Skin Cancer Reconstruction

Our Approach in Managing Skin Cancer Reconstruction

Clear margins. Functional restoration. Life, rebuilt.

Skin cancer reconstruction demands that two goals be achieved simultaneously: complete tumour clearance and optimal functional-aesthetic restoration. Our oncoplastic team never sacrifices one for the other; reconstruction is planned before excision so that the best outcome is achieved in a single operative event wherever possible.

1. Pre-Operative Assessment & Multidisciplinary Planning

Every skin cancer patient is reviewed by our oncoplastic team before surgery:

• Clinical photography and dermoscopy of the lesion; size, margins, and satellite involvement
• Biopsy review; histological subtype, depth (Breslow for melanoma), and margin status from prior biopsy
• Assessment of reconstructive options based on defect size, location, and patient anatomy
• Multidisciplinary tumour board review for high-risk, large, or recurrent tumours

2. Wide Local Excision with Clear Margins

Cancer clearance is the non-negotiable first step:

• Margin planning based on tumour type; 3–5mm for BCC, 5–10mm for SCC, 1–2cm for melanoma
• Basal cell carcinoma reconstruction — the most common scenario, particularly on the face
• Intraoperative frozen section or Mohs micrographic surgery to confirm clear margins before closure
• Complete excision of specimen including deep margins in high-risk or recurrent tumours

3. Mohs Surgery & Immediate Reconstruction

For high-risk or aesthetically sensitive tumours on the face:

• Mohs surgery and reconstruction specialist in Mumbai India — staged excision with real-time margin verification
• Smallest possible defect achieved by removing only tumour tissue confirmed on microscopy
• Reconstruction begins immediately following confirmation of clear margins
• Most efficient approach for peri-orbital, nasal, lip, and ear cancers

4. Local Flap Reconstruction

The first choice for facial skin cancer defects due to superior tissue match:

• Rhomboid flap, bilobed flap, banner flap; for cheek, temple, and forehead defects
• Nasolabial transposition flap for nasal ala and cheek reconstruction
• Abbe and Estlander flaps for lip defects involving the oral commissure
• Oncoplastic skin reconstruction principles; preserve function, respect aesthetic unit boundaries

5. Skin Graft Reconstruction

When flap closure is not appropriate or achievable:

• Full-thickness skin graft (FTSG) from pre-auricular, post-auricular, or supraclavicular donor sites for facial defects — best colour and texture match
• Split-thickness skin graft (STSG) for larger trunk or limb defects following melanoma excision and repair
• Primary dressing protocol to optimise graft take — bolster dressings, immobilisation, and pressure
• Graft donor site heals primarily (FTSG) or with dressings (STSG) without significant morbidity

6. Complex Regional & Free Flap Reconstruction

For large or full-thickness defects following extensive tumour excision:

• Forehead flap for nasal reconstruction — the gold standard for subtotal nasal defects
• Paramedian forehead flap staged over 3–4 weeks for complete nasal unit reconstruction
• Free flap reconstruction (radial forearm, ALT, or anterolateral thigh) for large defects of the scalp, cheek, or neck following extensive skin cancer excision and flap repair Mumbai
• Prosthetic auricular or orbital reconstruction when surgical reconstruction is not optimal

7. Sentinel Node Biopsy & Oncological Follow-Up

For melanoma and high-risk SCC, oncological surveillance is as important as reconstruction:

• Sentinel lymph node biopsy (SLNB) performed at time of wide local excision for melanoma >0.8mm
• PET-CT or CT staging for high-risk melanoma and Merkel cell carcinoma
• Structured dermatology and oncology follow-up at 3-monthly intervals for the first 2 years
• Reconstructed area documented photographically at every follow-up for comparison