Melanoma and the Face: Why Reconstruction Matters
Australia has one of the highest melanoma rates in the world, and a significant portion of melanomas occur on visible areas of the face, head, and neck. When life-saving cancer surgery is necessary, patients can be left with facial disfigurement that affects not only appearance but also function and emotional well-being. Facial reconstruction after melanoma treatment aims to restore form, preserve function (such as eyelids, lips, and speech), and help patients regain confidence in daily life.
Who Needs Reconstruction?
Reconstruction is tailored to each person’s tumor location, size, and the surrounding tissue’s condition after tumor removal. Factors influencing the approach include:
- Size and depth of the tumor excision
- Location on the face (forehead, cheek, lip, eyelids, nose)
- Availability of local tissue for advancement or rotation flaps
- Need for skin grafts from donor sites
- Preservation of critical structures such as nerves and vessels
The goal is to achieve the best possible aesthetic outcome while maintaining essential facial function and cancer control.
Reconstruction Options: A Multidisciplinary Approach
A skilled team typically includes a surgical oncologist, plastic and reconstructive surgeon, dermatopathologist, radiation oncologist, oculoplastic surgeon (for eyelid and eye protection), and a clinical psychologist or counsellor. The team discusses options to balance oncologic safety with cosmetic and functional results.
Local Flaps and Tissue Rearrangement
Local flaps use neighboring skin and underlying tissue to cover a defect. Examples include advancement, rotation, and transposition flaps. These techniques preserve skin color and texture, often yielding natural-appearing results with relatively shorter recovery times.
Skin Grafts
Skin grafts transfer healthy skin from another part of the body to the facial area. They can be useful for larger defects where local tissue is insufficient. Donor-site healing is considered in planning, and grafts are chosen to match skin tone and thickness as closely as possible.
Composite Techniques and Nerve-Sparing Surgery
In some cases, reconstructive plans incorporate nerve-sparing approaches to retain sensation and facial movement. More complex reconstructions might combine multiple procedures over months, gradually refining symmetry and function.
Advanced Options: Silastic Prosthetics and Implants
For certain defects, prosthetic options or osseointegrated implants can help restore facial contour and expression. These choices are typically discussed when tissue transfer alone cannot achieve desired outcomes.
Timing and Recovery
Timing depends on the cancer treatment plan and wound healing. Some patients undergo reconstruction in stages, especially after radiotherapy or when tissue swelling persists. Recovery includes wound care, scar management, and possible follow-up adjustments. Physical therapy or occupational therapy may help with facial movement and speech if muscles or nerves were affected.
Psychological and Social Support
Visible facial changes can impact self-esteem, social interactions, and mental health. Access to counselling, support groups, and peer mentorship can be crucial for coping. Patients are encouraged to discuss expectations openly with their care team, including realistic timelines for improvements and possible refinements.
Long-Term Care: Sun Safety and Surveillance
Melanoma survivors remain at risk for new or recurrent lesions. Ongoing skin checks, sun protection, and routine follow-ups with the oncology and dermatology teams are essential. A healthy skincare routine, sunscreen use, and protective clothing help safeguard the face during recovery and beyond.
Real-World Outcomes and Hope
With advances in reconstructive techniques and multidisciplinary care, many patients achieve results that restore facial aesthetics and confidence. While every case is unique, the shared goal is clear: to harmonize cancer control with a natural appearance and preserved function, enabling people to resume work, family life, and social activities with renewed self-assurance.
