Once your basal cell carcinoma has been removed the wound will need to be fixed. Very occasionally the wound can be left to heal by itself, but this is usually only for smaller wounds in certain areas. We described below a few of the more common ways that reconstruction may be performed after basal cell carcinoma surgery.

Simple closure

This method can be called a number of different terms, including direct suture, direct closure or primary closure. This is where there is enough loose skin to allow the surgeon to stitch the wound edges together. Whilst your basal cell carcinoma may have been removed as a round or oval shape, the surgeon will usually need to remove small areas of skin either side of the wound to allow it to close more smoothly. If this wasn’t done, then the skin would ‘poke upwards’ when closed.

It is quite common that basal cell carcinomas on the arms, chest, or back can leave wounds which can be closed directly. Smaller basal cell carcinomas on the facial areas such as cheeks, forehead or even eyelids can also sometimes be closed directly.

Skin grafting

For larger basal cell carcinomas, or those in certain areas, a skin graft reconstruction may be needed. A skin graft can be full thickness, or split thickness.

A full thickness skin graft is where a piece of skin is taken from somewhere else on your body to fix your wound. Common places to take these grafts from are in front of the ear, behind the ear, the neck, collar bone, upper arm or groin areas. The place where the graft is taken from is stitched closed, and the graft is then stitched into the wound. Over the next few days, the graft gets new blood flow from the wound bed underneath, a process known as ‘graft take’. Common areas for full thickness grafts are for basal cell carcinoma on the face.

A split thickness skin graft is similar to a full thickness graft, but instead a very thin shave of skin is taken, usually from the thigh. The area where the graft is taken from feels like a ‘bad graze’ for a few days, and then usually settles. The graft is then stitched into place, and after a few days will hopefully have ‘taken’. Split skin grafts are usually used for larger areas, such as large basal cell carcinomas on the scalp.

Whilst grafts can look very good, they can take a few months to settle. Also, grafts are thin pieces of skin, so tend to drape into the wound rather than fill it, and will not have the same tone and texture as the surrounding skin.

Local flap reconstruction

Whilst a skin graft is removed from where it usually is and has to gain a blood supply from where it is put, a local flap keeps its blood supply intact whilst being moved. These are taken from next to the wound left by the basal cell carcinoma, and can be of a vast range of different sizes, shapes and designs depending on where the wound is and its size.

Because a local flap uses skin that is near to the wound, the colour and texture match is often very good. Also, a local flap can be raised with skin and fat (and occasionally muscle), so can help to ‘pad out’ or fill the wound.

There are also a large number of more complex reconstructions, such as forehead flaps or complex eye reconstruction techniques. Often, there may be more than one method that could be used, and the experience of your reconstructive surgeon will be extremely valuable in such cases.

This information is provided for general knowledge only and does not replace information provided by healthcare professionals. If you have any concerns of any skin growth, you should consult a medical professional urgently. Please also read our disclaimer.