Efficacy and Cosmetics of Secondary Intention Healing for Facial Skin Cancer: A Single-Center Retrospective Study

Reconstruction after facial skin cancer excision requires balancing oncologic safety with cosmetic outcomes. Secondary intention healing (SIH) is a simple and cost-effective wound management approach that avoids complex reconstruction and permits close oncologic surveillance; however, it remains underutilized because of concerns regarding prolonged healing and unpredictable cosmetic results. Moreover, whether evidence derived primarily from Western populations can be extrapolated to Asian patients remains unclear. In this retrospective study, we reviewed 129 Japanese patients who underwent facial skin cancer excision, including 103 basal cell carcinomas and 26 squamous cell carcinomas. Among them, 87 patients were treated with SIH and 42 with surgical closure (SC). Cosmetic outcomes were evaluated in 48 patients by 10 independent evaluators using standardized postoperative photographs obtained approximately 1 year after surgery and assessed with a three-point scale ('noticeable', 'noticeable on close inspection', and 'not noticeable'). In the SIH group, the mean time to epithelialization was 39.51 ± 16.42 days, and defect size showed a significant positive correlation with epithelialization time. The median cosmetic score was 6.5 in the SIH group and 7.5 in the SC group, with no significant difference between groups (p = 0.755). Receiver operating characteristic curve analysis demonstrated that defects ≤ 14 mm in size were associated with a higher likelihood of favorable cosmetic outcomes. In univariate analysis, smaller defect size and concave surfaces of NEET (nose, eye, ear, and temple) location were associated with favorable cosmetic outcomes, whereas multivariate analysis identified defect size and female sex as independent predictors of unfavorable outcomes. These findings suggest that SIH is a cosmetically acceptable and clinically feasible reconstructive option after facial skin cancer excision in Japanese patients, in carefully selected cases with respect to sex, defect size and tumor location.