Skin Cancer Surgery An Issue of Facial Plastic Surgery Clinics 2019 PDF

Preface: State-of-the-Art in Skin Cancer Surgery xiii
Jeffrey S. Moyer
Nonmelanoma Skin Cancer 1
Michael G. Brandt and Corey C. Moore
This article reviews the most common nonmelanoma skin cancers affecting the head
and neck region. Although the most common of these malignancies rarely result in
mortality, local morbidity caused by the tumors and their extirpation cannot be
underestimated. Complete tumor extirpation with pathologically confirmed negative
margins is the gold standard. Regional and distant metastases are rare, but must be
treated appropriately should they occur. Although reconstructive surgery can be life
changing for the patients and rewarding for the clinicians, it behooves the treating
surgeons to remain true to oncologic principles above all else.
Mohs Micrographic Surgery 15
Emily Wong, Eileen Axibal, and Mariah Brown
Mohs micrographic surgery (MMS) is the gold standard for treating various cutaneous
tumors. MMS has evolved into a single-day, outpatient procedure. The tumor is
excised, mapped, and processed with frozen, horizontal sections for immediate histologic
evaluation. The process is repeated as necessary until the tumor is completely
removed, with maximal conservation of normal tissue. Evaluation of 100% of the surgical
margin allows for exceptional cure rates. The Mohs surgeon is trained in
tumor excision, histopathology interpretation, and surgical reconstruction. The use
of MMS is often part of a multidisciplinary approach to treating cutaneous tumors.
Management of Early-Stage Melanoma 35
Maria J. Quintanilla-Dieck and Christopher K. Bichakjian
Melanoma is a potentially aggressive skin cancer with a steadily rising incidence.
Most melanomas are diagnosed at an early stage and associated with an excellent
prognosis when treated appropriately. Primary treatment for melanoma is surgical.
Wider surgical margins and a variety of techniques for comprehensive histologic
margin assessment may be considered for lentigo maligna type melanoma on the
head and neck, due to characteristic broad subclinical extension. For invasive melanoma,
sentinel lymph node biopsy may be indicated for staging, and to guide
further management and follow-up. Appropriate treatment guidelines for earlystage
melanoma are reviewed and discussed.
Reconstruction of the Nose 43
Andrew W. Joseph, Carl Truesdale, and Shan R. Baker
Nasal reconstructive techniques have advanced significantly over the past 50 years.
Modern techniques in nasal reconstruction are based on the nasal aesthetic subunits.
In order to achieve ideal outcomes, reconstructive surgeons must consider
differences in tissue qualities across the nasal aesthetic subunits and formulate
reconstructive plans based on these differences. Local flaps, skin grafts, and several
types of interpolated flaps comprise the most commonly used techniques for nasal
Skin Cancer Treatment
reconstruction. Defects that involve structural or internal lining defects require
reconstruction of significantly higher complexity.
Reconstruction of the Cheek 55
Nathan D. Cass and Adam M. Terella
The goal of cheek reconstruction is to restore an illusion of “normal.” Attention must
be directed toward the contralateral cheek skin color, texture, thickness, and contour,
because this serves a template for reconstruction. The cheek is a peripheral
facial subunit and largely frames the more central subunits (eyelids, nose, lips). As
such, avoiding distortion or disfigurement of the central subunits is of paramount
importance. The cheek possesses significant tissue laxity, elasticity, and mobility,
thus allowing for the vast majority of cheek defects to be addressed with primary
closure, local flaps, or locoregional flaps.
Reconstruction of Defects Involving the Lip and Chin 67
Katie Geelan-Hansen, Joseph Madison Clark, and William W. Shockley
Successful perioral reconstruction is the result of consideration of both functional
and esthetic goals. The lips are complex esthetic units with multiple tissue layers
and distinct anatomic landmarks. Reconstruction can be difficult due to variables
affecting the defect, such as size, depth, location, and involvement of adjacent subunits.
There are many local flaps that can be used to match the complex tissue layers
and anatomic landmarks. Use of the same reconstructive principles can be applied
to secondary reconstruction to attain a successful outcome. This article focuses on
local reconstructive options for defects of the lip and chin.
Reconstruction of the Forehead and Scalp 85
Benjamin D. Bradford and Judy W. Lee
Tissue inelasticity and the hair-bearing nature of the scalp and forehead pose unique
challenges during reconstruction. A thorough understanding of the surgical anatomy
of the scalp and forehead is paramount for optimal reconstructive outcomes. Primary
wound closure is usually preferred over secondary intention healing and skin
grafting. Use of dermal alternatives and tissue expansion are adjunctive therapies
to facilitate scalp wound closure. Local skin and soft tissue flaps are commonly
used for most small to medium defects; however, microsurgical free tissue transfer
can be considered for large full-thickness skin defects of the forehead and scalp.
Reconstruction of the Ear 95
Ryan M. Smith and Patrick J. Byrne
Skin cancer is a common indication for reconstructive surgery of the ear. The unique
anatomy of the external ear makes the restoration of form and function challenging for
the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines
the goals of reconstruction, outlines the assessment of defects based on location,
and describes specific surgical techniques useful in auricular reconstruction.
Periocular Reconstruction 105
Kira L. Segal and Christine C. Nelson
Options for periorbital reconstruction include primary wound closure, local flaps,
regional/distant flaps, or full-thickness skin grafts. Optimal aesthetic and functional
outcomes are achieved by assessing regional contours, skin type, and facial
aesthetic units. Like tissue should replace like tissue; for example, skin with skin,
tarsus with tarsus (or equivalent material, eg, hard palate, ear cartilage, or autologous
substitute), and conjunctiva with mucous membrane or like substitute (buccal
mucous membrane, amniotic membrane). Patient characteristics including wound
care needs, transportation needs, smoking status, and history of radiation can influence
the reconstruction plan. Techniques most commonly used in our practice are
reviewed.
The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous
Malignancies 119
Faisal I. Ahmad, Shirley Y. Su, and Neil D. Gross
Sentinel lymph node biopsy uses the concept of selective lymphatic drainage and
the lymphatic microvasculature to identify first-echelon nodes draining a given malignancy.
Although initially considered difficult and unreliable in the head and neck,
experience with the technique has improved and evolved significantly over the last 3
decades. It is now recognized to be accurate and reliable for regional nodal staging
and detection of occult nodal metastasis in the head and neck. Although initially
described for nodal staging of melanoma, the usefulness of sentinel lymph node biopsy
continues to expand and is now extended to other cutaneous malignancies as
well as mucosal malignancies of the oral cavity and oropharynx.
Radiotherapy for Skin Cancers of the Face, Head, and Neck 131
Michelle L. Mierzwa
Radiotherapy plays a role in the definitive or adjuvant management of early and late
stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous
squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy
in skin cancers of the head and neck is reviewed including early and
advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma.
In particular, the indications, oncologic outcomes, and technical aspects of
radiotherapy for these diseases are discussed.
Adjuvant and Neoadjuvant Treatment of Skin Cancer 139
Assuntina G. Sacco and Gregory A. Daniels
Skin cancer represents a broad classification of malignancies, which can be further
refined by histology, including basal cell carcinoma, squamous cell carcinoma and
melanoma. As these three cancers are distinct entities, we review each one separately,
with a focus on their epidemiology, etiology including relevant genomic
data, and the current evidence-based recommendations for adjuvant and neoadjuvant
therapy. We also discuss future directions and opportunities for continued therapeutic
advances.
Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction 151
Kyle K. VanKoevering, David A. Zopf, and Scott J. Hollister
Three-dimensional (3D) printing has transformed craniofacial reconstruction over the
last 2 decades. For cutaneous oncologic surgeons, several 3D printed technologies
are available to assist with craniofacial bony reconstruction and preliminary soft
tissue reconstructive efforts. With improved accessibility and simplified design
software, 3D printing has opened the door for new techniques in anaplastology. Tissue
engineering has more recently emerged as a promising concept for complex
auricular and nasal reconstruction. Combined with 3D printing, several groups
have demonstrated promising preclinical results with cartilage growth. This article
highlights the applications and current state of 3D printing and tissue engineering
in craniofacial reconstruction.
Health Outcome Studies in Skin Cancer Surgery 163
Cristen E. Olds and Jon-Paul Pepper
As cutaneous cancers are the most common malignancies affecting US citizens,
they represent a significant public health problem and health care cost burden.
There are a variety of treatment options available to manage cutaneous malignancies,
but limited data are available regarding outcomes, including quality of
life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery
as they relate to sociodemographic data and treatment factors.
Skin Cancer Surgery An Issue of Facial Plastic Surgery Clinics 2019 PDF Ebook

JEFFREY S. MOYER, MD, MS, FACS
Professor and Division Chief, Division of Facial
Plastic and Reconstructive Surgery,
Department of Otolaryngology–Head and Neck
Surgery, University of Michigan, Ann Arbor,
Michigan, USA