Principles of reconstruction following excision of nonmelanoma skin cancer

Then dealing with nonmelanoma skin cancers, the primary and most important goal is to obtain tumor-free margins. A perfect cosmetic result with positive surgical margins only increases the complexity of the problem. A ''wait and watch'' approach to positive surgical margins can have grave consequences and recurrence rates up to 30% are not acceptable. Several excellent studies have outlined surgical margins necessary for excision of primary nonmelanoma skin cancers.(4,18) Well-defined primary basal cell carcinomas less than 2 cm in diameter should be excised with 4.0 mm margins Po obtain a 95% cure rate.(18) Primary squamous cell carcinomas require 4.0 mm margins for low-risk tumors and 6.0 mm margins for high-risk tumors (greater than or equal to 2.0 cm; > II histologic grade; scalp, lip, ears, eyelids, nose; invasion into the subcutaneous tissue) to obtain a 95% cure rate.(4) For difficult or recurrent skin cancers, Mohs micrographic surgery has become the treatment of choice.(9,19) Once tumor-free margins have been established, reconstruction of the surgical wound (usually a single-stage procedure) can be performed with confidence. The complexity of the reconstructive surgery need not parallel the complexity of the surgical wound. In fact, the simplicity of the reconstructive surgery will often identify the more experienced surgeon. Whereas the novice surgeon will commonly attempt a complex approach to a simple wound, the more experienced surgeon will always seek the simplest approach even to the most complex wounds. In this article, we emphasize a simplified approach to reconstruction of wounds resulting from excision of nonmelanoma skin cancers. The same basic principles of tissue dynamics and surgical techniques that are used for simple primary closure can also be applied to reconstruction of more complex wounds. Finally, appropriate postoperative instructions and wound care are extremely important to achieve the optimal functional and cosmetic result.