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Chapter 17
Skin Cancer
The great majority of skin cancers arising on the skin of the face, scalp,
and neck are basal cell carcinoma , followed by squamous cell carcinoma,
then malignant melanoma. Basal cell carcinoma is very common and
most often occurs on the face, so the otolaryngologist–facial plastic sur-
geon sees many cases.
The typical basal cell carcinoma is a nodular lesion with a raised, pearly-
white border. These lesions are usually brought to the physicians’ atten-
tion before they become very large. They do not metastasize and can be
treated in a variety of ways. Dermatologists may freeze or curette them.
When the patient is referred to an otolaryngologist–head and neck sur-
geon, the lesions are usually excised with a three- to
four-mm margin, followed by a meticulous closure
of the defect, which occasionally requires a rotation
or advancement flap from the neighboring skin.
These flaps restore cosmetic integrity to the facial
unit affected by the tumor.
Another approach to resecting basal cell and some
squamous cell cancers involves Mohs’ fresh tissue
chemosurgery technique. This technique requires
tumor mapping: using small, sequential tumor
resection in layers with immediate pathologic exam-
ination under a microscope to ensure complete
removal. This technique takes significantly longer
than any of the other methods, but the recurrence
rate can be lower. For this reason, certain tumors
with a higher-than-usual chance of recurrence with
conventional excisions may be better managed with
Mohs’ surgery. It is also performed near cosmeti-
cally and functionally sensitive structures, such as
the eyelids, nose, and ears, in order to preserve as
Figure 17.1.
Very large basal cell
carcinoma of the facial skin.
Note the rolled edges with
central ulceration, indicating
subepithelial extension.
Excision must ensure that the
tumor is completely removed
or recurrence is highly likely.