Skin Cancer Around the Mouth and Nose: Surgery and Facial Reconstruction

Skin cancer on the nose, lip or cheek brings a particular worry. The tumour must come out completely, and the face must still work and look like the person it belongs to. Modern treatment pairs two skills, precise removal and careful reconstruction, and understanding how they fit together makes the process less daunting.

Why this area is difficult

The skin around the nose and mouth sits close to structures that matter. The nostril rim keeps the airway open, the lips seal the mouth and shape speech, and the cheek folds shape expression. Cancers here often grow below the surface further than they appear, so a margin that seems generous can still leave tumour behind.

Tissue is also scarce. There is little spare skin to close a gap without distorting the nostril or pulling on the lip. That is why surgeons treat these sites differently from a cancer on the back or arm, where a simple excision and stitches usually suffice.

The page on Mohs surgery and reconstruction from the practice of Jonathan Dunne, a consultant plastic surgeon, explains that he usually works with a Mohs surgeon who removes the cancer while he performs the reconstruction. His site also lists nasal reconstruction among his special interests. Both skills matter here.

What Mohs surgery offers

Mohs micrographic surgery removes a tumour in thin layers, with each layer examined under a microscope while the patient waits, until no cancer cells remain. The Northern Care Alliance NHS Foundation Trust explains in its page on Mohs micrographic surgery that it gives the best chance of cure for high-risk non-melanoma skin cancers on the face and neck, and that the cure rate for a basal cell carcinoma treated this way is 98 to 99 percent.

The same page notes that most basal cell carcinomas and skin cancers do not need Mohs surgery. It is reserved for difficult cancers, often around the eyes, ears and nose. A general dermatologist assesses whether a referral to the Mohs service is warranted.

Because Mohs surgery removes only the cancerous tissue and spares healthy skin, the defect left behind is as small as it can be. That gives the reconstructive surgeon the best chance of a good cosmetic result.

Mohs surgery is not the only route. For smaller or lower-risk cancers, standard excision with a margin of healthy skin is often enough, and the removed tissue is sent to a laboratory for checking afterward. If the edges are not clear, a second operation follows. The choice depends on the type of cancer, its size, its position and whether it has been treated before, and a specialist should explain why one approach is recommended over the other.

How reconstruction is planned

Reconstruction begins with the defect. The surgeon looks at its size, depth and position, and at what lies beneath, such as cartilage, muscle or the lining of the nose. The goal is to restore function first, meaning an open airway and a mobile lip, and to keep the natural contours.

On the Mohs reconstruction page, Dr Dunne says that in most cases the reconstruction can be completed in a single session that takes approximately one hour, usually on the same day as the cancer removal, and that he assesses each case to provide an estimated timeline.

Not every repair is quick. Deep or wide defects may need cartilage grafts or a staged approach, in which a flap is moved in one operation and refined in another. The surgeon should explain which route is planned and why. Ask also how long the dressings stay on, when stitches come out and when you can return to work or exercise.

Reconstruction techniques

Several techniques are used. A local flap moves nearby skin, with its blood supply, into the gap, and is a mainstay on the nose and cheek because the colour and texture match. A skin graft takes skin from behind the ear or the neck for shallow defects. Direct closure suits small defects that sit in natural creases.

The nose often needs more. A full-thickness defect may require cartilage to restore the shape of the nostril and a lining layer inside, and a forehead flap is sometimes used for larger defects, in two stages. Lip defects are repaired with techniques that preserve the muscle ring and the red margin of the lip.

Scars are placed along natural lines wherever possible. They redden at first, then soften over months. A second small procedure, or scar treatment, can improve the result. Massage and silicone products help in some cases, if the surgeon advises them.

What to expect and what to ask

Mohs surgery is usually done under local anaesthetic. The Northern Care Alliance page says you may feel tired afterward and should arrange for someone to drive you home. Expect a long day, since the waiting between layers can take hours.

Ask your team a few direct questions. Who will remove the cancer and who will reconstruct? Will the repair happen on the same day? What are the alternatives? How will the scar look in a year, and what happens if more cancer is found at the edge?

Afterward, regular skin checks matter. A person who has had one facial skin cancer is at higher risk of another, so sun protection and follow-up appointments are part of the plan. Report any new sore, scab or lump that does not heal. Tell your GP or surgeon if the nostril feels blocked, if the lip feels tight or if you notice numbness that does not improve, since small adjustments can often help.