Treatment of Non-melanoma Skin Cancers in the Absence of Mohs Micrographic Surgery

Abstract

Non-melanoma skin cancers are the most common malignancies globally. Although non-melanoma skin cancers exhibit low metastatic potential, they can be locally destructive, necessitating complex excisions and reconstructions. Mohs micrographic surgery is the gold-standard treatment for high-risk non-melanoma skin cancers in patients who are appropriate surgical candidates. Despite its efficacy, Mohs micrographic surgery is not readily available in most geographic regions, necessitating that plastic surgeons be well-versed in alternative treatment modalities for non-melanoma skin cancer. Herein, we will discuss the management of non-melanoma skin cancers in settings where Mohs micrographic surgery is not readily available.

Fig. 1.

Incidence of non-melanoma skin cancers of the face.

Fig. 2.

Proper labeling of skin specimens. Skin specimens (including the outer layers of the skin) may be marked for orientation using a single suture at the 12 o’clock position (A). In contrast, deep specimens require a 3 o’clock or 9 o’clock suture so that the pathologist may identify the anterior aspect of the sample (B).

Fig. 3.

Patient with a post-excisional defect involving the entire vermillion of the lower lip (A). Application of biologic acellular dermal matrix (B). Patient 3 months postoperatively (C).

Fig. 4.

Patient with a large, circumferential defect of the infraorbital cheek following excision of her malignancy (A). The defect was reconstructed utilizing a cervicofacial flap (B). Patient 3 weeks postoperatively without signs of ectropion or lip retraction (C). Patient 1 year postoperatively with minimal scarring (D).

Fig. 5.

Patient with a full-thickness defect of the nasal ala following excision of a nonmelanoma skin cancer (A). Inset of the paramedian forehead flap into the alar defect (B). Patient 3 weeks post-operatively following inset of the flap (C). Patient 3 months postoperatively following flap division and inset (D).