Cheek (Cancer and Reconstruction)
Description
Ulcerated lesion over the right cheek malar eminence abutting the lower eyelid–cheek junction.
Following resection, full-thickness defect of the inferior lid–cheek junction that involves
Lower eyelid: Preseptal orbicularis muscle and orbital septum.
Suborbital cheek: Skin, fat, SMAS (superficial musculoaponeurotic system).
Moderate skin laxity on examination.
Work-up
History
Malignancy: Timeline of presentation.
History of sun and environmental exposure.
Personal and family history of skin cancer.
Genetic conditions: Xeroderma pigmentosum, Gorlin (nevoid basal cell) syndrome, albinism.
Complicating comorbidities
Cardiopulmonary/peripheral vascular disease, diabetes, obesity, tobacco use, prior irradiation, previous surgery, anticoagulation.
Physical examination
Full-body integument examination.
Lymph node examination to rule out concern for metastatic disease.
Wound characteristics (hair-bearing areas, adjacent skin laxity).
Subunit involvement (Fig. 10.2)
Facial subunits may be utilized to guide reconstruction.
Reconstruction based on correction of facial subunits.
Cheek may be considered one large subunit or it may be divided into zones.
Diagnostic studies
Full-thickness incisional versus excisional biopsy may be performed. Avoid shave biopsies.
Biopsy any other suspicious skin lesions (if previously not performed)
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