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Skin Cancer
Skin cancer on the face is common in Australia, where the face receives more cumulative ultraviolet exposure than any other part of the body. The three main types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. On the face they most often appear on the nose, cheeks, forehead, ears, eyelids and lips, where the skin is thin and the structures beneath it matter to both appearance and function.
Facial skin cancer is planned differently from skin cancer elsewhere. There is little spare skin, and the eyelid margin, nostril rim, ear cartilage and lip border all need to be rebuilt accurately when they are involved. Dr Maryam Seyedabadi is a Specialist Plastic Surgeon in Sydney who performs excision and facial reconstruction, and reconstruction after Mohs surgery carried out by a Mohs surgeon.
If you notice a spot on your face that is new, changing, bleeding or slow to heal, see your GP or dermatologist. Where melanoma is a possibility, do not delay having it examined.
Signs to look out for
- A pearly or raised lump on the nose, cheek or ear that bleeds when knocked or shaved.
- A scaly or crusted patch that keeps returning in the same place.
- A sore on the face or lip that has not healed within a few weeks.
- Loss of eyelashes, a notch in the eyelid margin, or a lump distorting the eyelid.
- A mole on the face or scalp that is changing in size, shape, colour or outline.
- A firm lump on the ear, temple or scalp that is enlarging.
How facial skin cancer is diagnosed
Assessment begins with examination of the lesion and the surrounding skin, usually with dermoscopy, a handheld lens that shows patterns below the surface. Measurements and photographs help with planning, and the rest of your skin is checked at the same time.
Diagnosis is confirmed by biopsy and histopathology. A sample, or sometimes the whole lesion, is removed under local anaesthetic and reported by a pathologist, who describes the type of skin cancer, how deep it extends and how it behaves at its edges. That report guides the margin required and the reconstruction that suits the site. Imaging is added for some larger, recurrent or deeper tumours.
Conditions we treat
Basal Cell Carcinoma (BCC)
The most common facial skin cancer. BCC grows slowly and rarely spreads, but on the nose, eyelid or ear it can extend into deeper tissue over time, so it is usually excised with a margin.
Read more about basal cell carcinoma
Squamous Cell Carcinoma (SCC)
SCC arises from cells in the outer layers of the skin, often on the lip, ear, temple or scalp. It can grow faster than BCC and has some capacity to spread to lymph nodes, so earlier assessment matters.
Read more about squamous cell carcinoma
Melanoma
Melanoma arises from pigment cells and occurs on the face, neck and scalp. It is staged on histopathology by thickness and other features, which guide the margin taken and whether further tests or referral are needed.
Post-Mohs Reconstruction
In Mohs surgery the Mohs surgeon removes the tumour and checks the margins during the procedure. Dr Maryam then reconstructs the wound, using direct closure, a local flap, cartilage support or a skin graft as the site requires.
Read more about post-Mohs reconstruction
Recovery and follow up
Most facial excisions are day procedures under local anaesthetic, sometimes with sedation. How long recovery takes depends on the size and site of the wound.
- Bruising and oedema around the eyes, nose and lips are usual in the first week or two.
- Facial sutures are commonly removed within about five to ten days.
- Scars stay pink and firm for a period and generally soften over roughly six to twelve months.
- Your pathology result is discussed at follow up, and further surgery is sometimes needed if the margins are not clear.
- Continue regular skin checks with your GP or dermatologist and daily sun protection, since having one skin cancer increases the chance of another.
Your care with Dr Maryam
Dr Maryam Seyedabadi, MBBS FRACS, consults at 2c Heeley Street, Paddington and operates at St Luke’s Hospital in Potts Point, East Sydney Private Hospital, Sydney Day Hospital, The Skin Hospital in Darlinghurst and Double Bay Day Hospital. A referral from your GP or dermatologist allows a Medicare rebate to be claimed for these procedures.
What can be achieved depends on the type, size, site and stage of the lesion, and on what the pathology shows. Your consultation covers the likely extent of the excision, the reconstructive options for that part of the face, the scar to expect and the follow up recommended. To arrange an appointment, call 1300 067 668.
What actually happens
Your Journey, Step by Step
Before your consultation
Common questions, answered plainly.
What does skin cancer on the face usually look like?
Facial skin cancers often appear as a new spot, a lump with a pearly or shiny surface, a scaly patch, or a sore that bleeds, crusts and does not settle within a few weeks. Some are flat and slightly pink. Changes around the eyelid, nose, ear or lip can be subtle. If you notice anything like this, see your GP or dermatologist for assessment.
How is facial skin cancer diagnosed before surgery?
Your GP or dermatologist examines the lesion, often with dermoscopy, and usually takes a small biopsy under local anaesthetic. The tissue is sent for histopathology, and the report confirms the type of skin cancer and how deeply it extends. That information guides the excision margin planned and the reconstruction discussed with you. A referral allows a Medicare rebate to be claimed for these procedures.
How is skin cancer on the face treated by a plastic surgeon?
Dr Maryam Seyedabadi, Specialist Plastic Surgeon, performs excision of the lesion with a planned margin, then reconstructs the area at the same time or in stages. She also works alongside Mohs surgeons, who perform the Mohs excision themselves, and she carries out the reconstruction afterwards. The approach depends on the type, size, site and stage of the lesion. Margins are checked by pathology and further surgery is sometimes needed.
What does facial reconstruction after skin cancer surgery involve, and where is it done in Sydney?
Reconstruction may use direct closure, a local flap that borrows nearby skin, or a skin graft, chosen to respect features such as the eyelid margin, nostril rim and lip border. Some cases are staged over several procedures. Dr Seyedabadi operates at St Luke’s Hospital in Potts Point, East Sydney Private Hospital, Sydney Day Hospital, The Skin Hospital in Darlinghurst and Double Bay Day Hospital.
