Skin cancer
A growing plague
The incidence of skin cancer is rising worldwide. Some of these are life threatening, while some are rarely life-threatening but will keep growing and growing unless removed. Unfortunately, skin cancers often affect the face, scalp, hands, and other areas that are frequently exposed to the sun. This means that removing them can result in facial disfigurement or risk injury to the hands and feet.
Changing the appearance of a person's face or body by removing cancer can be psychologically disturbing, sometimes in a profound way. Therefore, plastic surgery reconstruction for skin cancer needs to be done extremely thoughtfully and skillfully.
Some skin cancers can be both excised and reconstructed by plastic surgeons. More complex cases benefit from Mohs surgery, which is performed by specialized dermatologists in a way that has a higher chance of completely removing the cancer. Mohs surgeons can at times perform reconstruction as well, but their options are more limited because they have not had more than one year in surgical training and do not have the extensive training in reconstructive surgery that plastic surgeons do (6 years minimum!)
For this reason, if you are dealing with a large, complex, or cosmetically sensitive defect after excision of a skin cancer, it can be beneficial to consult with a board-certified plastic surgeon.
Watch the video below to see what I mean about treating complex cases with advanced reconstructive options. Scroll through the before and after galleries below to see before and after results. Click the images in the galleries to be taken to a blog post and learn more about the principles of reconstructive plastic surgery in each case.
WARNING! This section contains graphic images of cancers and surgical wounds
plastic surgery reconstruction AFTER MOHS SURGERY for basal cell carcinoma of the cheek - with the reverse cheek rotation flap by Dr. Felder
Recurrent basal cell carcinoma of the right cheek
Defect of the cheek after Mohs surgery excision
Surgical preparation for reconstruction
Cheek skin cancer reconstruction with reverse cheek rotation flap
Result after reconstruction
Side / dynamic view: Result after reconstruction
Plastic surgery treatment for skin cancer of the cheek with the cervicofacial flap - The Reconstructive Surgeon
Right cheek demonstrating squamous cell carcinoma and melanoma in situ
Multiple skin defects of the right cheek after tumor excision
On table appearance of cervicofacial flap closure for cheek reconstruction
Healed appearance of cervicofacial flap at 4 months
Healed appearance of cervicofacial flap - frontal view
Plastic surgery reconstruction after mohs surgery: for skin cancer of the nose with local flaps - The Reconstructive Surgeon
Mohs surgery defects of the left nasal tip and sidewall following excision of two basal cell carcinomas
Reconstruction of dorsal defects with dorsal nasal flap
Nasal sidewall defect reconstructed with cheek advancement flap
Healed appearance 4 months after nasal reconstruction with combined local flaps
Healed appearance after nasal reconstruction with combined local flaps, frontal view
Plastic surgery reconstruction after mohs surgery for skin cancer of the nose with a forehead flap - The Reconstructive Surgeon
Nasal tip Mohs excision defect encompassing >50% of the tip subunit
Markings for completion resection of the tip subunit and left paramedian forehead flap
On table appearance of forehead flap
3 week postoperative appearance of paramedian forehead flap
Profile view - Note the excess flap thickness and presence of hair
Second stage forehead flap re-elevation and thinning
Second stage inset
Profile view - a substantial decrease in flap thickness has been achieved.
Healed appearance 3 months after division and inset of 3-stage forehead flap
Healed appearance of nasal tip reconstruction with forehead flap
minimally invasive reconstruction for skin cancer of the nose with Integra® Bilayer matrix and micro skin grafting - The Reconstructive Surgeon
A large basal cell carcinoma excision defect with standard margins
The wound is dressed with Integra
The Integra neodermis is populated with punch grafts of adjacent nasal skin
Healed appearance at 1 year
Healed appearance at 1 year
Healed appearance at 1 year
Healed appearance at 1 year
Plastic surgery treatment for skin cancer of the ear with the antia-buch flap - The Reconstructive Surgeon
Mohs surgery defect of the ear helical rim
Surgical preparation for reconstruction
Elevation of the Antia-Buch flaps, anterior
Posterior degloving of the auricular cartilage for flap mobility
Closure of the Antia-Buch flaps
Healed appearance of ear reconstruction at 3 months
Plastic surgery treatment for skin cancer of the scalp with Rotation flaps - The Reconstructive Surgeon
A prominent squamous cell carcinoma of the scalp
Lesion marked for excision with 6 mm margins
Defect following excision, markings made for rotation flap
Elevation of the "snail flap" in the subgaleal plane
Rotation and inset of the "snail" rotation flap
Healed appearance of scalp reconstruction at 3 months
Squamous cell carcinoma of the scalp in a hair-bearing region
Tumor excision defect and markings for rotation flap
Elevation of "snail flap"
The tip of the snail flap is folded in to recruit tissue for closure
Inset and closure
Healed appearance of scalp reconstruction at 4 months.
Healed appearance of scalp reconstruction at 4 months. The scars are not noticeable within the hair
Healed appearance of scalp reconstruction at 4 months. The scars are not noticeable within the hair
Plastic surgery reconstruction for skin cancer of the Neck and temple - The Reconstructive Surgeon
A prominent basal cell carcinoma of the submandibular neck
Scars crossing the border of the mandible are closed with a Z plasty to prevent contracture
A large squamous cell skin cancer of the temple
Hair is shaven for surgery, but hairline and beard line are marked in purple
Resection with wide margins leaves a substantial defect of the temple, not amenable to primary closure. Skin grafting would create a bald patch.
Multiple flaps are necessary in a jig-saw fashion, requiring creativity to reconstruct the hairline.
An island superfical temporal V-Y flap, a hair-bearing rhomboid flap from the beard, and a sliding rectangular forehead flap are all brought together
Result of temporal hairline reconstruction at 3 months
Result of temporal hairline reconstruction at 3 months
Result of temporal hairline reconstruction at 3 months
Plastic surgery reconstruction for skin cancer of the chest with propeller flaps - The Reconstructive Surgeon
Plastic surgery reconstruction for skin cancer of the hand and arm - The Reconstructive Surgeon
This is an invasive and potentially deadly skin cancer (squamous cell carcinoma) that must be treated with finger amputation.
A well-performed ray amputation of the cancer-affected finger results in a natural-appearing, balanced hand.
Surprisingly, most people never even notice the amputation
Plastic surgery reconstruction for skin cancer of the leg and foot - The Reconstructive Surgeon
Skin cancers of the leg can be tricky
There is often not enough skin to close the defect
The keystone island flap is an excellent solution
This can be performed under local anesthesia
Squamous cell carcinoma of the foot
Removal of the squamous cell carcinoma leaves quite a hole in the foot. This would not heal without reconstructive surgery.
Here, we have outlined the approach to recipient vessel exposure for a free flap
Here, tissue from the back with thick skin is transferred to the foot to give the patient durable skin for weight bearing
