Cheek and inferior eyelid reconstruction after skin cancer ablation

Most patients with actinic lesions and skin cancer are skin type I or II, older than 50 years of age, and have a history of extensive sunlight exposure. These patients have been treated in our units according to universal principles. A multidisciplinary team approach can produce encouraging long-term results. The size and depth of the lesion are assessed in planning the ablation. The residual defect after the tumor resection is anticipated in the preoperative plan. Adequate resection is mandatory, even if the reconstruction must be delayed to ensure clear margins. Attention to unit and subunit anatomy facilitates adequate reconstruction with acceptable deformity. Placing scars in borders or along the lines of minimal skin tension reduces deformity. Planning the flap so that the donor site is in tissue areas with maximum laxity guards against donor site deformity. Flaps must be planned to avoid excess tension on the lower lid and central face. Attempts should be made to reduce scarring in the central face as seen in the frontal view. Respecting these principles will allow for reconstruction of the largest facial unit in a manner acceptable to the patient.