Basal Cell Carcinoma: Facial Reconstruction Timing

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

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About Dr. Ryan Osborne

Ryan F. Osborne, M.D. is the Director of Head and Neck Surgery at OHNI and is an internationally renowned expert in head and neck oncology. He has developed a special interest for the treatment of parotid gland tumors and focuses on the use of minimally-invasive techniques in the care of patients needing parotid surgery.

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When should reconstruction of the face occur after Mohs surgery?

Basal cell carcinoma is one of the most common cancers worldwide. Due to the chronic sun exposure of the head and neck region, the great majority of basal cell cancers occur within this area. Diagnosis of skin cancer is typically done through a primary care office or a dermatologist. Biopsies are initially done in order to confirm the diagnosis of skin cancer. Resection of the tumor in the majority of the cases is curative and no further treatment is needed. Resection can be done at the primary care office or dermatologist office. Occasionally, Mohs micrographic surgery is needed to ensure that the tumor is removed completely.

However, due to the visibility of the facial region, treatment of skin cancers that occur in these areas require a special cosmetic approach. Excision and reconstruction of facial skin cancers can result in visible scars. These scars can in turn become an unwanted and anxiety provoking reminder to patients. Once scarring has occurred, it is possible to undergo scar revision procedures and other laser procedures to improve their appearance, however, the best solution is to try to prevent that scar from occurring in the first place. One way to ensure cosmetically pleasing result is to have the defect reconstructed by a board-certified plastic or facial plastic surgeon. Many patients are unaware that dermatologist Mohs surgeons are not plastic or facial plastic surgeons.

Patients are also unaware that they have a choice as to who reconstructs their facial defect. Often the dermatologist or the Mohs surgeon can remove the cancer and clear the margins and the patient can have their defect reconstructed by a plastic surgeon or a facial plastic surgeon the same day or even a few days later.

If you are having skin cancer removed from your face, you can request a plastic or facial plastic surgeon of your choice to close the defect in order to achieve a better cosmetic result.

Figure 1: Patient image depicting a defect on the face 1 day after Mohs surgery.
Figure 2: Patient image two months after facial reconstruction by Dr. Zandifar.