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Not every skin cancer excision requires input from a plastic surgeon, but location can make a significant difference. Lesions around the eyelids, nose, lips, and ears sit close to structures that affect both appearance and function, which means the way a defect is closed can matter more than in other areas of the body.
In these cases, a GP or dermatologist may refer patients to a plastic surgeon either before excision, to plan reconstruction from the outset, or afterwards, once a defect has been identified that needs specialist repair.
Options: Excision, Closure, and Reconstruction Pathways
Treatment for a facial skin cancer generally begins with excision, where the lesion and a margin of surrounding tissue are removed and sent for pathology to confirm that the cancer has been fully cleared. The size of this margin depends on the type of skin cancer involved and its characteristics, and is determined on a case-by-case basis rather than a fixed rule.
Once the lesion has been removed, the resulting defect needs to be closed, and the appropriate approach depends largely on its size, depth, and location. Options generally fall into a few categories:
- Direct closure. For smaller defects, the edges of the wound can often be brought together and closed directly, generally resulting in a simpler recovery and a fine-line scar.
- Skin grafts. Where a defect is larger, or the surrounding skin cannot be stretched to close it directly, a graft using skin from another part of the body may be used to cover the area.
- Local flaps. In many facial cases, particularly around the nose, eyelids, and lips, a local flap, which uses nearby tissue along with its own blood supply, can offer a closer match in skin colour, texture, and thickness than a graft, while helping to preserve the shape and function of the area.
The choice between these options is rarely straightforward, and reflects a balance between removing the cancer completely, preserving function, and achieving an acceptable cosmetic result. You can read more about the full range of facial skin cancer surgery options, and where Mohs surgery has already been performed elsewhere.
Risks Around Eyelids, Nose, Lips, and Ears
Skin cancer excision and reconstruction carry risks wherever they are performed, but certain facial sites warrant particular care because of how delicate and functionally important they are. The eyelids, nose, lips, and ears each present their own considerations.
- Eyelids. Reconstruction here must protect the eyelid’s role in covering and lubricating the eye. Poorly planned closure can pull the eyelid out of position, potentially affecting blinking, tear drainage, or corneal protection, alongside the usual risks of infection, bleeding, and scarring.
- Nose. The nose has limited surrounding skin laxity and a complex three-dimensional shape, which means even modest defects can be technically challenging to close without affecting symmetry or airflow.
- Lips. Reconstruction around the lips needs to account for both appearance and the muscle function involved in speech and eating, since even small changes in tissue tension can affect movement.
- Ears. The ear’s cartilage framework and thin skin covering mean that reconstruction options are more limited than in some other areas, and changes in shape or contour can be more noticeable.
Beyond these site-specific concerns, general risks such as infection, bleeding, altered sensation, and unpredictable scarring apply as they would with any excision or reconstruction. Dr Flood discusses these risks individually for each patient, taking into account the exact location and size of the lesion, so that you understand what is involved, what the realistic range of outcomes looks like, and what would happen if further treatment were needed, before deciding to proceed.
Recovery and Follow Up
Recovery time and follow-up needs depend on the size and location of the area treated. Pathology results are typically reviewed with you once available, and further treatment or monitoring is planned based on those findings.
Referral Pathway
If your GP or dermatologist has raised the possibility of a facial skin cancer that may need surgical input from a plastic surgeon, a referral is generally the next step. This referral pathway helps ensure that any relevant history, prior test results, or imaging are shared ahead of your consultation, so that Dr Flood can review your case with the full picture in mind before you meet.
If a lesion’s location or complexity means specialist reconstruction may be needed, your GP or dermatologist can advise on the appropriate timing for this referral, whether that is before excision, to plan reconstruction from the outset, or afterwards, once the extent of the defect is known.
Questions for Your GP or Dermatologist
Useful questions to raise at this stage include:
- Does the location of my lesion mean reconstruction is likely to be complex?
- Would you recommend a referral to a plastic surgeon before excision, so reconstruction can be planned from the outset, or afterwards, once the defect is known?
- What should I expect from the pathology process, and how long will results take?
- What does the follow-up process typically involve after excision?
- Are there any features of my specific lesion that make specialist input more important?
For general background reading, Cancer Council Australia, Healthdirect Australia, and the Royal Australasian College of Surgeons patient resources provide independent information on skin cancer and surgical care.
Ask About a Referral for Specialist Facial Skin Cancer Repair
If lesion site, closure complexity, or function may need specialist repair, ask your GP or dermatologist about a referral, or contact Dr John Flood’s practice for more information.
