Inverted T–shaped resection for midline anterior chest wall skin cancers: achieving oncologic clearance with primary closure

Abstract Midline anterior chest wall skin cancers may pose a reconstructive challenge due to limited presternal skin laxity. Conventional elliptical excision using a 3:1 length-to-width ratio can result in excessive cranio-caudal scar extension toward the cervical or upper abdominal regions. We report two cases of midline anterior chest wall skin cancers—a nodular melanoma and an extensive squamous cell carcinoma—managed using an inverted T–shaped resection design. Oncologic margins were planned according to histologically confirmed diagnoses, followed by en bloc excision and bilateral local tissue advancement to achieve primary closure. In both cases, complete tumor excision with negative margins was achieved without postoperative complications. This inverted T–shaped resection represents a simple and reproducible surgical approach that facilitates primary closure while preserving oncologic principles in selected midline anterior chest wall skin cancers.