Skin Cancers Involving the Eyebrow: Clinical Considerations

About Dr. Hootan Zandifar

Dr. Hootan Zandifar is board-certified in Otolaryngology and fellowship-trained in Facial Plastics and Reconstructive Surgery. Dr. Zandifar is the director of the Skin Center at the Osborne Head and Neck Institute based at Cedars-Sinai Medical Towers.

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About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

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Case presentation

A female patient in her 40s presented with a lesion of the left eyebrow that had been increasing in size for several months. A biopsy of the lesion was positive for basal cell carcinoma. She underwent Mohs excision of the lesion with a resulting defect. The defect was 1.5 cm by 1.5 cm in size and involved part of the hair-bearing region of her eyebrow. The patient presented to Dr. Zandifar for reconstruction of this defect. The reconstruction was done using local rotational flaps and 3 months after reconstruction the eyebrow has healed with minimal scarring and little to no loss of her eyebrow.

Figure 1: Large defect after skin cancer removal. Defect involves a major portion of the eyebrow.
Figure 1: Large defect after skin cancer removal. Defect involves a major portion of the eyebrow.
Figure 2: Three months after reconstruction the scar is not visible and the hair has grown through the scar.
Figure 2: Three months after reconstruction the scar is not visible and the hair has grown through the scar.

Skin Cancer overview

Basal cell and squamous cell carcinomas of the skin are grouped together as non-melanoma skin cancers (NMSC). They are the most common types of cancers that occur worldwide. Of these NMSC, nearly 85% are encountered in the head and neck region. Reconstruction of the ensuing defects in the head and neck is associated with many challenges. Several structures in the head and neck have both cosmetic and functional considerations that need to be addressed. The lips, for example, should be reconstructed in a way that allows for eating and swallowing. The areas of the head and neck that are covered with hair have their own special consideration. Damage to hair cells during removal and reconstruction can result in areas of baldness.

Clinical Consideration of the Eyebrow Region

The area of the forehead and specifically the eyebrows poses a unique challenge for reconstruction. First, because the eyebrows are paired, asymmetry is highly visible in this region. Second, elevation of the eyebrow can mean elevation of the eyelid and in extreme cases can lead to incomplete closure of the eyelid. Finally, if careful attention is not paid during reconstruction, hair loss can ensue. In order to address these concerns, several specific techniques are used during reconstruction of an eyebrow. For example:

  • Careful tissue handling can minimize damage to hair cells.
  • Specially designed flaps can be used to reconstruct these defects preventing any elevation of the eyebrow and asymmetry in this region.
  • In the event that hair loss does occur, hair transplant techniques can be used to regrow hair in the region.
Figure 3a: Scar leading to hair loss of the right eyebrow.
Figure 3a: Scar leading to hair loss of the right eyebrow.
Figure 3b: One year after hair transplant to the right eyebrow.
Figure 3b: One year after hair transplant to the right eyebrow.

For more information about skin cancer and reconstruction, visit: http://www.ohniskin.com