What is Skin Cancer Reconstruction?

Skin cancer is one of the most common types of cancer affecting humans. This is especially common on the face, head, and neck because of exposure to the sun. Aside from skin type, sun exposure is the greatest risk factor for skin cancer. The primary treatment for skin cancer is surgery. This can be especially traveling for a person given the cosmetic changes that occur with facial surgery.

Dr. David Chan at Century Ear, Nose, and Throat specializes in the reconstruction of facial defects caused by skin cancer removal.

The 3 most common types of skin cancers are:

• Squamous cell carcinoma
• Basal cell carcinoma
• Melanoma

Depending on the cancer type, the margin of removal could be very large and may also require removal of lymph nodes at risk for cancer.  Depending on the location of the tumor, Dr. David Chan may partner with a dermatologist to remove the tumor using a technique called “Mohs” micrographic surgery to minimize removal of normal tissue.

Goals of Reconstruction

The primary goal of reconstructive surgery is to return a patient to as close to normal form and function. As you can imagine, any changes to the face may have an impact on a patient’s identity. This stress is compounded by a new cancer diagnosis.

As no skin cancer surgery can be performed without a scar, it is crucial to place the scars in areas that are less detectable and use facial plastics techniques to close wounds that minimize the visibility of a scar.

This will optimize appearance and minimize the impact on a patient’s health.

Technique

Primary Closure

This refers to closing a wound using an end-to-end closure. The open ends are matched to minimize scars and heaped-up tissues are removed to minimize the visibility of the scar. There is a minimal rearrangement of tissue.

Skin Graft 

This is moving skin from another location, such as behind the ear or neck, and bringing it to the face. This is a quick and easy procedure but has some disadvantages relating to the skin match, texture, and thickness of the skin. Also, skin grafts do not heal 100% of the time, so it may take a long time for complete healing. It’s a good technique in the right situation.

Local Flap Reconstruction

This is the most common type of reconstruction for facial skin cancer defects. Tissue adjacent to the defect is used to close the wound. There are many different types and designs of local flaps, but they all require extending an incision near the defect and moving skin from a neighboring location to close the wound. Incisions are made in areas that are well hidden to improve cosmetic outcomes. This is a good option because these are low-risk flaps and have a good skin color and texture match.

Nasal Reconstruction

this is one of the most challenging types of reconstruction because nasal reconstruction requires considering function and appearance of the nose, which is a three-dimensional structure that has an inner linking, cartilaginous structure, and outer skin layer. One or all of these layers may require reconstruction after removal of skin cancer. The reconstructive options are simple skin grafts, local flaps, or regional flaps.

The most common flap is a multi-staged procedure in which forehead skin is moved to the nose while remaining connected to its blood supply, letting it heal and then dividing the blood supply 3-4 weeks later. Sometimes additional procedures are used to refine the contours of the skin.

Free Flap Reconstruction

For very large defects that require extra skin, a free flap could be used to rebuild a large part of the face. In the example below, the entire lower lip had cancer, so it was removed and rebuilt with skin from the forearm. (reference the reconstructive surgery webpage).