Reconstruction of Large Facial Defects after Delayed Mohs Surgery for Skin Cancer

The face is a common localization for skin malignancies. Mohs surgery or delayed Mohs surgery are considered the gold standard of treatment despite new drug developments. We analyzed our patient files over a three-year period. Only large facial defects ≥3 cm in diameter after complete tumor removal were considered. Twenty patients (9 men and 11 women) were found, with a mean age of 83.6 years. The following tumor entities were responsible for large defects: basal and squamous cell carcinoma, melanoma, Merkel cell carcinoma, atypical fibroxanthoma, and cutaneous angiosarcoma. Surgery was performed in all cases using regional or local anesthesia. Defect repair was done using linear sutures (n=1), skin grafts (n=1), and flaps (n=18). The various types of repair are illustrated in this review, advantages and limitations of each type of repair are discussed. Patient satisfaction was high. Complications or adverse events were rare. The need for repair of large facial defects after tumor surgery is not uncommon. Careful planning and the use of a number of techniques allows a tailored approach for each patient.