Background: Head and neck keratinocyte carcinomas are frequently managed surgically; anatomic constraints may increase the risk of incomplete excision and influence reconstructive choices. Objectives: To describe the clinicopathological characteristics of head and neck non-melanoma skin cancers (NMSC) treated in a tertiary care dermatology department and to explore factors associated with resection status (R0 vs R1) and reconstructive approach after conventional excision. Methods: We performed a retrospective observational study of 117 patients undergoing excision of 134 primary head and neck NMSC between September 2025 and January 2026. Demographic, clinical, histopathological, and procedure-related variables were extracted from medical records and pathology reports. Margin status was assessed for conventionally excised lesions. Results: Most lesions were basal cell carcinomas (113/134, 84.3%) and were located on the cheek (31.3%) or nose (29.8%). Conventional excision was performed in 126/134 lesions (94%). Among conventionally excised lesions, 92% had complete resection (R0) and 8% had positive margins (R1), most commonly involving the lateral margin. Conclusions: In this single-center cohort, head and neck NMSC clustered in high-risk anatomic regions, and a small proportion of conventionally excised tumors showed positive margins. Clear reporting of margin involvement and reconstruction patterns may support quality improvement and guide future prospective follow-up.
