The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.
Figure 1 shows a patient for whom a "bi-lobed" fl ap was chosen after cancer surgery. Left, the original open wound with the Mickey Mouse ears-shaped bi-lobed fl ap. Right, the well-healed fl ap.
is the transfer of skin tissue from one part of the body (the "donor site") to an- other (the wounded area). Skin donor sites are carefully chosen, taking into account the location on the body (the more inconspicuous the better), skin color, thickness and a whole host of other factors. In some instances, the wound may need to settle down prior to reconstruction, since there may not yet be a good "bed" on which to place a skin graft — the skin will likely be infl amed and swollen. In that situation, standard local wound care is initiated and a graft is applied several days later. But if the wound appears to be ready for it, a skin graft can be performed on the same day as the skin cancer removal. Once the graft is placed, a new blood supply should develop naturally to keep the area vital. When preferable, a skin "fl ap" may
be chosen for the surgery instead. A fl ap is a piece of tissue that, like a graft, is moved from one area of the body to another. Unlike skin grafts, fl aps are typically left attached to one or more sides of their original site to maintain the blood supply. They also usually include the underlying fat or muscle to provide a better blood supply and thicker coverage at the site of the wound. Local fl aps (the vast majority of skin fl aps for skin cancer recon- struction), which come from the area
Figure 2, left, shows an extremely large basal cell carcinoma which involved the cheek, side of the nose, lower eyelid and upper lip. Right, the patient after postsurgical reconstruction.
immediately adjacent to the wound, are ideal if cosmetically feasible. Figure 1 shows a patient for whom
a "bi-lobed" fl ap was chosen. The left photo shows the original open wound with a Mickey Mouse ears- shaped bi-lobed fl ap. The fl ap tissue was transplanted from an area just outside the plane of the photo and then
edges, or inject cortisone under the fl ap to decrease swelling. Careful observa- tion and follow-up appointments will allow the best course of action.
It is always better to undergo treatment before the cancer grows larger, thereby destroying more tissue and requiring more diffi cult surgery and reconstruction.
rotated onto the open wound, being distributed over the greater surface area of both the donor site and the postsurgical cancer wound. When the donor site is closed, the cancer defect site is generally closed as well. The
"after" photo shows a well-healed fl ap; no further treatment was necessary. In some cases as the fl ap heals there may be a need to dermabrade (sand) the
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CONCLUSION Many people delay seeing their derma- tologist for fear of having to undergo a surgical procedure, but it is always better to undergo treatment before the cancer grows larger, thereby destroy- ing more tissue and requiring more diffi cult surgery and reconstruction. Figure 2 shows an extremely large basal cell carcinoma which involved the cheek, side of the nose, lower eyelid and upper lip. Fortunately, despite the size of this skin cancer, the fi nal surgical result was quite acceptable. Today, many options exist to restore one's appearance after skin cancer surgery — from letting the wound heal on its own to a variety of grafts and fl aps. Your dermatologist and plastic surgeon are available to advise you and share their expertise, even if it means no repair is indicated.
DARRICK ANTELL, MD, is a plastic and reconstructive surgeon with an appointment as Assistant Clinical Professor of Surgery at Columbia University. Dr. Antell is a member of The Skin Cancer Foundation's Amonette Circle.