Consideration of Facial Aesthetic Units When Resecting Malignant Facial Lesions

Abstract

When resection of a malignant facial lesion is followed by reconstruction, the functional aspects and appearance of the face must be carefully considered. Reconstruction of facial aesthetic units requires a negative oncological margin. Herein, on the basis of our experience of reconstruction after resecting a skin tumor in the upper lip, we describe the optimal range of resection for a malignant facial tumor and optimization of reconstruction. A 68-year-old man with an elevated lesion on the upper right lip and nasal cavity consulted a dermatologist at our hospital. A biopsy revealed malignant fibrous histiocytoma, and the patient was referred to our department for radical treatment. After excising the tumor to ensure a macroscopic negative margin, we reconstructed the upper lip and nasal wing by using an Abbe's flap and nasolabial orbicularis oris myocutaneous flap, respectively. The recommended method for excising a soft tissue sarcoma on the face requires removal of many free rims or tissues that are difficult to replace, which can result in extremely low postoperative quality of life for the patient. As an alternative to definite wide-margin excision, we recommend that radical treatment by marginal excision and adjuvant therapy should be considered when indicated. In addition, when excising tumors in areas of aesthetic importance, wide-margin excision may not always be necessary. Reconstruction of each aesthetic unit after individual excision may help achieve a satisfactory aesthetic result.