Patients undergoing biopsy and removal of advanced skin cancer of the face and neck have many concerns. Diagnosing the cancer and removing it completely are essential. These procedures can also involve extensive tissue loss, calling for special skills to restore form and function to the structures of your face. The Facial Plastic and Reconstructive Surgery team offers unparalleled skill and compassion to help patients with even the most challenging facial skin cancers.
Advanced Facial Skin Cancer: Why Choose Johns Hopkins Facial Plastic Surgery?
- Our team's skill and the large number of patients we see helps us address even the most complex skin cancers of the face, including melanoma, advanced basal cell and squamous cell carcinoma as well as Merkel cell carcinoma.
- We have extensive experience in performing a high volume of sentinel lymph node biopsies of the head and neck. We work with our nuclear medicine colleagues in the radiology department to precisely identify head and neck sentinel lymph nodes, which allows for minimally invasive incisions — essential to addressing the cosmetically sensitive area of the face and neck.
- Every facial skin cancer removal procedure is carefully planned with reconstruction in mind.
Surgery for Advanced Skin Cancer: What to Expect
Biopsy results are very important for melanoma and other advanced skin cancers of the face. The thickness, or depth of the cancer’s penetration into the skin’s layers, determines the margins — how much normal-appearing skin around the melanoma should be removed.
Depending on the biopsy results, we may also recommend that you undergo a sentinel lymph node biopsy, which tests the lymph node(s) close to the cancerous area and determines if the cancer has spread.
All cases of melanoma, Merkel cell carcinoma and advanced skin cancers are discussed at the Johns Hopkins Multi-disciplinary Cutaneous Malignancy Tumor Board.
Surgery to Remove the Cancer
You must get a preoperative physical exam within 30 days of your surgery date. You can arrange for the physical with your primary care physician or at the preoperative clinic at Johns Hopkins. Depending on your medical history, you may also need an anesthesia evaluation before your procedure.
Surgery is generally performed at an ambulatory surgery center as an outpatient, which means you can go home the same day. Depending on your general health, the surgery may take place in the hospital.
After the surgeon removes the cancerous tissue and surrounding margins, he or she will check carefully to see that no cancer remains. You will have bandages over the defect—the area where skin was cut away—to ensure the area stays clean until reconstruction.
Reconstructing the Face
For facial reconstruction, your surgeon’s goal is to achieve the best function and appearance possible. If only a small amount of tissue is removed, your surgeon may simply let the wound heal. However, for most advanced cancers, thorough removal of all the cancer and its surrounding skin may leave a substantial defect (area of missing tissue).
Your surgeon may repair the defect with a flap, which is a section of skin or tissue from a nearby area cut away, stretched and then moved to cover the defect. Or, you may require a skin graft, which involves a patch of skin removed from another part of the body and grafted onto the defect.
Some reconstructions require more than one operation: one to prepare the flap and move it into place, and another to smooth and sculpt the tissue for optimal function and appearance.
All procedures involve a certain amount of risk and limitations. Although the risks of skin cancer reconstruction are low, they can occur: Bleeding, infection, numbness, facial weakness, delayed wound healing, less-than-optimal appearance and other problems may occur. The risks are significantly increased in patients who smoke or those with a history of radiation therapy applied to the face, head or neck.
If your surgeon uses a skin graft for reconstruction, you will have a special bandage called a bolster dressing in place, which requires removal seven to 10 days after surgery.
Some patients return to work a week or two after their first postoperative visit. However, if you are undergoing a flap procedure or other approach that requires multiple stages, you will likely want to take off several weeks from work.
When your procedures are complete, your scar(s) will be red at first, and the redness will gradually fade over the course of one year. Protecting your face from sun exposure and using sunscreen are critical for minimizing lasting discoloration.
Our doctors are uniquely dual board certified in both otolaryngology — head and neck surgery and facial plastic and reconstructive surgery, which gives our team a unique and comprehensive level of expertise.
Shaun Desai, M.D.
Assistant Professor of Otolaryngology - Head and Neck Surgery
Lisa Ishii, M.D.
Professor of Otolaryngology - Head and Neck Surgery
Kofi Boahene, M.D.
Professor of Otolaryngology - Head and Neck Surgery
Patrick Byrne, M.D.
Professor and Director - Division of Facial Plastic and Reconstructive Surgery
Nasal Tip Surgical Reconstruction: Options After Mohs Surgery
Learn about three options for nasal tip reconstruction following Mohs surgery: local flap, skin graft and forehead flap, from Johns Hopkins facial plastic and reconstructive surgeon Patrick Byrne.