Skin Cancer Reconstruction

Overview

Skin cancer is an unfortunate, albeit fairly common, problem that can affect any part of the body. It is of particular concern when it affects the face and nearby structures due to the possible impact to an individual’s facial appearance and function. Common techniques for surgical removal of skin cancers that are often employed on other parts of the body (such as wide local excision, which can result in oversized defects) are often not ideal for surgical removal of skin cancers of the face. Mohs micrographic surgery, performed by a fellowship-trained dermatologist, is a highly specialized technique that results in a highest cure rates with the smallest possible defects.

Large and/or recurrent skin cancers of the face and head present multiple challenges for patients and surgeons. First, removing the cancer with the best chance of permanent cure requires full surgical margin clearance and coordination of additional care (e.g., radiation therapy) as needed. Additionally, large skin and soft tissue defects created by removal of the tumor require complex and often multi-stage reconstruction to achieve an acceptable appearance.

It is well established that dermatologic surgeons using Mohs margin techniques provide the best chance for control of skin cancers. This method allows for confident reading of 100% of the tissue edges surrounding the tumor to ensure full removal of cancerous cells. However, at most hospitals, coordination of this technical tissue read with large cancer removal and reconstruction under anesthesia is not logistically possible. As a result, many larger cancers receive less reliable oncologic management.

At Cleveland Clinic, we have an established, coordinated approach which combines the expertise of dermatologic and cancer surgeons with reconstructive surgeons. This allows for the best tumor removal and simultaneous facial reconstruction under one anesthesia.

In addition, we have experts in secondary reconstruction and scar revision. Our goal in all instances is to make reconstructions unnoticeable and restore normal appearance and function for our patients.

Our Doctors

Reconstructive Surgeons

Patrick Byrne, MD, MBA

Chair, Head & Neck Institute

Peter Ciolek, MD

Facial Plastic and Reconstructive Surgeon

Michael Fritz, MD

Section Head, Facial Plastic and Microvascular Surgery

Dane Genther, MD

Facial Plastic and Reconstructive Surgeon

Raffi Gurunian, MD, PhD

Staff

Jamie Ku, MD

Staff

Eric Lamarre, MD

Associate Staff

Sara Liu, MD

Associate Staff

Brandon Prendes, MD

Staff

Graham Schwarz, MD

Program Director, Microsurgery Fellowship & Vice Chair, Quality

Dermatologic Surgeons

Jennifer Lucas, MD, MHCM

DPSI Quality and Patient Safety Officer

Jon Meine, MD

Staff

Christine Poblete-Lopez, MD

Vice Chair, Department of Dermatology

Allison Vidimos, MD

Retired Contract Staff

Alok Vij, MD

Director, Dermatology Residency Program

Oculoplastic Surgeons

Catherine Hwang, MD

Staff: Orbital and Oculofacial Surgery

Julian Perry, MD

Staff: Orbital and Oculofacial Surgery

Conditions and Treatments

• Eyelid reconstruction.
• Lip reconstruction.
• Mohs Surgery.
• Nasal reconstruction.
• Scar revision.
• Skin cancer (advanced and/or recurrent).
  • Basal cell carcinoma.
  • Squamous cell carcinoma.
  • Melanoma.

Appointments

Make an Appointment

Cleveland Clinic Center for Facial Reconstruction and Facial Nerve Disorders offers consultations at Cleveland Clinic's main campus.

Phone: 216.445.9259
Email: FacialReconCenter@ccf.org

After you call to arrange an initial appointment with our team, one of our providers will reach out to you to perform a pre-visit intake. Please make arrangements to have copies of prior imaging, imaging reports, operative notes, laboratory studies, pathology reports, and consult notes available that you would like us to review prior to your appointment.

Virtual Visits

You can now stay connected to your healthcare team through virtual visits, using your smartphone, tablet or computer.

Why go virtual? It's an easy, convenient and secure way to see your provider face-to-face without having to leave home. This saves you travel time, parking fees and time spent in the waiting room — and you can also have a loved one or caregiver join you. If appropriate, you can also get a prescription sent to the pharmacy of your choice.

Many insurance companies cover the cost of virtual visits, so check with your insurance company ahead of time. Interested in getting started? Call your provider to find out what virtual visit options are available.

• Learn more about virtual visits for scheduled appointments.

MyChart

A secure online tool connecting patients to their own health information from the privacy of their home.

• Learn more at MyChart

The MyChart • Caregiver service, an optional feature in MyChart, allows you to view family members' records. When clicking on a particular name, you will access that family member's MyChart account.

Whether you have caregiver access over one family member or several, you can view this list in MyChart under “My Family’s Record.”

Before & After Photos

1 of 12

• Close Up View: This 69 year old woman with an advanced basal cell carcinoma of the central upper lip and the nasal base was resected with full margin clearance. She underwent reconstruction with local flaps and ear cartilage grafts.

• Front View: This 69 year old woman with an advanced basal cell carcinoma of the central upper lip and the nasal base was resected with full margin clearance. She underwent reconstruction with local flaps and ear cartilage grafts.

• Side View: This 69 year old woman with an advanced basal cell carcinoma of the central upper lip and the nasal base was resected with full margin clearance. She underwent reconstruction with local flaps and ear cartilage grafts.

• Side View: This 76 year old patient with extensive skin cancer of the forehead extending into the upper eyelid and skull base. After a resection, he underwent reconstruction with free anterolateral thigh (ALT) fascia flap and skin graft with blood supply accessed through a small facelift incision.

• Close Up View: This 67 year old patient with recurrent skin cancer of the nose, cheek and upper lip underwent combined management in the operating room to achieve full tumor clearance (Moh's margins). He then underwent nasal reconstruction with free anterolateral thigh (ALT) flap for cheek contour and nasal lining and movement of adjeacent skin for coverage. Nasal resonstruction was performed with rib cartilage wrapped with fascia from the ALT flap, a technique developed at Cleveland Clinic, and forehead flap for external coverage.

• Front View: This 67 year old patient with recurrent skin cancer of the nose, cheek and upper lip underwent combined management in the operating room to achieve full tumor clearance (Moh's margins). He then underwent nasal reconstruction with free anterolateral thigh (ALT) flap for cheek contour and nasal lining and movement of adjeacent skin for coverage. Nasal resonstruction was performed with rib cartilage wrapped with fascia from the ALT flap, a technique developed at Cleveland Clinic, and forehead flap for external coverage.

• Side View: This 67 year old patient with recurrent skin cancer of the nose, cheek and upper lip underwent combined management in the operating room to achieve full tumor clearance (Moh's margins). He then underwent nasal reconstruction with free anterolateral thigh (ALT) flap for cheek contour and nasal lining and movement of adjeacent skin for coverage. Nasal resonstruction was performed with rib cartilage wrapped with fascia from the ALT flap, a technique developed at Cleveland Clinic, and forehead flap for external coverage.

• Front View: This 61 year old patient had recurrent cancer of the nose and septum after radiation therapy. He underwent total nose, total septum and upper lip resection. Reconstruction was performed with a rib bone and cartilage scaffold wrapped with an anterolateral thigh fascia lata flap, techniques that were developed at Cleveland Clinic, as well as a forehead flap for nasal coverage.

• Side View: This 61 year old patient had recurrent cancer of the nose and septum after radiation therapy. He underwent total nose, total septum and upper lip resection. Reconstruction was performed with a rib bone and cartilage scaffold wrapped with an anterolateral thigh fascia lata flap, techniques that were developed at Cleveland Clinic, as well as a forehead flap for nasal coverage.

• Front View: This 54 year old patient underwent resection of a recurrent melanoma of the nose which included near total removal of the nose and septum. Reconstruction was performed with a rib bone and cartilage scaffold wrapped with an anterolateral thigh fascia lata flap, techniques developed at the Cleveland Clinic, and a forehead flap for nasal coverage.

• Side View: This 54 year old patient underwent resection of a recurrent melanoma of the nose which included near total removal of the nose and septum. Reconstruction was performed with a rib bone and cartilage scaffold wrapped with an anterolateral thigh fascia lata flap, techniques developed at the Cleveland Clinic, and a forehead flap for nasal coverage.