faceThe incidence of skin cancer continues to grow, especially in younger people. In fact, one in five Americans will develop skin cancer in their lifetime, making reconstructive procedures increasingly common.

A surprising 87 percent of facial plastic surgeons surveyed by the American Academy of Facial Plastic and Reconstructive Surgery reported seeing patients for reconstructive work related to skin cancer. In 2014, the nose (68 percent) was the most common site followed by cheeks (16 percent), ears (six percent), and forehead (four percent). Skin cancer removal and reconstruction options depend on the type of cancer, its size, and its location. From simple to complex, the goal is to remove the cancer, repair damaged tissue, and rebuild features to restore appearance and function.

Cancer removal

Skin cancer is usually diagnosed by removing all or part of a growth and examining the cells under a microscope—a procedure known as a biopsy. There are various methods of treatment; however, most skin cancers are removed surgically.

A small or contained lesion with clear borders may be removed with a simple surgical process called excision. If the lesion is large or has spread elsewhere in the body, additional treatments or procedures may be required, such as cryosurgery (freezing the cancer cells), radiation therapy, topical chemotherapy, and Mohs surgery.

In Mohs surgery, cancer is excised from the skin, followed by the detailed mapping and complete microscopic examination of the cancerous tissues and the margins surrounding it. More tissue is removed until only cancer-free tissue remains. This technique eliminates the guesswork of how far or how deep to go, allowing the surgeon to spare as much healthy tissue as possible.

Reconstruction

Reconstruction after cancer surgery tries to preserve or restore both the function and the appearance of the area involved. In most cases, reconstructive surgery is performed at the time of cancer removal. If the area is small, the wound may be closed by bringing the edges of the skin together. A local skin flap—where a portion of nearby skin, tissue, and blood supply is repositioned over the wound—may be used as an option for closure. For larger wounds, a skin graft may be needed to cover the area. Skin grafts are taken from another part of the body, such as the neck or leg. With complicated or large cancers, reconstruction may be delayed until the pathologist can confirm that the tumor has been completely removed.

Skin cancer is the most common form of cancer in the United States; 80 percent of cases involve the face, head, or neck. If you or someone you know has received a skin cancer diagnosis, make an appointment with your facial plastic surgeon to discuss an optimal treatment, recovery, and reconstruction plan.