This chapter will focus specifically on reconstruction of soft tissue defects of the dorsal surface, where the hand, digits, and nail unit are particularly vulnerable to skin cancer from chronic ultraviolet exposure. This chapter also addresses more detailed anatomy of the muscles and tendons when applicable to a specific reconstruction or critical anatomic relationship. The most common cutaneous malignancy of the hand is squamous cell carcinoma, and other cutaneous neoplasms such as basal cell carcinoma and melanoma occur less frequently. Reconstructive surgery may be necessary to preserve or restore function after excision or Mohs micrographic surgery of cutaneous neoplasms. Dermatologic surgeons frequently encounter defects on the hand that require reconstruction after tumor extirpation. A comprehensive knowledge of hand anatomy, with specific attention to the hand’s unique fasciocutaneous and vascular makeup, allows the surgeon to approach reconstructing these defects with confidence.