Confirmed skin cancer
Patients with biopsy-proven BCC, SCC, or another skin malignancy may need discussion of treatment options, margin assessment, and reconstruction. The diagnosis and risk features guide the plan.
Skin Cancer & Reconstruction
Surgical treatment of skin cancer may leave a defect that requires careful reconstruction. Planning begins with the diagnosis and appropriate cancer treatment, followed by consideration of tissue coverage, function, appearance, and the need for ongoing surveillance.
Understand the TreatmentUnderstanding skin cancer
Cancer treatment comes first.
Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) are common forms of skin cancer. Their behaviour, risk of recurrence, and potential for spread differ. Other skin cancers require different assessment and treatment pathways. A suspicious lesion should be evaluated rather than assumed to be benign or suitable for cosmetic removal.
Diagnosis may involve clinical examination, dermoscopy, biopsy, or review of existing pathology. The treatment plan considers the tumour type, location, size, depth, previous treatment, risk features, and the patient's overall health. Further investigation or specialist referral may be necessary.
The method of cancer treatment is selected according to the diagnosis and available clinical resources. Reconstruction must not compromise adequate tumour treatment or the ability to assess margins and provide further treatment when required.
Who may need assessment
When is surgical assessment appropriate?
Patients may be referred with a confirmed diagnosis, a suspicious lesion, or a defect following cancer treatment. The appropriate pathway depends on the clinical findings and whether additional diagnostic or oncological care is needed.
Suspicious or changing lesions
A new, changing, bleeding, non-healing, or otherwise concerning lesion should be assessed. Examination and appropriate biopsy or referral may be needed before definitive treatment is planned.
Defects after tumour removal
Patients may require reconstruction after excision or margin-controlled surgery performed by another specialist. The pathology, wound condition, and need for further treatment are important to review.
A rapidly changing lesion, significant bleeding, or a lesion affecting vision, breathing, or another important function warrants timely medical assessment. Online enquiries are not an emergency service.
Individual surgical planning
The diagnosis and resulting defect guide the plan.
Assessment includes the pathology and previous treatment, tumour location and extent, medical history, and the structures that may be affected. The surgical plan considers the need for adequate tumour removal, the method of margin assessment, and whether reconstruction can safely be performed at the same operation or should be delayed.
In the head and neck, reconstruction may need to preserve eyelid position and eye protection, nasal airway and support, lip competence, or the contour and function of the ear. Defect size alone does not determine the reconstructive technique; depth, tissue quality, blood supply, and surrounding anatomy are also important.
Cancer treatment and margin assessment
Options may include conventional surgical excision or margin-controlled techniques such as Mohs micrographic surgery when indicated and available. The appropriate approach depends on tumour characteristics, risk, location, and access to relevant expertise. A wider excision is not automatically preferable to every alternative. Further excision or other treatment may be necessary if pathological findings indicate residual disease or higher-risk features.
Single-stage or staged reconstruction
Immediate reconstruction may be appropriate when the oncological plan and margin-assessment strategy support it. In other circumstances, delayed or staged reconstruction may allow additional margin assessment, treatment planning, or wound preparation. The choice considers medical safety, the defect, and the patient's circumstances rather than a preference for a single operation in every case.
Reconstructive approaches
Selecting tissue to restore coverage and function.
The reconstructive method is chosen after considering the defect, tissue requirements, vascular supply, donor-site effects, and the need for further cancer treatment or surveillance. More complex reconstruction is not necessarily better.
Direct closure
Selected defects may be closed by bringing adjacent wound edges together. This may be appropriate when sufficient tissue is available without excessive tension or distortion of nearby structures. Scar position and functional effects must be considered.
Skin grafting
A skin graft transfers skin from another site to cover a suitable wound bed. Graft survival depends on adequate blood supply and wound conditions. Differences in colour, texture, contour, and donor-site scarring may remain.
Local flap reconstruction
A local flap moves adjacent tissue while maintaining its blood supply. Advancement, rotation, and transposition flaps may be considered according to the defect. Flap design must account for tissue movement, vascularity, scars, and the risk of distortion or compromise of important structures.
Larger or more complex defects may require regional or free-tissue reconstruction, staged treatment, or referral to a specialist team and facility with appropriate capabilities. These options are not automatically indicated or available for every case.
Recovery & follow-up
Healing is one part of the treatment journey.
Recovery varies with the cancer treatment, defect, reconstructive technique, and general health. Dressings, wound care, activity restrictions, and follow-up are individualised. Swelling, bruising, discomfort, and changes in sensation may occur. Grafts and flaps may require close early monitoring.
Wound healing and scar maturation may continue for months. Further treatment may be required for wound problems, functional concerns, scar revision, or cancer-related findings. A particular appearance or recovery timetable cannot be guaranteed.
Pathology and cancer surveillance
Review of the final pathology and any required further treatment is essential. Follow-up may include examination of the treated site, assessment for recurrence, and monitoring for additional skin cancers. The schedule and need for dermatology, oncology, or other specialist care depend on the diagnosis and risk profile.
When to seek urgent advice
Uncontrolled bleeding, rapidly increasing swelling, severe or escalating pain, fever with worsening wound symptoms, or concerning changes in graft or flap colour require prompt medical assessment. Sudden visual changes, breathing difficulty, or other serious symptoms require emergency care. Follow the treating team's instructions rather than waiting for a routine appointment.
Safety & limitations
Understanding the risks and trade-offs.
Cancer treatment and reconstruction have distinct risks. The individual plan should address both the medical priorities and the potential effects of surgery on the surrounding tissues.
Oncological considerations
Residual or recurrent cancer, positive or close margins, and the need for further excision or additional treatment are possible. Risk depends on the tumour and treatment. Reconstruction does not establish cancer clearance, and a satisfactory appearance does not replace pathology review or surveillance.
Healing & tissue survival
Bleeding, infection, wound breakdown, delayed healing, haematoma, and graft or flap compromise or loss may occur. Tissue blood supply, previous treatment, medical conditions, and nicotine exposure may influence risk. Donor sites may also have complications.
Function, appearance & further surgery
Scarring, asymmetry, altered sensation, contour differences, and distortion or limitation of nearby structures may remain. Further surgery may be required. Complete restoration of the original appearance or function cannot be guaranteed.
The proposed operation, alternatives, expected benefits, limitations, and possible need for further treatment should be discussed after individual assessment. The safest appropriate plan may differ from the shortest or most aesthetically appealing option.
Clinical results
Reconstruction in clinical context.
Clinical photographs may illustrate the tumour, resulting defect, reconstruction, and healing. Each case should include the diagnosis, treatment sequence, reconstructive technique, relevant pathology context, and follow-up. Photographs cannot establish cancer clearance or predict an individual's outcome.
View Patient ResultsFeatured clinical case
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AfterImage pending
Clinical photographs and case details will be added here. Diagnosis · Treatment · Reconstruction · Follow-up
Related pathways
Explore related reconstructive care.
Surgeon-led care
A considered approach to reconstruction.
Dr. Joe Areejunthawat is a board-certified plastic surgeon in Bangkok. His reconstructive approach begins with understanding the underlying condition and evaluating the tissues and functions involved before recommending a treatment plan.
Planning considers medical priorities, available reconstructive options, potential benefits, limitations, and risks. When appropriate, care may involve other specialists and hospital facilities suited to the patient's condition and proposed treatment.
About Dr. JoeYour consultation
Seeking assessment for skin cancer or reconstruction?
A consultation provides an opportunity to review your concern, diagnosis or pathology, previous treatment, and available records or photographs. Dr. Joe can assess whether treatment is appropriate and whether further investigation, another specialist, or hospital-based care is required. Online enquiries are not suitable for emergencies.