Facial Skin Cancer
Careful treatment of facial skin cancer, with reconstruction planned around both the cancer and the anatomy of the face.
Facial skin cancers are common, but the consequences of treatment depend heavily on where they occur. A small lesion close to the eyelid, nose, lip or ear can require more planning than a larger lesion elsewhere. The aim is appropriate cancer treatment together with reconstruction that preserves function, respects facial landmarks and achieves the most natural result the defect allows.
Assessment and treatment
Facial skin cancer forms an important part of my private reconstructive practice. Patients may be referred with a facial lesion of concern, a biopsy-proven skin cancer, or for reconstruction after excision by another specialist.
I am happy to see patients at any stage of the pathway. Where assessment and excision can be managed directly, the reconstructive plan is considered from the outset rather than only after the lesion has been removed.
Where care involves another specialist—such as a dermatologist, Mohs surgeon or ENT surgeon—reconstruction can be planned to fit appropriately within that treatment pathway.
The priority is complete and appropriate treatment of the cancer. Reconstruction is then tailored to the defect, the surrounding facial anatomy and the individual patient.
What influences the reconstruction
Site & anatomy
The eyelids, nose, lips and ears have little tolerance for distortion. The same-sized defect can therefore have very different reconstructive requirements depending on its position.
Size & depth
Reconstruction depends not only on the surface dimensions of the defect, but also on which deeper tissues have been removed and what support or lining remains.
Function
Planning needs to protect important functions such as eyelid closure, oral competence, nasal airway and the position of the ear where these structures are involved.
Skin, scar & contour
Skin colour, thickness, natural creases and facial contours all influence where tissue is borrowed from and how scars are positioned.
Reconstructive options
The simplest reconstruction that provides a sound functional and aesthetic result is usually preferred. The technique is chosen for the defect rather than applying the same solution to every lesion.
Direct closure
Selected defects can be closed directly, with the scar placed as favourably as the anatomy allows.
Local flaps
Nearby skin can be rearranged to replace missing tissue with skin of similar colour, thickness and texture.
Skin grafts
A graft can be useful for selected defects where moving surrounding tissue would create greater distortion.
Staged or complex reconstruction
Larger, deeper or anatomically demanding defects may require staged reconstruction or tissue from another site.
Cancer treatment comes first
Reconstruction may follow excision performed by me or be coordinated with a dermatologist, Mohs surgeon, ENT surgeon or another treating specialist. Where pathology or margin assessment requires a staged approach, reconstruction can be timed accordingly.
The reconstructive plan should support the cancer treatment rather than compromise it.
The face is treated as a whole
The aim is not simply to close a wound. Eyelid position, nasal contour, lip shape, facial symmetry and the transition between neighbouring aesthetic units can all matter to the final result.
Sometimes several reconstructive options are reasonable. Consultation is used to explain the trade-offs clearly, including likely scars, recovery, possible staged procedures and the limitations of reconstruction.
When to refer
A facial lesion of concern
GP referrals are welcome when a facial lesion is clinically concerning and specialist assessment or surgical treatment may be appropriate.
A biopsy-proven skin cancer
Patients with a confirmed facial skin cancer can be referred for treatment planning, excision and reconstruction where appropriate.
Reconstruction after another excision
Referral is also welcome when a dermatologist, Mohs surgeon or other specialist is treating the cancer and reconstructive input is required.
An existing facial defect
Patients with wound-healing problems, distortion or a previous reconstruction can be assessed where further reconstructive treatment may be useful.