A skin cancer diagnosis is a frightening possibility for anyone with significant exposure to the sun, but treatment is often readily available. Mohs surgery is performed by dermatologists with specialized surgery and pathology training. It removes the cancerous cells from your skin while leaving the rest of your skin and the underlying tissues intact. The removal process can, however, leave a wound that requires specialized closure techniques. This is referred to as Mohs surgery reconstruction, Mohs reconstruction, or post-Mohs reconstruction.
What is Mohs Surgery?
Mohs surgery, or “MMS” (Mohs micrographic surgery), was named after Frederick Mohs, an American general surgeon who developed a technique for removing a tumor, assessing the microscopic margins of removal, and removing more tumor as needed. It is a highly effective treatment for certain types of skin cancer, such as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). It is an exacting procedure that produces very high rates of complete removal. While some treatments seem invasive or risky because Mohs surgery uses precision microscopy to aid the surgical removal process, it allows your dermatologist to remove as many of the cancerous cells as possible while preserving your surrounding healthy skin.
When is Mohs Surgery Used?
Mohs surgery is usually used for BCC and SCC, which are the two most common types of skin cancer. It is not typically used for melanoma. Mohs surgery is a particularly fitting treatment option when the cancer is/has:
- Large
- Blurred borders
- Aggressive
- Recurred after an initial removal
- On thin skin, like your ear or eyelid
- Located in a cosmetically-sensitive area, such as the face
When is Mohs Reconstruction Performed?
Mohs Reconstruction is performed by a plastic surgeon, such as Dr. Kristopher Day, following the dermatologist’s surgery. These procedures are usually performed within days or approximately one week of each other, which requires coordination of both procedures by the plastic surgery and dermatology offices. A temporary dressing, “bolster” (secured bulky dressing), or even small vacuum device may be placed after the skin cancer removal surgery, followed by reconstruction a few days later. Wet-to-dry dressings may also be used daily, as needed, usually for larger lesions. Because the size of the tumor and the resulting wound is sometimes not fully known until after the Mohs surgery itself, sometimes modifications to surgical planning must be made to accommodate the reconstructive option that is best.
What is Mohs Reconstruction Might be Required?
There are an almost infinite number of possibilities for Mohs reconstruction after the surgical removal of a facial skin cancer. For example, there may be a missing portion of the eyelid, ear, nose, or lip. This defect could even involve not just the skin but also structures such as cartilage, nerve, or even bone. In plastic surgery, Dr. Day employs a principle known as “like replaces like.” This means that he uses portions of the body to replace the parts of the body that were removed. For example, if the cartilage of the nose is removed along with the skin to remove the tumor, then he may use a piece of cartilage from the ear and skin from the cheek to replace this removed tissue. Most often, the tissues used to replace defects of the face are “borrowed” or moved from other parts of the face in a “local,” “regional,” or “pedicled” (meaning it has its own blood vessel) flap. For large or complex resulting defects, this can even involved taking tissue from the forehead to the nose (a so-called paramedian forehead flap) or switching tissues from the lower to upper lip, or vice versa (such as the so-called Abbe, Estlander, and Karapandzic flaps). In some cases, if only the skin is missing from a relatively concealed place, then a skin graft can be used to replace it. The source of the skin graft can even sometimes be concealed from behind the ear. Regardless of the situation, the goal of Mohs surgery reconstruction is to correct the defect created by the removal of a skin cancer to as close to normal as possible.
Recovering From Mohs Reconstruction
Even though post-Mohs reconstruction is a surgical procedure, it’s minimally invasive enough that you can leave the hospital or office immediately after the surgery ends. You should be prepared for several hours of surgery, since your plastic surgeon cannot always predict how extensive a reconstruction will be required for your individual defect. Patients typically experience swelling, bruising, and some mild discomfort immediately following the procedure up until a few days. Patients commonly shower after 48 hours and dry the surgical site gently. Dr. Day and his team will direct you to use a pain and other prescription medications, as needed. They will also provide a prescription ointment to apply to your surgical incisions. Walking and other low-grade activities are encouraged the day after surgery with higher intensity activities restricted for usually approximately two weeks. Follow-up care from Mohs surgery and reconstruction involves scar cares and sometimes skin and minimally-invasive treatments to make scars look as good as possible.
Reach Out to Us
If you have received a diagnosis of skin cancer from your dermatologist and think you will require reconstruction, then Pacific Sound Plastic Surgery is available to help in your reconstruction. Dr. Kristopher Day, MD, is a board-certified plastic surgeon with specialized training in facial reconstruction that enjoys helping patients return to their normal form and function. Just call 425-818-8991, email Info@PacificSoundPlasticSurgery.com, or reach out through our website to coordinate your reconstruction with the removal of your skin cancer.
