Skin Cancer Reconstruction
Skin cancers are common on
the face. Basal cell carcinoma is the most common type of
skin cancer found on the face. It usually presents as an elevated
nodule with white edges. There are fine blood vessels on the
surface. (see photo below). There
are other varieties of basal cell carcinomas, as well. Some
are pigmented, others are flat and red and may bleed occasionally
(see photo below). Basal cell carcinoma rarely spreads to
other regions of the body. Usually, when the cancer is removed
and the region is reconstructed the patient is essentially
cured. There is a chance that the cancer may recur but it
is usually less than 5% recurrence with the Mohs technique.
Squamous cell carcinomas are the second most
common cancer found on the face. Clinically, squamous cell
cancer comes in two varieties. The more common clinical type
is a flat, red, scaly lesion (see photo below). Some squamous
cell cancers can grow rapidly and does have a small potential
for spread to other regions in the body (metastasize). Usually
the cancers have to be greater than 2 centimeters for this
to occur (see photo below). Squamous cell cancers can be managed
with Moh's surgery. If the cancer is large, the patient may
require lymph node dissection by a head and neck surgeon.
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Squamous
Cell Carcinoma
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Flat Squamous Cell Cancer
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Large Squamous Cell Cancer
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Malignant melanoma is seen in the facial region.
These cancers are treated aggressively since they have a tendency
to metastasize, and are not treated with the Mohs technique.
Melanomas that are small and shallow have the best prognosis.
Currently, the tumors are widely excised along with a technique
called sentinel lymph node dissection and biopsy. This procedure
involves injecting a radioactive dye into the cancer region
and following the dye as it drains to the lymph nodes. The
lymph node is then removed and evaluated for cancer spread.
Reconstruction of the face after removal of
the cancer is dependent on the size and location of the defect.
Flaps, skin grafts and other options are available. A flap
is a technique whereby adjacent skin is rotated into the region
(See photos below). Flaps are often used for nasal and cheek
reconstruction. Skin grafts are also sometimes used to reconstruct
the defects. Ideally, the skin graft should match in color
and consistency. For example, in the eyelid region skin grafts
are usually taken from behind the ear or from the adjacent
lid. Skin grafts for nasal defects are taken form the inside
of the ear (concha) or from the forehead. These areas have
a high concentration of oil glands, which is similar to the
comosition of skin on the nose.
Rotation Flap
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Cancer Removed From Nose
(showing planned flap incision)
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Immediately After Reconstruction (using
bi-lobed rotation flap)
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Skin
Graft Reconstruction
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After Removing Skin Cancer
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After Graft Reconstruction
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At times if the defect is
shallow and in the right location it is allowed to heal on
its own. The cosmetic result can be excellent although the
color of the skin may be slightly different from the surrounding
skin (See photos below).
Healing Without
Reconstruction
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After Cancer is Removed
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After Healing
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