This chapter considers skin cancer as an emerging health challenge. The causes are analyzed in terms of population, lifestyle, and epidemiological factors. Certain facial skin cancers have high-risk factors which are considered in pathological, clinical, and metastatic risk categories. Other facial skin cancers are high-risk by virtue of their anatomical site, clinical and radiological extent, and reconstructive challenge. Patients presenting with high-risk facial skin cancers require proper oncological and reconstructive management. Certain facial cancers are best managed by multidisciplinary teams, with tailored treatment by surgeons and specialists trained to a very high standard. Specific clinical examples are illustrated, but principally the concepts of complete local excision + aesthetic reconstruction (CLEAR) or delayed reconstruction after pathological examination (DRAPE) are emphasised. High-risk facial cancers include those of the skin and cancer of the upper aerodigestive tract arising from the mucosal surface, most commonly squamous cell carcinoma with poor differentiation, perineural invasion, and malignant melanoma. Less commonly basal cell carcinoma with morphoeic patterns, basosquamous carcinomas, de-differentiated basal cell carcinoma and even rarer but very aggressive cancers such as sebaceous carcinoma, Merkel cell cancer and sarcoma.
- Extreme facial skin cancer
- The size of the problem
- Complete local excision
- Aesthetic reconstruction (CLEAR)