Skin Cancer

Skin Cancer Before & After Photos – PG 2

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Skin Cancer Patient 11


This patient was referred to Dr. Bhama for reconstruction of a large Mohs defect on the right side of the nose. She had a history of previous rhinoplasty. Because of her age and her history of previous nasal surgery, the decision was made to avoid local flaps. Options were discussed with the patient and she elected for Integra followed by full-thickness skin graft. Because of the close proximity of the defect to the nostril rim, nasal valve repair was also required. Cartilage was harvested from the patient’s ear. Surgery went well, and the patient underwent dermabrasion and was also referred to one of Dr. Bhama’s colleagues for laser treatment of the scar. Postoperative photos are shown demonstrating a well-healed scar, which should continue to fade with time. The patient was very happy with the results from a cosmetic and nasal breathing standpoint.


Skin Cancer Patient 12


This patient was seen by Dr. Bhama for reconstruction of a large defect of the lower lip following Mohs surgery. On exam, notice the large full-thickness defect of approximately 60% of the lower lip. Options were discussed with the patient, and he elected for Estlander (lip switch) flap. Dr. Bhama performed surgery, which went well. Early post-operative photos are shown, demonstrating an excellent result. The patient was very satisfied, and was able to eat and speak well. The scar will continue to fade with time.


Skin Cancer Patient 13


This patient underwent Mohs surgery for excision of a basal cell carcinoma from the nose and was referred to Dr. Bhama for repair of the resulting defect. Note the defect of the left nasal ala. Because of the importance of this structure in breathing, the patient had to undergo not only reconstruction of the skin defect, but repair of the nasal valve to facilitate breathing. She underwent complex staged reconstruction using an interpolated melolabial flap with auricular (ear) cartilage grafting. Her intermediate photo is also shown, demonstrating the pedicled flap. Also shown in an early post-operative view demonstrating excellent contour of the nose. No revision surgery has been performed, and no steroid injections have been performed.


Skin Cancer Patient 14


This patient was referred to Dr. Bhama for repair of a Mohs defect after removal of a skin cancer. Options were discussed and the patient elected for local flap closure and dermabrasion. Post-operative photos are shown demonstrating an excellent result. The scar will continue to fade with time.


Skin Cancer Patient 15


Dr. Bhama was asked to perform reconstruction on this patient who underwent Mohs surgery for treatment of skin cancer. Pre-operative photographs show a substantial defect of the right nasal ala and sidewall extending nearly down to the mucosa. Options were discussed with the patient including melolabial interpolated flap, paramedian forehead flap, and delayed reconstruction technique. The patient elected for delayed reconstruction technique using a full thickness skin graft from the pre-auricular region (in front of ear) on the right side. Early post-operative photos show an excellent cosmetic result. No revision surgery has been performed, and no steroid injections have been performed. The patient’s ability to breathe through the nose on that side has also been preserved. The appearance of the donor site in the cheek in front of the right ear will continue to improve with time.


Skin Cancer Patient 16


This patient underwent Mohs surgery for excision of a lentigo maligna from the nose and was referred to Dr. Bhama for repair of the defect. Note the defect of the nasal tip and dorsum. Options were discussed with the patient, and she elected for bilobe flap repair of the nose. Surgery went well, and shown is a very early post-operative result. No revision surgery, dermabrasion, or steroid injection were performed as the patient was very happy with the results. The scar will continue to heal, improving the result with time.


Skin Cancer Patient 17


This patient was referred to Dr. Bhama by a Mohs surgeon for management of a defect of the right nasal ala. On pre-operative photos, notice the large, thick defect of the nasal ala following Mohs surgery. Base view demonstrates collapse of the external nasal valve. Because the nasal valve was involved, reconstruction using auricular cartilage (ear cartilage) was required. Options were discussed with the patient and she elected for paramedian forehead flap reconstruction using auricular cartilage grafting. Surgery went well, and the patient recovered uneventfully. Intermediate photos are shown demonstrating the forehead flap in position. Takedown of the flap pedicle was performed several weeks later. She was very happy with results of surgery from a cosmetic and functional standpoint. Early post-operative photos are shown demonstrating excellent contour of the nasal ala and restoration of the external nasal valve.


Skin Cancer Patient 18


This patient was referred to Dr. Bhama by a Mohs surgeon to discuss reconstructive options following nasal surgery for skin cancer. Pre-op views demonstrate a defect of the right nasal ala. Dr. Bhama discussed options with the patient, and the patient elected for paramedian forehead flap reconstruction. Dr. Bhama also used auricular cartilage to stabilize the nasal valve and preserve the patient’s ability to breathe through the right nostril. Intermediate photos demonstrating the forehead flap in place are shown. Early post-op photos are shown demonstrating an excellent cosmetic result. The patient is very happy and is able to breathe well through the nose.


Skin Cancer Patient 19


This patient was referred to Dr. Bhama to plan reconstruction after removal of a large melanoma from the right cheek. On pre-op photos, notice the pigmented lesion of the right cheek. The surgical oncologist performed excision along with sentinel lymph node biopsy. Notice the large defect of the right cheek and eyelid, and the incision in the neck. Normally, Dr. Bhama considers cervicofacial advancement flap (face and neck flap) to reconstruct these defects, but the neck incision for the sentinel lymph node biopsy could interrupt the blood supply to this flap. This is a very complex defect to repair given the close proximity to the eyelid, therefore a rhombic transposition flap was designed such that the vectors of tension would pull the lower eyelid upwards instead of down. Early post-op pics are shown. The patient was very happy with the cosmetic result. Notice that there is no distortion of the eyelid. No revision surgery or dermabrasion has been performed. The scar will continue to fade with time.


Skin Cancer Patient 20


This patient was referred to Dr. Bhama by a Mohs surgeon to plan reconstruction following Mohs surgery for a melanoma in situ of the left cheek. Pre-operative pictures are shown demonstrating a pigmented lesion of the left cheek. The patient underwent Mohs surgery with another surgeon. Shown is the defect. There is a large skin defect of the left cheek involving skin and soft tissue. This defect presented a unique challenge because of its close proximity to the frontal branch of the facial nerve and the eye. Dr. Bhama performed rhombic flap reconstruction under local anesthesia with the patient completely awake. She was able to go home immediately after reconstruction. Her post-op photos with sutures in place are shown. Early post-op photos after suture removal are also shown demonstrating an excellent cosmetic result. Notice there is no distortion of the eyelid. The facial nerve is completely intact. The patient was very happy with results, and her scar will continue to fade with time.


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