The face is the most common part of the body to develop skin cancer. While skin cancer on the face may sound like bad news, the silver lining is that with excellent surgical techniques and the right wound care, you can treat and recover from facial skin cancer. Fortunately, the face usually heals better than any other area on the body because it has a very rich blood supply.
Still, it’s important to detect and treat skin cancer as early as possible, especially in key ‘danger zones’ on the face. Fortunately, Mohs surgery offers the highest cure rate for skin cancer with the best cosmetic outcome.
How nerves can be impacted during Mohs Surgery for facial skin cancer
If a skin cancer becomes too large, it can grow deep to invade nerves or the areas around nerves. Dr. Mark Abdelmalek, a dual-board certified and fellowship trained Mohs Surgeon at Dermatology of Philadelphia said, “even if a skin cancer hasn’t actually invaded a nerve, sometimes the repair of the area after skin cancer is removed can impact nearby nerves.”
If a nerve is damaged or cut, this can mean a change or loss of sensation in that area- like numbness and tingling. Often these symptoms improve with time. That can take up to a full year, but sometimes a loss of sensation is permanent.
One of the areas where a loss of sensation after Mohs surgery is most noticeable and bothersome is on the mid-forehead and scalp (Figure 1).
“The forehead is an area on the face where we prefer to catch skin cancers early– the earlier the skin cancer is detected, the lower the chance that you will have nerve involvement,” Abdelmalek said.
In most areas of the face only sensation is impacted by treating skin cancer- with no impact on facial movement or expression.
‘Danger zones’ for Skin Cancer on the Face
Unfortunately, sometimes nerves that control how facial muscles move can be impacted as well. This is a more serious issue compared to a loss of sensation. Mohs surgeons refer to sites where nerves that control movement of muscles may be impacted as “danger zones”.
Skin cancers in these areas aren’t more dangerous, but the word ‘danger’ is used to signal that a very important nerve is nearby.
The Temple and Facial Skin Cancer
The temple is one of the ‘danger zones’ of the face. The ‘temporal branch of the facial nerve’ controls the movement of the forehead including the eyebrow. This is the most common nerve injured during surgery on the face.
If the temporal branch of the facial nerve is damaged during Mohs surgery or the repair process after skin cancer removal, you may be unable to raise the forehead and can experience an eyebrow drop which can feel heavy. Figures 2 and 3 show what can happen when a skin cancer impacts the key nerve in this ‘danger zone.’
When a nerve like this is injured, additional surgery may be performed to repair the nerve. When possible, the two ends of the nerve that were severed can be repaired.
Nerve grafts and newer nerve substitution techniques may also be used. These surgeries are usually performed by head and neck surgeons that Mohs surgeons work with. If the nerve can not be repaired, a forehead or eyebrow lift can also be performed.
Facial Skin Cancer Along the Jawline
Another important ‘danger zone’ on the face is the lower face, where a branch of the facial nerve called the ‘marginal mandibular branch of the facial nerve’ can be superficially located. (Figure 4)
Damage to this nerve causes a facial asymmetry where the lower lip remains elevated when a smile is attempted. This nerve can be injured after Mohs surgery, but can also be injured during cosmetic procedures of the lower face and neck including liposuction.
While these danger zones are very real, the majority of skin cancers treated on the face do not impact these nerves.
Facial Skin Cancer Surgery: Lower Your Chance of Nerve Damage
Intensive training and meticulous surgery lowers the chance of nerve damage. A thorough understanding of facial anatomy is one of the most important reasons to make sure your Mohs surgeon is fellowship-trained to perform Mohs surgery and dual board-certified with the American Board of Dermatology in Mohs Surgery and Dermatology.
“Mohs surgery and meticulous surgical techniques are critical in these areas to avoid any unnecessary damage to nerves,” said Dr. Abdelmalek.
Mohs Surgery for Facial Skin Cancer
Mohs surgeons go through extensive training to fully understand facial anatomy and how their work can impact these nerves. This training starts in medical school with anatomy, and continues on during the four years of dermatology residency training.
A select group of surgeons, like Dr. Mark Abdelmalek, are able to join the prestigious American College of Mohs Surgery (ACMS) after an intensive Mohs surgery fellowship training. ACMS fellowship-trained Mohs surgeons have extensive experience performing complex reconstruction and removing tumors in difficult locations, lowering the risk of damaging important nerves.
Schedule Your Skin Cancer Screening
Call us today at (215) 315-3197 or schedule your appointment online to see a board-certified dermatologist for your skin cancer screening, or to learn more about Mohs surgery for skin cancer removal.