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Karl D. Lewis, MD


Skin Cancer on the Face: Case Study of Wide Excision Surgery With Frozen Section

By: Cordi Craig, MS
Posted: Monday, August 15, 2022

The incidence of squamous cell carcinoma has increased over the past 3 decades and for patients with high-risk cases, wide excision is the standard procedure. Surgery followed by intraoperative frozen section may reduce recurrence rates and metastases by establishing a tumor-free margin. Reconstruction using flaps or skin grafts, albeit challenging, may be used to mitigate postoperative defects. A study, published by Endang Sutedgja, PhD, of the University of Padjadjaran, Indonesia, and colleagues in Clinical, Cosmetic and Investigational Dermatology, explores the management of a high-risk squamous cell carcinoma case using wide excision and intraoperative frozen section followed by forehead interpolation flap reconstruction and a skin graft.

The study authors reported a case study of a 50-year-old woman who was diagnosed with squamous cell carcinoma and a large (4 cm x 6 cm x 0.3 cm) solitary ulcer on her face. The surgeons performed wide excision followed by an intraoperative frozen section to sample the cancer cell–free margin. Some residual tumor remained, and an additional 1-cm excision was performed.

Ideal management of squamous cell carcinoma is based on local tumor control and the maximum preservation of function and cosmetics. To cover the extensive defects from the surgery, a forehead interpolation flap reconstruction followed by a full-thickness skin graft was performed. Following the procedures, the patient had ectropion of the left lower eyelid and some dissimilarity of the skin graft with the surrounding skin. However, the patient was generally satisfied and recovered within 8 weeks without complications.

Disclosure: The study authors reported no conflicts of interest.

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