Facial Reconstruction After Skin Cancer Surgery

basal cell carcinoma cancel lesion on the nose
Brian Lawrence/Getty Images

In the United States alone, over one million cases of skin cancer are diagnosed every year, and that number seems to be steadily on the rise. Moreover, it is estimated that 93% to 97% of all skin cancer occurs on a highly visible part of the body such as the head, face, ears, neck, hands, and arms. It’s not hard to understand why this is the case, considering the fact that these are the parts of the body which typically receive the most sun exposure.

The good news about skin cancer is that early detection (while the cancer is still in its localized stage) means a near 99% survival rate. The survival rate drops steadily in proportion to how far the cancer has spread at the time of detection, so regular screenings are important.

Treatment of Skin Cancer

While certain types of skin cancer can be treated with cryotherapy (freezing), lasers, electrodesiccation and curettage (aka ED&C, which is alternate scraping and burning of the lesion), and even topically applied chemotherapy, others require surgical excision.

Often, the best way to accomplish skin cancer excision while preserving as much normal tissue as possible in highly visible areas is to undergo Mohs surgery. A Mohs surgeon is a dermatologist who has received at least one year of additional specialized training in the surgical removal of skin cancer lesions.

What Happens After the Cancer is Removed

Once the Mohs surgery is completed, however, the job is often not done.

Although your Mohs surgeon can sometimes simply close the wound left after excision, it is quite likely that the cosmetic result of a simple close will be less than satisfactory to you. Especially on the face, many patients will desire the help of a plastic surgeon to restore their appearance as close to normal as possible.

How to Find the Right Surgeon for Reconstruction

This type of surgery is reconstructive in nature and should be performed by a plastic surgeon who specializes in this type of surgery. Although there are no special requirements to do this type of surgery, it is recommended that you seek the services of a facial plastic surgeon (as opposed to a general plastic surgeon) who is certified by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The best way to find such a surgeon is typically to ask for a referral from your Mohs surgeon.

The Keys to Great Results

According to board certified facial plastic and reconstructive surgeon, Andrew Jacono, MD, any surgeon doing this kind of work must have a lot of experience in facial plastic surgery, and possess a thorough anatomical understanding of the structures of the face. Dr. Jacono states that the keys to good results include maintaining good blood supply and using a donor site which is a good match with the skin surrounding the injured area (surgical excision site).

Why Skin Grafts are Not Ideal

While some surgeons use skin grafts to repair these types of injuries, Dr. Jacono says this is not ideal because matching the color and texture of the skin can be a problem.

Skin grafts should be used for this type of surgery only as a last resort if the affected area is much too large to be covered using a flap technique.

When Is Reconstructive Surgery Done?

Although reconstructive surgery can happen as a part of, or at any point after, the initial excision surgery, Dr. Jacono points out that most people don’t want to wait to feel “whole” again. He usually performs reconstructive surgery the same day as excision, although sometimes it can be delayed up to one week.

Special Challenges of Facial Reconstructive Surgery

Facial reconstructive surgery after skin cancer presents special challenges because there is a limited amount of well-matched door tissue available.

In cases where a large percentage of facial tissue has been excised, a flap may need to be taken from elsewhere on the body to be used on the face. In the most extreme case, Dr. Jacono says that a face transplant could be considered as an option as the last resort.


In most cases, reconstructive surgery after skin cancer excision will be covered by your health insurance plan. Even if your health plan covers the procedure, make sure you check with your surgeon’s billing office to determine whether or not your plan is accepted by the practice.

If you are uninsured, the costs vary greatly, depending on the type and amount of reconstruction needed. Only your surgeon can give you an idea what the costs are for your unique procedure.

When speaking to your surgeon, be sure to ask about costs not only for his surgical fee, but for anesthesia, medications, facility fees, and lab work.

View Article Sources