Skin Cancer And Oncologic Reconstruction

A 68-year-old man has a 1.4-cm recurrent basal cell carcinoma involving the nasal ala. The lesion has poorly defined borders and was previously treated with curettage. There is no clinical nodal disease. What is the most appropriate oncologic management before reconstruction?

A 72-year-old woman undergoes complete excision of a basal cell carcinoma from the nasal tip, leaving a 1.2-cm full-thickness skin defect with intact perichondrium and no exposed cartilage. The surrounding nasal skin is relatively lax, and the defect cannot be closed primarily without distortion. What is the most appropriate reconstruction?

A 70-year-old man undergoes excision of an invasive squamous cell carcinoma of the helical rim. The final defect measures 2.5 cm and includes skin and cartilage, but the posterior auricular skin remains healthy. What is the most appropriate reconstructive approach?

A 64-year-old man has a rapidly enlarging cutaneous squamous cell carcinoma of the temple with numbness extending into the forehead. Magnetic resonance imaging shows tumor tracking along a sensory nerve toward the skull base. What is the most appropriate next management step?

A 58-year-old woman presents with an irregular pigmented lesion on the upper back measuring 1.5 cm. Melanoma is suspected, but the depth is unknown and the lesion can be removed without functional deformity. What is the most appropriate initial procedure?

A 55-year-old man has a biopsy-proven melanoma of the calf with a Breslow thickness that meets criteria for regional nodal staging. There are no palpable lymph nodes or distant metastases. What is the most appropriate management at the time of definitive wide excision?

A 73-year-old man undergoes excision of a squamous cell carcinoma from the lower eyelid. Clear margins leave a full-thickness defect involving 60% of the horizontal lid length. The globe is intact. What is the most appropriate reconstructive principle?

A 66-year-old woman undergoes margin-negative excision of a scalp squamous cell carcinoma. The resulting 7-cm defect has exposed calvarium without intact pericranium. The patient is medically fit for reconstruction. What is the most appropriate reconstructive option?

A 69-year-old man undergoes excision of an aggressive squamous cell carcinoma of the cheek. Frozen sections remain positive at the deep margin adjacent to the parotid fascia. A cervicofacial flap has been designed but not elevated. What is the most appropriate next step?

A 62-year-old woman has a recurrent dermatofibrosarcoma protuberans of the shoulder after previous incomplete excision. Imaging shows a localized cutaneous and subcutaneous tumor without distant disease. What is the most appropriate surgical strategy?

A 72-year-old man presents with a recurrent 2.2-cm cutaneous squamous cell carcinoma involving the preauricular cheek. Examination shows fixation to the underlying tissue and weakness of the frontal branch of the facial nerve. Magnetic resonance imaging demonstrates extension toward the parotid gland without skull-base involvement. What is the most appropriate next management step?

A 65-year-old woman undergoes margin-controlled excision of a basal cell carcinoma from the lower nasal sidewall. The final defect measures 2.5 cm, extends to but does not include the alar rim, and has exposed cartilage with preserved internal lining. The surrounding nasal skin is tight. What is the most appropriate reconstruction?

A 58-year-old man has a biopsy-proven melanoma on the plantar heel. Excisional biopsy shows a Breslow thickness of 2.1 mm without distant disease. Wide excision will leave a weight-bearing defect with exposed plantar fascia. What is the most appropriate reconstructive strategy?

A 70-year-old immunosuppressed man presents with a 3-cm squamous cell carcinoma of the scalp. Imaging shows no bone invasion, but the lesion is poorly defined and located within a previously grafted burn scar. What is the most appropriate oncologic and reconstructive approach?

A 61-year-old woman undergoes wide excision of a soft-tissue sarcoma from the anterior thigh. The resection removes skin, subcutaneous tissue, and part of the quadriceps, leaving exposed femur and planned postoperative radiotherapy. What is the most appropriate reconstructive principle?

A 67-year-old man undergoes excision of a lower eyelid sebaceous carcinoma. Frozen sections confirm clear margins, but the resulting full-thickness defect involves 75% of the lower lid. The upper eyelid is healthy. What is the most appropriate reconstruction?

A 74-year-old man undergoes orbital exenteration for an advanced periocular squamous cell carcinoma. The orbital walls are intact, the margins are clear, and postoperative radiotherapy is planned. What is the most appropriate reconstructive option?

A 69-year-old woman undergoes excision of a recurrent squamous cell carcinoma involving the lateral lower lip and oral commissure. The defect includes skin, mucosa, and orbicularis muscle and measures approximately 40% of the lip width. What is the most appropriate reconstructive goal?

A 63-year-old man has a recurrent cutaneous squamous cell carcinoma involving the external auditory canal. Imaging shows extension into the cartilaginous canal without temporal bone invasion. What is the most appropriate management?

A 60-year-old woman undergoes wide excision of a high-grade sarcoma from the posterior shoulder. The defect includes skin, deltoid muscle, and exposed scapular bone. Final margins are negative, and adjuvant radiotherapy is planned. What is the most appropriate reconstruction?

A 68-year-old man undergoes margin-negative excision of a squamous cell carcinoma from the lateral forehead. The resulting 4-cm defect extends to the periosteum, and primary closure would elevate the eyebrow and distort the temporal hairline. The surrounding scalp and forehead tissue are mobile. What is the most appropriate reconstruction?

A 75-year-old woman undergoes excision of a basal cell carcinoma involving the upper lip philtrum. Clear margins leave a 1.5-cm skin and subcutaneous defect without mucosal or orbicularis oris loss. Direct closure would distort the Cupid’s bow. What is the most appropriate reconstructive approach?

A 64-year-old man has a biopsy-proven cutaneous squamous cell carcinoma on the radial aspect of the index finger. Wide excision leaves exposed bone and flexor tendon, but the digit remains perfused and sensate. What is the most appropriate reconstructive strategy?

A 59-year-old woman undergoes wide excision of a melanoma from the anterior lower leg. The defect measures 6 cm, exposes the tibia, and lies within a poorly vascularized field affected by chronic venous disease. What is the most appropriate reconstruction?

A 71-year-old man undergoes excision of a basal cell carcinoma from the lower nasal sidewall. The initial permanent pathology unexpectedly shows tumor at one peripheral margin after a local flap has already been inset. What is the most appropriate next management step?

A 66-year-old woman undergoes excision of a squamous cell carcinoma from the posterior trunk. The resulting 12-cm defect has exposed paraspinal muscle, a large dead space, and planned postoperative radiotherapy. Primary closure would be under substantial tension. What is the most appropriate reconstruction?

A 62-year-old man undergoes excision of a squamous cell carcinoma involving the lateral orbital rim and adjacent temple. The resection leaves exposed bone and a defect extending into the temporal fossa, but the globe and eyelids are preserved. What is the most appropriate reconstructive goal?

A 57-year-old woman undergoes wide excision of a recurrent abdominal wall sarcoma. The resection removes full-thickness skin, muscle, and fascia, leaving a 15-cm defect with exposed peritoneum but no bowel injury. What is the most appropriate reconstructive principle?

A 70-year-old man undergoes excision of a squamous cell carcinoma from the vertex scalp. The defect is 10 cm with exposed calvarium, and the surrounding scalp has been heavily irradiated and is poorly mobile. What is the most appropriate reconstruction?

A 65-year-old woman undergoes excision of a recurrent sarcoma from the groin. The defect exposes the femoral vessels and includes loss of overlying skin and soft tissue. Final margins are negative, and postoperative radiotherapy is planned. What is the most appropriate reconstruction?

A 69-year-old man undergoes margin-controlled excision of a basal cell carcinoma from the nasal dorsum. The final defect measures 1.8 cm, has intact perichondrium, and is surrounded by mobile nasal skin. Primary closure would create visible deviation of the nasal axis. What is the most appropriate reconstruction?

A 73-year-old woman undergoes excision of a squamous cell carcinoma involving the upper eyelid. Clear margins leave a full-thickness defect involving 45% of the lid width, while the lateral canthus and remaining tarsus are intact. What is the most appropriate reconstructive approach?

A 65-year-old man presents with a neglected ulcerated squamous cell carcinoma on the anterior chest wall. Imaging demonstrates invasion through the pectoralis muscle into two ribs but no distant metastases. What is the most appropriate treatment plan?

A 62-year-old woman undergoes wide local excision of a melanoma from the dorsum of the foot. The defect exposes extensor tendons with intact paratenon, and postoperative examination confirms adequate distal perfusion. A thin reconstruction is required to permit footwear. What is the most appropriate option?

A 70-year-old man undergoes excision of a squamous cell carcinoma from the cheek. The defect includes the oral mucosa and creates a communication between the oral cavity and external skin. There is no mandibular bone loss. What is the most appropriate reconstructive principle?

A 56-year-old woman undergoes wide excision of a malignant peripheral nerve sheath tumor from the upper arm. Tumor clearance requires sacrifice of a short segment of the radial nerve, while the proximal and distal nerve ends remain available and the soft-tissue bed is well vascularized. What is the most appropriate reconstructive strategy?

A 74-year-old man undergoes excision of a large posterior scalp squamous cell carcinoma with partial-thickness outer-table calvarial involvement. The involved outer table is burred to healthy bleeding bone, and the pericranium is absent. The patient is medically frail and cannot tolerate prolonged microsurgery. What is the most appropriate reconstruction?

A 61-year-old man undergoes resection of an oral commissure squamous cell carcinoma. Clear margins leave a full-thickness defect involving the commissure and adjacent upper and lower lip, but enough orbicularis muscle remains on both sides. What is the most appropriate reconstructive objective?

A 68-year-old woman undergoes excision of a recurrent basal cell carcinoma from the nasal root and medial canthus. The final defect exposes bone and lies adjacent to the lacrimal sac. The lacrimal drainage system is intact, and postoperative radiotherapy is not planned. What is the most appropriate reconstruction?

A 59-year-old man undergoes wide excision of a recurrent soft-tissue sarcoma from the popliteal fossa. The defect exposes the popliteal vessels and tibial nerve, and postoperative radiotherapy is planned. Knee motion is currently preserved. What is the most appropriate reconstruction?

A 76-year-old man undergoes resection of an advanced scalp squamous cell carcinoma involving the full thickness of the calvarium. The dura is intact but exposed over a 6-cm area, and postoperative radiotherapy is anticipated. What is the most appropriate reconstructive strategy?

A 68-year-old woman undergoes margin-negative excision of a basal cell carcinoma involving the central nasal ala. The defect measures 1.3 cm and includes external skin and part of the alar cartilage, but the internal nasal lining remains intact. What is the most appropriate reconstruction?

A 64-year-old man undergoes wide excision of a high-risk cutaneous squamous cell carcinoma from the preauricular region. Tumor clearance requires sacrifice of a segment of the main facial nerve trunk, and both proximal and distal nerve ends are available. The defect will be covered with a vascularized flap. What is the most appropriate facial reanimation strategy?

A 71-year-old man undergoes excision of a cutaneous squamous cell carcinoma from the lower eyelid and cheek. The posterior eyelid lamella remains intact, but the anterior lamellar defect extends vertically onto the cheek. What is the most important reconstructive maneuver to reduce postoperative ectropion?

A 60-year-old woman undergoes wide excision of a recurrent dermatofibrosarcoma protuberans from the abdominal wall. Permanent sections show a focally positive deep margin beneath a large rotational flap that was placed at the same operation. What is the most appropriate management?