Lip Reconstruction after Mohs Cancer Excision: Lessons Learned from 615 Consecutive Cases

BACKGROUND:The lips provide key functional and aesthetic features of the face. From social interactions and speech to swallowing and oral competence require a functional dynamic structure. This interaction with surrounding landmarks presents a challenge for reconstruction. There are a myriad of ways reported to reconstruct these defects but as our practice has evolved, a more refined approach was developed to optimize results and minimize the complexity of each patients surgery. METHODS:A retrospective review from 2004 to 2018 was performed of consecutive patients who underwent lip reconstruction following MOHS cancer resection by a single surgeon. Each case was evaluated for key patient characteristics, defect location, defect size, defect composition, reconstructive modality, and complications. Additionally, the evolution of treatment types over those 14 years was evaluated. RESULTS:Six hundred fifteen patients underwent lip reconstruction. Defects most commonly involved the upper lateral lip and 247 (40%) involved both the skin and vermillion. A significant majority of the patient’s defects were repaired using either linear closure or V-wedge excision and closure. A complication rate of 10.2% (63) was found, ranging from oral incompetence to cancer recurrence. There was no significant difference in complication rates in patients over 75 years old, smokers or in patients who were on anticoagulation. CONCLUSION:The authors techniques have evolved from more invasive advancement and rotation flaps to a more reliable linear closure method over the last 14 years. The study showed that lip reconstruction is safe in elderly patients, smokers and in patient who are on anticoagulation.