Plastic surgeons deal with a lot of skin cancers and moles and are therefore excellent at diagnosing different skin lesion pathology. Plastic Surgeons have generally dealt with an array of skin lesions and blemishes and skin cancers. Plastic Surgeons have been involved in this mainly because of the superior scarring that can be achieved with plastic surgery techniques. The vast majority of skin lesions and skin cancers that are referred to plastic surgeons are generally on the face. Larger skin cancers and melanomas elsewhere on the body are also referred to plastic surgeons as they have the know-how to close the resulting defects.
My philosophy regarding the excision of skin cancers on the face are that if I can avoid a skin graft in these areas, I will, as skin grafts leave different colour skin leaving a patchwork on the face. I usually close these defects with flaps. Flaps are often taken from the adjacent area which means that the skin colour will be identical to the surrounding skin. The scarring will however be a little longer, but with time the scarring will diminish that much that it becomes virtually invisible.
If possible one always likes to close defects left from excision of the skin lesions, or skin cancer directly (ie without a flap or graft). If this is not possible then I prefer a flap as the next stage. If the flap is inappropriate or the defect too large a skin graft might be necessary. Full thickness skin grafts give better cosmetic results than split thickness skin grafts.