It seemed like Vera Martin did everything right after her doctor diagnosed her with skin cancer.
She immediately had surgery to remove the cancerous tissue above her left eye and then meticulously cared for her wound until it healed. For the active, bubbly woman in her 50s, having skin cancer was soon a distant memory.
But no one told her to follow up with radiation treatment at the North Carolina facility that treated her. Residual cancer cells grew undetected underneath her skin and the cancer spread for the next year, almost reaching her brain before Vera realized something was wrong.
She knew she needed help when a golf ball-sized lump developed just below her eyebrow. This time she decided to drive 500 miles back to her hometown – Jacksonville – to see Walter Smithwick IV, MD, who specializes in oculoplastic and reconstructive surgery and ophthalmology at UF Health Ophthalmology – Jacksonville.
“He was my lifesaver. He made time to see me the very next day,” Vera said.
After a biopsy of the tissue showed it was squamous cell cancer, Smithwick recommended immediately going to UF Health Jacksonville’s multidisciplinary head and neck tumor board, where the case would be reviewed not just by one person, but by a large group of physicians.
With no time to waste, Vera saw Rui P. Fernandes, MD, chief of head and neck surgical oncology at UF Health Jacksonville, who brought her case before the tumor board the same day he met her. Together with the board, he decided her best option was to “sacrifice” her eye and remove the tumor before it spread any further.
“The cancer had gone into her left eye and was working its way toward her brain. By the time I saw her, it was already in the lining of the brain,” Fernandes said. “It could have taken her life out very quickly.”
Fernandes, a University of Florida associate professor of oral and maxillofacial surgery, is known worldwide for his surgical skills in facial reconstruction. In fact, he was the first oral and maxillofacial surgeon in the United States to be trained to use robotic surgery equipment. But to Vera, he was the man who would save her life and whom she would make a point of hugging every time she saw him from that day forward.
“Rendering a person whole again”
In surgery, Fernandes removed a 5-by-3 centimeter section of Vera’s face that included her eye, the tumor, and the tissue surrounding it. Former UF neurosurgeon Michael Petr, MD, assisted, removing some bone that had been infiltrated by the tumor. Once every remnant of the tumor was removed, Fernandes had to recreate Vera’s eye socket and replace the skin.
“It’s not just our ability to take these things out that is important, but also to be able to render the people whole again,” Fernandes said. “The reconstruction we offer is a lot more technically challenging and sophisticated. It’s offered only a few places in the state, and we’re seen as a leader in the field around the world, actually.”
Fernandes replaced lost bone with titanium plates that would protect Vera’s brain. Then the surgeon, who is program director of the University of Florida College of Medicine – Jacksonville’s microvascular reconstruction fellowship, completed a microvascular resection on Vera’s face. To match the delicate skin of the eye socket, Fernandes took a patch of skin from Vera’s wrist, taking special care to keep arteries and veins in the skin intact. Then he connected them to arteries and veins in the eye socket. It is one of the most advanced surgical options available to rehabilitate patients after tumors are removed from their faces or necks. A microscope is used to suture the vessels together, allowing the tissue to “live” as if it had always belonged in its new location.
Returning to an active lifestyle even during radiation
Once she recovered from her surgery, Vera had to undergo an intensive series of treatments at the University of Florida Proton Therapy Institute. She went to the center for radiation therapy three times a day, five days a week for six weeks.
Proton therapy is a cancer treatment that targets tumors with high accuracy and a lower risk of side effects than traditional radiation. It was ideal for Vera. She also received chemotherapy and spent 10 days in an oxygen chamber designed to rejuvenate the blood capillaries.
The long stint of radiation treatments eventually damaged the delicate skin Fernandes had attached to Vera’s face. The titanium plate underneath the skin began to show through. Fernandes performed a second surgery, using another section of thin skin from Vera’s back to replace the damaged skin and complete another microvascular resection. The skin healed and Vera completed treatment after two months.
Cancer-free at last
Finally cancer-free, Vera’s next step was cosmetic. She traveled to anaplastologist Lisa Skowron in Chicago. The woman designed a prosthetic that includes a lifelike eye, complete with eyelashes, set in what looks like flesh.
Four years later, Vera, 60, still gets hug after hug from nurses and staff when she returns to UF Health Jacksonville for follow-up visits.
“I want other people to know how awesome the staff are. They’re talented, genuine, good people,” Vera said. “They’re just the best of doctors and the best of personalities. If you saw how you could get treated there, you wouldn’t want to go anywhere else.”
Seek help if you suspect you have skin cancer
Fernandes said it is important to immediately have any suspected sign of skin cancer evaluated by a professional.
“People think it’s something you can just freeze or cut out, but in reality it can become quite problematic,” he said.
Signs to look for include spots on your skin that are any of the following:
Rui P. Fernandes, MD, DMD, FACS, FRCS
Associate Chair, Department of Oral and Maxillofacial Surgery; Chief, Division of Head and Neck Surgery; Program Director, Head and Neck Oncologic Surgery and Microvascular Fellowship; Director, UF Center for Reconstructive Surgery; Co-Director, UF Health Skull Base Team