Tumor-Related Determinants of Reconstructive Method After Excision of Facial Basal Cell Carcinoma

Basal cell carcinoma (BCC) is increasingly encountered in the context of population aging in Japan, and facial lesions frequently require reconstruction to preserve both function and appearance. This retrospective study analyzed 1149 facial BCCs treated with surgical excision at a single cancer center to describe reconstructive patterns and to identify factors influencing reconstructive method. Overall, local flap was the most frequently used reconstructive modality, followed by primary closure, skin graft, and secondary intention healing. In univariate analyses, tumors located at anatomical free-margin sites, larger tumor diameter, and aggressive histopathological subtypes were associated with increased use of flap or graft reconstruction. To identify factors independently associated with reconstructive method in clinically relevant settings, multivariate logistic regression analysis was performed among 649 cases in which primary closure was not feasible, comparing skin graft versus local flap reconstruction. Tumor diameter and histopathological subtype remained independently associated with reconstructive method. Specifically, larger tumor diameter and aggressive histopathological subtypes were independently associated with selection of skin graft reconstruction, whereas patient age, sex, and tumor location were not. These findings suggest that, when primary closure is not an option, tumor-centered factors-particularly tumor size and histopathological subtype-are associated with reconstructive strategy for facial BCC.