of the defect, reconstruction may involve local flaps, cartilage grafting, or composite tissue techniques to restore the ear's natural contour. Dr. Palakodeti performs these reconstructions with the cosmetic precision that the anatomy demands.

Gauge Piercing Repair
Stretched or gauged earlobes whether from intentional gauging or traumatic tearing can be surgically restored. Gauge repair involves removing the stretched or scarred tissue and carefully reconstructing the earlobe to restore a natural appearance. Patients considering the procedure should understand that the result depends on the degree of stretching and the quality of the remaining tissue — outcomes are discussed honestly at the consultation. Re-piercing, if desired, is typically possible after full healing.

Cartilage Deformity & Structural Ear Issues
Cartilage irregularities, post-traumatic deformity, constricted ear deformities, and other structural issues affecting ear shape and projection are within Dr. Palakodeti's reconstructive scope. Each case is evaluated individually, and the surgical plan is tailored to the specific anatomic problem.

A Note on Cauliflower Ear
Cauliflower ear the thickened, irregular deformity of the outer ear caused by repeated trauma, hematoma, and subsequent cartilage changes is a condition Dr. Palakodeti is experienced in evaluating. It is important to be direct: established cauliflower ear is one of the most surgically challenging ear deformities to meaningfully correct. The fibrotic, irregular cartilage that characterizes the condition does not respond predictably to surgical intervention, and results are variable even in experienced hands. Acute auricular hematoma (a fresh collection of blood following trauma) can be drained promptly to prevent cauliflower ear from developing, and this is strongly encouraged. For patients with established deformity seeking surgical evaluation, Dr. Palakodeti provides an honest assessment of what is realistically achievable before any commitment to surgery is made.

Who this practice serves for skin cancer

• Patients with a new diagnosis of melanoma, SCC, BCC, or Merkel cell carcinoma requiring surgical excision
• Patients with melanoma requiring wide local excision and sentinel lymph node biopsy who want both performed in a single operation
• Patients with skin cancer in aesthetically sensitive locations (face, nose, ear, scalp, neck, hands) where reconstruction requires more than primary closure
• Patients referred from dermatology following Mohs surgery with complex defects requiring advanced reconstruction
• Patients with recurrent skin cancer following prior excision
• Patients seeking a second opinion on surgical approach or reconstructive options

The consultation
Your consultation covers the diagnosis, the excision plan, the margin strategy, and the reconstructive approach — all in one appointment. For melanoma cases, the sentinel node protocol is discussed at the same visit. You will leave understanding exactly what the surgery involves, what the reconstruction will look like, and what to expect during recovery.

The operation
Most skin cancer excisions and reconstructions are performed as outpatient procedures under local anesthesia with or without sedation, depending on the complexity of the case. For melanoma requiring sentinel node biopsy, general anesthesia or monitored sedation is typically used. Most patients go home the same day.

Wound care and recovery
Recovery depends on the size and location of the excision and the type of reconstruction performed. Most patients resume normal activity within one to two weeks. Specific wound care instructions — dressing changes, activity restrictions, sun protection — are reviewed at discharge and at your first post-operative visit.

Pathology
Final margin and pathology results return within five to seven business days. For melanoma, sentinel node pathology may take slightly longer. Dr. Palakodeti reviews all results with you directly and coordinates any next steps — whether that is radiation oncology referral, medical oncology consultation, or surveillance imaging — with your broader care team.

Beyond Skin Cancer

Not every skin condition that requires surgical care is a cancer. Two of the most undertreated and underserved conditions in dermatologic and general surgical practice hidradenitis suppurativa and pilonidal disease cause significant, chronic suffering for the patients who have them, and are frequently managed inadequately because the patients who have them don't know that definitive surgical treatment exists.

Dr. Palakodeti treats both conditions, in coordination with dermatology, across both the acute and chronic phases of disease.

Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition affecting the hair follicles in areas where skin contacts skin: the axillae, groin, inner thighs, and under the breasts. It produces painful nodules, abscesses, and tunneling tracts that drain chronically, recur repeatedly, and significantly affect quality of life. It is frequently misdiagnosed, undertreated, and stigmatized patients often live with it for years before receiving an accurate diagnosis and appropriate care. 

Surgical management of hidradenitis is stage-dependent and works best in coordination with dermatology, which manages the inflammatory and medical dimensions of the disease.

In the acute setting: painful abscesses require prompt drainage to relieve pressure and infection. Dr. Palakodeti performs abscess drainage for acute HS flares providing immediate relief when medical management alone is insufficient.

In the chronic setting: for patients with recurrent disease in a defined anatomic region, wide local excision of the affected tissue removing the involved skin and subcutaneous tissue down to healthy margins offers the best chance at long-term disease control in that area. Where the resulting defect requires closure beyond primary approximation, rotational flap reconstruction is performed to close the wound with well-vascularized local tissue. This eliminates the diseased tissue and reduces in many cases dramatically the cycle of recurrence that characterizes inadequately treated chronic HS.

Pilonidal Disease

Pilonidal disease affects the sacrococcygeal region — the cleft at the top of the buttocks — and produces cysts, abscesses, and chronic sinus tracts that are painful, recurrent, and significantly disruptive to daily life. It disproportionately affects younger patients and is a condition that many patients suffer with in silence because of embarrassment, or because they have been told that recurrence is simply inevitable.

It is not inevitable. Definitive surgical management exists.

In the acute setting: pilonidal abscesses require incision and drainage to relieve the acute infection. Dr. Palakodeti performs acute pilonidal drainage when patients present with an acute flare requiring prompt intervention.

In the chronic setting: for patients with recurrent pilonidal disease — those who have been drained repeatedly, who have chronic sinus tracts, or whose disease has returned after prior excision — wide excision of the diseased tissue with rotational flap reconstruction offers the most durable long-term solution. Rotational flap closure which brings healthy, well-vascularized tissue from the adjacent area to fill the surgical defect and flatten the natal cleft significantly reduces the recurrence risk compared to primary closure or healing by secondary intention, which are associated with high recurrence rates.

The goal of surgical management for chronic pilonidal disease is not another temporary fix. It is definitive treatment that allows patients to stop cycling through abscess, drainage, and recurrence and move on.

Coordination with Dermatology

Both hidradenitis suppurativa and pilonidal disease are best managed through a coordinated approach between dermatology and surgery. Dermatology manages the inflammatory, medical, and ongoing surveillance components of care including biologic therapy for HS patients who are candidates. Surgery addresses the anatomic disease burden that medical management alone cannot resolve.

Dr. Palakodeti welcomes referrals from dermatology for both conditions and works directly with referring dermatologists to coordinate the surgical component of care within the broader treatment plan.

If you are living with either of these conditions

If you have hidradenitis or pilonidal disease and have been told that recurrence is something you simply have to manage or if you are cycling through acute flares without a long-term plan a surgical consultation is worth having. Definitive treatment exists. It is not always the right answer for every patient at every stage of disease, but it is a conversation that should happen before another recurrence does.