Mohs Surgery
blepharoplasty
 
ectropion
 
entropion
 
eyelid ptosis
 
skin cancer - mohs surgery
 
tear duct surgery
 
facial spasms
 
facial palsy
 
hyperhidrosis
 
migraines
 
thyroid eye disease
 
orbit tumors and trauma
 

Mohs Surgery


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.

Basal Cell Carcinoma

Nodular Basal Cell
Flat Basal Cell Cancer

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.

Squamous Cell Carcinoma
Flat Squamous Cell Cancer
Large Squamous Cell Cancer

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

Cancer Removed From Nose
(showing planned flap incision)
Immediately After Reconstruction (using bi-lobed rotation flap)
 
Skin Graft Reconstruction
After Removing Skin Cancer
After Graft Reconstruction

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

After Cancer is Removed
After Healing

 

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