Reconstruction for skin cancer

• Ensuring the complete removal of the cancer cell
• Restoring the appearance and function of the affected area

The reconstructive approach varies considerably depending on the size, depth and location of the defect as well as the patient's state of health and aesthetic needs.

Skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma, can lead to significant defects after removal, especially if the affected area is in cosmetically sensitive or functionally critical areas such as the face, hands and legs.

Reconstruction can be performed immediately after cancer removal or only after the wound has healed or further cancer treatment has been completed.

Immediate reconstruction often offers the best cosmetic results and can shorten the overall recovery time.

However, in cases where there is a high risk of cancer recurrence, delayed reconstruction may be recommended, allowing for easier monitoring of the area.

Reconstructive surgery after skin cancer removal is not only about closing wounds, but also about restoring the patient's appearance and self-confidence.

Surgeons must consider the aesthetic outcome, especially in facial reconstruction where symmetry, contour and minimising visible scarring are crucial.

In addition, preserving or restoring function is of paramount importance, especially in areas such as the eyelids, nose, lips and ears.

Treating complex cases often requires a multidisciplinary approach involving dermatologists, oncologists, plastic surgeons and other specialists.

Working together ensures that the patient receives comprehensive care, from cancer removal and reconstruction to aftercare and rehabilitation

Reconstructive surgery following skin cancer removal is a blend of art and science and requires surgeons to utilise a variety of techniques tailored to the individual needs of each patient.

Advances in surgical methods and a better understanding of wound healing and aesthetics improve outcomes for patients undergoing these procedures, allowing not only survival but also a return to normality and confidence after treatment.

Primary closure
Small defects can be closed directly by suturing the wound edges together to minimise scarring and preserve the function and appearance of the surrounding tissue.

This method is often favoured for small lesions due to its simplicity and effectiveness.

Skin grafts
Skin grafting involves transferring a piece of skin from a donor site to the area where the skin cancer has been removed. This can be a split-thickness skin graft, where only the uppermost layers of skin are removed, or a full-thickness graft, which includes deeper layers and gives a more natural appearance.

Skin grafts are generally used to cover larger defects, particularly on the body or limbs.

Localised flaps
In localised flap surgery, tissue from an area adjacent to the defect is transferred to cover the donor site. This method preserves the original blood supply to the tissue, which promotes healing and enables a better colour and texture match than with skin grafts.

Depending on the location and size of the defect, different flap designs such as rotation, transposition and advancement flaps are used.

Free flaps
Free flap surgery can be performed for extensive defects or if local tissue is unavailable or insufficient. This involves transplanting tissue from another part of the body together with its blood supply to the reconstruction site. The surgeon then reconnects the blood vessels using microvascular techniques.

Free flaps can reconstruct large areas and are particularly useful for complex reconstructions, including those where a lot of soft tissue is lost or muscle and bone need to be introduced.

Secondary intentional healing
Some defects, particularly in well-vascularised areas and small superficial wounds, can be left to heal by secondary intention. With this procedure, the wound closes by itself over time.

Although this method can lead to larger scars, it may be suitable for certain areas or patients.