Seeing a MOHs surgeon for lentigo maligna on cheek. Very large and close to mouth. Dr says my mouth will be pulled to the side

He will cut from cheek to ear and down neck. Skin will be pulled very tight. Area is heart shaped. Bottom of heart right next to mouth. Top about 3-4 inches above on my cheek I am terrified!!! Are there no other alternatives to this drastic surgery?

Doctor Answers 2

Lentigo Maligna

Thank you for reaching out.  I can certainly appreciate where you are coming from both from the concern about the pathology and about the proposed surgery.  

As I'm sure your dermatologist and/or facial plastic surgeon has discussed with you, Lentigo maligna is best treated with surgery.  Of course, LM presents a very unique issue when it is large and involves your face.  The reconstructive approach you are describing sounds like a cervical rotation flap reconstruction where remaining cheek skin and neck skin is raised up, rotated, and moved to rebuild the area involved by the LM.  This is typically the best option when reconstructing large facial defects and leads to the best possible outcome. 

Even though it is the best choice, that doesn't mean it is not anxiety provoking and I can appreciate where you are coming from.  While the surgery itself can be a relatively rough recovery for the first few days, by a few months you should be looking great (save some well camouflaged scars).  It is impossible to know without actually examining you, but with accurate planning your mouth should not be pulled sideways and there should be minimal distortion to your natural facial features.  Scarring is part of any surgical procedure but these should also heal well.   

Take the time to chat with your surgeon about your concerns so that you feel comfortable proceeding.  

Best of luck.


Toronto Facial Plastic Surgeon

Lentigo Maligna of cheek

Thank you for your question. Lentigo Maligna standard of treatment is surgical excision. Some physicians will use a chemotherapeutic cream known as aldara (Imiquimod) to try and decrease the size of very large tumors before excision. I would discuss your options with your treating physician to see which one is most appropriate for you. 

Lenore Sikorski, MD
Orange County Dermatologist
4.3 out of 5 stars 24 reviews

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