Skin cancer – Surgical treatment

Dermatological surgery

Important anatomical points during dermatosurgery

  • Lines of minimum skin tension or Langer's lines

They are imaginary lines that are perpendicular to the longitudinal axis of the underlying muscles. In the head and neck area they coincide with facial expression lines and natural folds. The direction of the cuts should be, as far as possible, parallel to the lines of minimum stress.

Fig.1: The relationship of lines of least tension, incisions and excisions, to the underlying facial muscles. (From "Plastic Reconstructive & Aesthetic Surgery" by Professor Othonas N. Papadopoulos.)

  • Anatomical lines of the face (Junction contour or boundary lines)

They are the natural anatomical folds of the face, in which an incision can be placed and "hidden". Examples of these folds are the forehead folds, the lower eyelid fold, the nasolabial fold and the nasolabial fold.


Fig.2: Natural anatomical aspects of the face
  • Aesthetic subunits of the nose

The topography of the external nares is a complex composition of contiguous convex and concave surfaces. This characteristic allows its separation, in the sensory subunits of the nose, which were described by Burget and Menick in 1985. 

Fig.3: Sensory subunits of the nose

The sensory subunits of the nose are: 

  1. the back of the nose (dorsum) 
  2. the lateral nasal wall (sidewall)
  3. the top of the nose (nasal tip)
  4. the alar lobule
  5. the style (columella) 
  6. the soft triangle

When planning the reconstruction of nasal skin defects, the incisions should be placed at the borders of the esthetic subunits, as they are less obvious.

Causes of personal country skin deficits

The causes of cutaneous nasal defects are:

  1. Malignant neoplasms

It is the most common cause of skin deficiency on the face. Basal cell carcinoma is the most common type, followed by squamous cell carcinoma. Melanoma is the rarest, but also the most aggressive form of skin cancer. When surgically removing a skin cancer, the principles of oncological surgery must be followed.

  1. Injuries

It is the second most common cause of skin deficiency. It concerns younger patients, where the skin incisions are more visible. Correct placement of the incisions is critical to achieving a good aesthetic result.

  1. Congenital anomalies

They are rare and require treatment by a specialized team of surgeons, as they often coexist with other congenital anomalies.

Classification of flaps

Krimnos it is a piece of tissue that can be transferred from one area of the body to another, maintaining its own blood supply. Pedicel is the part from which the flap is blooded. 

Fig.4: Classification of flaps

Choosing the right flap

Reconstruction of facial skin defects must protect functionality and maintain facial symmetry. The complex anatomical construction, with adjacent convex and concave surfaces, the reduced availability and elasticity of the skin and the composition of the subcutaneous tissue, affect the outcome of the operation. The decision to reconstruct a skin defect and the selection of the appropriate flap requires a detailed analysis of the characteristics of the defect and the patient's facial features. The surgeon must carefully consider the size, location, shape, and depth of the defect. The texture, color, elasticity, and availability of the skin of the donor area, combined with its portability provided by the design of the flap and the characteristics of the skin defect, contribute to the most beneficial decision for the patient. . Finally, the patient's characteristics, such as age, underlying diseases, especially the existence of vascular disease and diabetes mellitus, influences, such as smoking and alcohol and his expectations for the expected aesthetic result, will determine the final choice, the which will arise after an extensive discussion with the patient.

Incidents

1) Squamous cell carcinoma of the nasopharynx – Surgical removal and plastic reconstruction using an island-promoting flap (U-plasty)

THE plastic U involves a single-lobed, contralateral, random, thrusting flap. It is a flap with a linear design, which is moved by the method of advancement, sliding towards the deficit. The common boundary of the flap and the deficit becomes the leading edge of the propulsive flap.

Fig.5: U-plasty

Plastic U is particularly useful for small and medium skin defects of the tip and dorsum of the nose. The scars created are placed on the borders of the aesthetic subunits of the nose, making them less visible and ensuring a good aesthetic result.

Fig. 6: Initial damage
Fig.7: Surgery planning
Fig.8: Day of surgery
Fig.9: 1st postoperative image
Fig.10: Removal of stiches
Fig.11: 5 months after surgery
Fig.12: 1 year after surgery
Fig.13: Initial lesion vs 1 year after surgery
2)Basal cell carcinoma of the nasopharynx in recurrence – Surgical removal and plastic reconstruction, using an island-promoting flap (VY advancement flap)

THE thruster flap VY is a single-pedicle, random, advancing island flap with a subcutaneous pedicle. It is a flap that moves by the method of promotion, sliding towards the deficit. The common boundary of the flap and the deficit forms the leading edge of the propulsive flap.

Fig.14: Initial damage
Fig.15: Surgery planning
Fig.16: Day of surgery
Fig.17: Removal of stiches
Fig.18: 1 month after surgery
Fig.19: 1 year after surgery
Fig.20: Initial lesion vs 1 year after surgery
3)Squamous cell carcinoma of the lower lip, stage T2N0M0 – Surgical excision and plastic reconstruction using a Bernard-Webster flap

The reconstruction of full-thickness deficits of the lower lip, after the removal of squamous cell cancer, which occupies more than 1/3 of its length, must be done with respect to the function of the mouth and the symmetry of the face.

Fig.21: Initial damage
Fig.22: Surgery planning
Fig.22: Day of surgery
Fig.23: 1st postoperative day
Fig.24: 1 month after surgery
Fig.25: 5 months after surgery
Fig. 26: 1 year after surgery
Fig. 27: Initial damage vs 1 year later
Fig. 28: Initial damage vs 1 year later

For the surgical treatment of any skin damage, make an appointment at the following link.