Facial Skin Malignancies

The incidence of skin malignancies is increasing at a staggering rate due to a combination of factors including increased life expectancy, increased exposure to UV light as the ozone layer is depleted, exposure to an ever increasing number of carcinogenic chemicals and pollutants, increased sun tanning booth visits, increased survival of those genetically susceptible who then reproduce propagating those genes, and a nonchalant attitude toward skin cancer as not being life-threatening thus delaying doctor visits where pre-cancerous lesions could have been removed. Finally, an increased awareness through such mediums as internet education may also lead greater numbers of people to seek treatment for suspicious lesions. Although many types of skin malignancies exist, by far the most common ones treated in an average private practice include basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Basal cell carcinomas end to remain only locally invasive, squamous cell carcinomas are also locally invasive but occasionally metastasize and melanoma are notorious for systemic metastases, depending on the graded depth of the tumor biopsy specimen, when the lesion is first discovered.

In comparison to other anatomic areas, facial skin malignancies are of particular significance because of the importance of facial structures from both a cosmetic and mimetic perspective. The delicate facial structures and the associated complexities associated with post-excisional reconstruction make this a challenging area for any surgeon. Many treatment modalities are available for treatment including cryotherapy, fulguration, radiation or chemical destruction and the time tested standard of excision with frozen section control or MOHS surgery. Newer treatments include photosensitive chemical enhanced laser treatment and for melanomas in particular sentinel node biopsies and interferon injections.

Vital structures of the face make excision and reconstruction highly sophisticated requiring years of specialized training not only to remove malignancies in such a way as to preserve as much natural tissue as possible, but also to reconstruct the excision site to restore normal function and create a cosmetically acceptable outcome. A good example is that of an eyelid melanoma where classic depth dependent excision margins cannot be respected because of the limited size of the eyelid and the presence of the underlying eye. Modified margins using frozen section control are required and reconstruction usually requires flap closures in contrast to skin graft placement, making detection of recurrences somewhat challenging due to flap thickness that may mask recurrent tumor cells. In addition the eyelids must not only continue to protect the eye but must be dynamically functional to allow blinking over the eye surface. Complex reconstruction using tissue transplantation from the uninvolved lids, composite grafts harvested from the palate for structural support along with grafts of lining tissue to replace lost conjunctiva make these reconstructions extremely detailed. At Medical Eye Associates we have over 20 years experience handling such difficult cases as our certified skin cancer specialist is both an Ophthalmologist and Plastic Surgeon. Many cases are handled in conjunction with a Dermatologist and or a MOHS surgeon.