Reconstruction-Mohs Defects

MOHS micrographic surgery, which is performed by a specially trained dermatologist, is a specialized form of skin cancer treatment in Beaumont, Texas in which skin cancers are excised and then examined under a microscope. This process ensures that all involved tissue is removed layer by layer while as much normal, healthy tissue as possible is preserved. MOHS excision has one of the highest cure rates. However, the procedure can leave defects, which are quite extensive.

Many times, a facial plastic surgeon is called upon to reconstruct the MOHS defect, particularly when cosmetically sensitive areas like the lips, nose or eyelids are involved or when there are large, complex skin cancer defects of the face.

RECONSTRUCTION OF MOHS PROCEDURE

Reconstruction of MOHS defects is the reconstruction of skin defects resulting from excision of cancerous lesions and is often performed immediately after the skin cancer removal. Reconstruction is aimed at restoring form and function of the treated area. Dr. O’Mara performs MOHS defect reconstructions at his office or at an outpatient surgery center. General anesthesia is most often used, though IV sedation is also an option. While surgical times will vary, they average one to three hours.

RECONSTRUCTION OF MOHS TECHNIQUES

There are a vast array of reconstructive techniques which may be used depending on the size and location of the defect. Because of this, the MOHS micrographic surgery is very individualized and is most often not fully determined until the skin cancer defect has been evaluated. All attempts are made to minimize scar visibility as much as possible.. In some cases, a skin graft may be used in which skin is borrowed from a distant location, such as behind the ear, and then used to cover the defect. In other cases, a skin flap may be performed in which tissue is borrowed from an adjacent area to cover the defect. Also, cartilage grafting is commonly used in reconstruction of the nose.

RECONSTRUCTION OF MOHS RECOVERY

Recovery times will vary but average one to three weeks. During this time, patients may experience some mild to moderate swelling and discomfort. Sutures are usually removed after one week and most patients can return to work within one to two weeks, though more strenuous activities and exercise should be postponed for three weeks.

FAQ

Is it better to have Mohs surgery and reconstruction performed by a dermatologist or to have Mohs surgery performed by a dermatologist and then have the reconstruction performed by a plastic surgeon?

It depends on the location and size of the defect to be reconstructed.  The Mohs surgeons I work with are very adept at reconstructing defects that they feel comfortable with.  For more complex Mohs defects, I will usually get consulted for the reconstruction.

I had a skin cancer lesion removed from my cheek with Mohs surgery and it left a big scar that’s impossible to hide. Is there any way to make it less conspicuous?

If your Mohs reconstruction was performed over a year ago, giving time for the scar to mature, scar revision could be considered.  Other options for visible scars include dermabrasion, laser treatments and sometimes an injectable filler for depressed scars.  A thorough evaluation would be required to make that determination.

I’m a 40-year-old woman and I had Mohs surgery on the tip of my nose, leaving me with missing skin. Will I ever look normal again?

Nasal tip defects resulting from Mohs surgery can vary in size, shape, and depth. There are also a variety of ways to reconstruct these defects. This includes direct closure, transferring adjacent skin (flap closure), or a skin graft. While there will be a scar in the region of the reconstruction, in most cases, the end result is a normal appearing nose.

I’m having Mohs surgery for a spot beneath my eye. After my reconstruction will I still be a candidate for a blepharoplasty?

I have performed blepharoplasty in patients undergoing Mohs reconstruction of the lid.  These are usually smaller defects that need reconstruction.  Larger defects may need reconstruction followed by possible blepharoplasty later.  If you are desiring upper blepharoplasty, this can be performed at the same time.