More than 5 million people are diagnosed with skin cancer every year, according to the American Cancer Society. In fact, it’s the most commonly diagnosed cancer in the U.S. For those who are suffering from skin cancer, the concerns about disfiguration and scarring can often be as troubling as the cancer itself. While no surgery can be performed without leaving some scar, there are reconstruction options can help to bring back a sense of normalcy to both appearance and function.
The first thing a dermatologist will consider before choosing a treatment path is the location of the wound. For skin cancer on the face, and particularly the nose, great case must be taken to minimize scarring for aesthetic reasons.
Primary Repair Vs. Secondary Intention
In the case of smaller skin cancer defects on the face, primary repair of the wound edges and sutures might be the most direct approach. In this method, the skin cancer wound is extended from a circular opening to a linear one so that the edges can come together evenly instead of bunching. This longer, smoother scar can be made in the same direction as the face’s natural lines in order to blend in.
For skin cancer wounds that can easily be hidden on the body, or where appearance isn’t a concern, a dermatologist might suggest secondary intention healing. This requires less intervention by allowing the body to heal naturally. Wounds healed in this manner often leave more noticeable scarring, have a lighter colors or depression in height than the surrounding skin.
For more involved skin cancer reconstruction, a dermatologist might recommend skin grafting, local flap reconstruction, or free flap reconstruction. Each has its own benefits.
This method involves taking skin from one part of the body and using it to repair a skin defect. Partial thickness grafts, which are the shaving off of the top layer of skin, are not typically the first choice of procedure as they tend to heal with contraction. They usually appear lighter and shinier than the skin surrounding it, so are usually done in less visible areas. Full thickness grafts, however, are used to repair facial defects. In this procedure, the skin is surgically removed and sutured closed. With skin grafting, you can expect a good aesthetic outcome, particularly for facial defects. Plus, there’s no need to lengthen the incision, which makes it a much quicker procedure. Skin grafts do not work for deeper skin cancers as taking thicker grafts may not continue to supply enough blood supply to succeed. Also, because the skin is taken from another part of the body, you have less of a chance of the skin matching in color and contour.
Local Flap Reconstruction
As the most common reconstruction surgery used for facial skin cancer defects, local flap reconstruction uses the skin immediately next to the cancer site to replace the defect. During this procedure, incisions are extended from the cancer site, a flap of skin is elevated, and then rotated to cover the defect. With local flaps you benefit from a much better color and contour match, as the skin used is adjacent to the defect site. The scar will be a bit longer than the defect and irregular in shape. The idea, however, is to hide the scar in the face’s natural lines, making them less obvious.
Free Flap Reconstruction
If there is inadequate tissue surrounding the cancer defect to use as a local flap, a free flap might be utilized instead. In this procedure, which is much more involved, skin and additional tissue is taken from another part of the body (such as the arm, leg, or back) along with its artery and vein and transplanted in the defect site in order to supply blood flow. It is a proven way to repair damage from severe skin cancer defects, performed only by skilled professionals. While the healing time is longer, the long-term aesthetic benefits are well worth it.
Talk to a board-certified dermatologist about your skin cancer concerns and reconstruction options by requesting a consultation with The Derm Group online or by calling 973.571.2121.