Fig. 13.1
(a) 95 year old male presented with a LM on the nasal tip. (b, c) An excision with narrow margins was performed and repaired with a porcine xenograft followed by 12 weeks of topical imiquimod to treat any residual disease. (d) Patient had a satisfactory result at 12 months postoperatively
In a study evaluating responses of patients with facial skin cancers, all patients were concerned with removal of the skin cancer. However, some patients experienced continued distress over the appearance of their scar, as well as anxiety during early postoperative sequelae such as edema and a large bandage [4]. Patient-reported outcomes have not been studied specifically in the facial LM/LMM population, but some of these findings may be extrapolated to this population due to the propensity of LM/LMM to occur on sun damaged skin.
Reconstruction Considerations
Reconstruction following a surgical procedure should be a consideration in the informed decision-making discussion. While a staged reconstructive procedure may offer the optimal cosmetic outcome, some patients with medical comorbidities may opt for a less invasive approach yielding a less than ideal aesthetic result. The ability of wounds to heal by secondary intention must not be overlooked and can be a very reasonable option for patients unwilling or unable to undergo reconstruction, as demonstrated in Fig. 13.2.
Fig. 13.2
(a) 87 year old man with a 0.4 mm LMM on the nasal dorsum who chose treatment with staged excision. (b) Surgical defect with clear margins. (c) Patient declined reconstruction due to multiple medical comorbidities and the defect healed by secondary intent. He had a reasonable result at 4 months postoperatively
Anticipated aesthetic outcome following tumor excision and reconstruction should be comprehensively discussed. An elderly patient who would potentially need to undergo a disfiguring surgery may choose to observe a lesion or opt for a less invasive approach rather than live out their final years with a significantly altered facial appearance. The use of facial prosthetics should also be considered in cases of extensive LMM in which very large defects result or entire anatomic units such as the ear or nose are removed.
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