Dr. Dean Toriumi Performs Facial Reconstruction after Melanoma and Other Skin Cancers

    MARINA DEL REY, CA, January 16, 2010 /24-7PressRelease/ -- American Cancer Society reporting a doubling of the skin cancer rate in the last two decades, many of these among Baby Boomers.

More than a million cases of non-melanoma skin cancer diagnosed annually in the U.S. are thought to be related to exposure to the sun. Add the nearly 70,000 new melanoma cases projected in 2009, many of these sun-related, and it's clear that skin cancer is now more common than in any time in history.

When baby boomers were younger, the problems associated with sun exposure were not as well known. Use of sunscreen was not as prevalent, and tanning was very popular. Unfortunately, many of these sun worshipers are now acquiring facial skin cancers.

The most common sites for facial skin cancers include the nose, ears, and cheeks. The most common type of skin cancer is a basal cell cancer. These cancers only spread locally and do not spread to distant sites as can other more aggressive cancers. However, when patients present with facial skin cancers, they can be left with significant skin defects that require reconstruction.

One treatment for facial skin cancers is Mohs surgery, a micrographic technique designed to remove all parts of cancerous skin tumors while preserving as much healthy skin as possible. "Preserving healthy skin requires careful analysis of the tumor margins," says Dr. Dean Toriumi, a facial plastic surgeon at the University of Illinois at Chicago.

Dr. Dean Toriumi works closely with Mohs surgeons who remove the skin cancer with microscopic guidance to minimize the amount of normal tissue removed and to reduce chances of tumor recurrence. "Once the cancer is removed," Dr. Dean Toriumi adds, "patients are left with one or more facial defects that require reconstruction. Reconstruction may involve primary closure, use of a skin graft, or flap reconstruction," he said.

"The means of reconstruction used depends on the size and location of the defect. In some patients with superficial defects, the wound can be left to heal by itself but will usually leave a scar, and the healing can take several weeks. In most patients this type of 'healing by secondary intention' is not appropriate." says Dr. Toriumi.

"In some patients, skin grafting can be used to reconstruct facial defects," says Dr. Dean Toriumi . "Areas that can be treated with skin grafting include some areas of the nose and some eyelid defects. Defects that are more superficial can be successfully treated with skin grafts," Dr. Toriumi noted. "Typically the skin graft is harvested from in front of the ear. Skin grafts usually leave the patient with some differences in skin texture and skin coloration."

The first patient shown above had a right sided nasal defect closed with a skin graft. The postoperative outcome is good but does show mild skin contour irregularities.

In most patients, their defects are deep enough that they will require reconstruction using skin flaps, Toriumi said. "Skin flaps involve the geometric reorientation of adjacent or distant skin to the site of the defect to close it. Skin flaps that recruit adjacent skin usually do well, typically leaving the patient with some skin irregularity and asymmetries. However, these patients tend to heal quickly, and recovery is in a couple of days."

The second image above is a patient with skin cancer on her nose that was reconstructed using a bilobed transposition flap, which involves moving adjacent skin into the defect.

Some patients have very large defects that are too large to close with local skin and require transferring skin from an adjacent site, Toriumi said.

"Larger defects of the nose may require use of a forehead flap, which involves a multiple-stage reconstruction using forehead skin to reconstruct the nasal defect."

"In these cases, a flap of skin is transposed from the forehead to the nasal defect and left in place for three weeks. Then an intermediate stage debulking of the flap is performed," Toriumi said. "During this period there is a pedicle of skin that runs from the region of the medial brow to the site of the defect (see photo below). This intermediate period can be taxing to the patient, as he or she is visibly deformed. Three weeks later, the pedicle of skin from the forehead to the nose is divided and the closure of the defect is completed. On occasion an additional scar revision may be needed to maximize the outcome."

The third patient above had a very large nasal tip defect after resection of a recurrent basal cell cancer on his nasal tip. After reconstruction with a forehead flap, the patient has a reasonable result with some tissue color mismatch.

For more information on facial reconstruction after skin cancer, please call Dr. Dean Toriumi at (312) 255-8812 or email Pat Goldman, RN. at [email protected] or visit our website at http://deantoriumi.com/.

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