Skin cancer · reconstruction

Reconstruction after skin cancer removal

First, adequate cancer removal. Then, restoration of form and function with the most appropriate reconstructive method.

The oncological step determines reconstruction

Closure must not dictate an inadequate excision. Margins and the likely defect are planned together, but definitive reconstruction follows adequate tumour control.

The reconstructive ladder

Direct closureFor defects that can be closed without excessive tension or distortion.

Secondary intentionAppropriate only for selected sites and situations.

Skin graftTransfer of split- or full-thickness skin onto a prepared wound bed.

Local flapMovement of adjacent tissue with its blood supply to restore form and function.

Nose - direct closure after margin assessment

A separate nasal basal cell carcinoma case: marking and immediate direct closure. These images do not show the full microscopic assessment or a late cosmetic result.

Immediate closure; this is not the final scar appearance.

Face and periocular area — one clinical case

After defining the oncological defect, local flap repair considers nasal and eyelid form and function. Both images are from one patient; immediate closure is not the final scar appearance.

Defect beside the nose after tumour removal, desaturated clinical image — Graphic clinical image
**After tumour removal:** a defined defect in an anatomically complex area.

Immediate local flap closure beside the nose, eyes obscured — **After reconstruction:** the immediate result of local flap repair to restore form and function.

A Keystone flap for a larger defect

These three images show one clinical case: planning, the post-excision defect and immediate local-flap closure. The middle image is graphic.

Planning excision and a local flap on a limb — Before surgery: marking the excision and flap.

Defect after soft-tissue tumour removal, greyscale clinical image — Graphic clinical image
After excision: the defect and oriented specimen.

Defect closed with a local Keystone flap — Immediate closure with a Keystone flap.

What is assessed afterwards

Tissue viability, healing, function, final margins and the need for further treatment. A final cosmetic result cannot be judged from an immediate postoperative image.

Mohs margin control DFSP

Clinical material from the author's archive, published with confirmed consent. Social overlays were removed and the graphic frame was desaturated.

This educational material does not replace clinical examination, a complete pathology report or an individual treatment plan.