Resection of Skin Cancer Resulting in Free Vascularized Tissue Reconstruction: Always a Therapeutic Failure?

Sep 24, 2026

Uploaded by Miles

The globally rising incidence of cutaneous malignancies contributes to increasing cases of locally advanced skin cancer that require reconstructive surgery. This retrospective study (2015–2020) analyzes 17 patients undergoing microsurgical free-flap reconstruction to identify pitfalls in diagnosis and treatment. Locally advanced disease may stem from delayed presentation or aggressive tumor biology such as desmoplastic growth and perineural invasion. High-risk histopathological features (desmoplastic growth, perineural invasion, and tumor depth ≥6 mm) characterized all tumors and supported more extensive surgery despite defect size.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

1. Introduction

Locally advanced skin cancer drivers and clinical challenges

Prior treatment attempts, dissemination mechanisms, and diagnostic delay

cancers Article Resection of Skin Cancer Resulting in Free Vascularized Tissue Reconstruction: Always a Therapeutic Failure? Tina Rauchenwald 1, Angela Augustin 1, Theresa B. Steinbichler 2, Bernhard W. Zelger 3, Gerhard Pierer 1, Matthias Schmuth 4, Dolores Wolfram 1, * and Evi M. Morandi 1 Citation: Rauchenwald, T.; Augustin, A.; Steinbichler, T.B.; Zelger, B.W.; Pierer, G.; Schmuth, M.; Wolfram, D.; Morandi, E.M. Resection of Skin Cancer Resulting in Free Vascularized Tissue Reconstruction: Always a Therapeutic Failure? Cancers 2023, 15, 2464 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)cancers15092464 Academic Editors: Pedro Redondo and Rafael Salido-Vallejo Received: 9 March 2023 Revised: 14 April 2023 Accepted: 24 April 2023 Published: 25 April 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria 2 Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria 3 Private Praxis for Dermatopathology Innsbruck & Zams, 6020 Innsbruck, Tyrol, Austria 4 Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, 6020 Innsbruck, Tyrol, Austria * Correspondence: [dolores.wolfram@i-med.ac.at](dolores.wolfram@i-med.ac.at); Tel.: +43-512-504-22731 Simple Summary: As the global burden of skin cancer rises, complex cases of locally advanced skin cancer are rising as well. Rare and aggressive dissemination mechanisms are often the cause for extensive skin cancer. Incohesive spreading patterns complicate correct diagnoses and may result in large tumors with multiple misguided treatment attempts. The aim of this study was to create awareness for cutaneous malignancies with rare, aggressive dissemination mechanisms to improve diagnostic and therapeutic strategies in such complex cases. We identiﬁed high-risk characteristics of locally advanced skin cancer warranting extended surgical treatment and a cohesive interdisciplinary approach. Abstract: The globally increasing incidence of cutaneous malignancies leads, in parallel, to increasing numbers of locally advanced skin cancer resulting in reconstructive surgery. Reasons for locally advanced skin cancer may be a patient's neglect or aggressive tumor growth, such as desmoplastic growth or perineural invasion. This study investigates characteristics of cutaneous malignancies requiring microsurgical reconstruction with the aim of identifying possible pitfalls and improving diagnostic and therapeutic processes. A retrospective data analysis from 2015 to 2020 was conducted. Seventeen patients (n = 17) were included. The mean age at reconstructive surgery was 68.5 (􀀆 13) years. The majority of patients (14/17, 82%) presented with recurrent skin cancer. The most common histological entity was squamous cell carcinoma (10/17, 59%) . All neoplasms showed at least oneof the following histopathological characteristics: desmoplastic growth (12/17, 71%), perineural invasion (6/17, 35%), or tumor thickness of at least 6 mm (9/17, 53%) . The mean number of surgical resections until cancer-free resection margins (R0) were achieved was 2.4 (􀀆 0.7) . The local recurrence rate and the rate of distant metastases were 36% . Identiﬁed high-risk neoplastic characteristics, such as desmoplastic growth, perineural invasion, and a tumor depth of at least 6 mm, require a more extensive surgical treatment without concerns about defect size. Keywords: skin cancer; perineural invasion; desmoplastic; dermatologic surgery; reconst

FAQs

What was the purpose of this study on locally advanced skin cancer reconstruction?

To identify high-risk characteristics of locally advanced skin cancer that require microsurgical reconstruction and to improve diagnostic and therapeutic decision-making in complex cases.

What period and patient cohort were analyzed?

A retrospective analysis was conducted from 2015 to 2020, including 17 patients who underwent reconstructive surgery.

Which histopathological features were most strongly associated with these cases?

All tumors showed at least one high-risk feature, including desmoplastic growth, perineural invasion, and tumor thickness of at least 6 mm.

Sep 24, 2026

Uploaded by Miles