Indications and contraindications

Authors: Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD

Indications

Suspicion of malignancy is the most common indication for facial excision.
Facial skin tumors are most frequently found by dermatologists and general practitioners. 

High risk factors 

• Tumors in the H-zone around the eyes, nose and lips
• recurrent carcinoma
• aggressive type of tumor – BCC morphed type or deep infiltrating BCC or SCC

High risk BCCs should be removed surgically by a plastic surgeon.
Low risk tumors may also be removed by curettage or treated with photo dynamic therapy or Aldara (immunosuppressive drug). 

Contraindications

Relative contraindication

BCC located on the tip of nose, as local flaps in the area often have a less aesthetic outcome. May instead be treated with radiotherap

Procedure

• The tumor should be excised using an elliptical (Fusiform) excision
• The width : length ratio = 1 : 3, (Some times 1 : 2)
• The ends should have an angle of 30 degrees to avoid excessive skin
• Standard drawing for elliptical excision

For region specific cases, please choose the designated chapter in the left hand menu. See the chapter non-melanoma skin cancer for further information of pathophysiology and excision margins.