While treatment for your Skin Cancer is your primary concern, reconstruction of the treated area is also crucial. Once your Mohs Surgeon is confident that all of the Cancer has been removed, together you will decide how the wound will be repaired. In addition to removing Skin Cancer, Fellowship Trained Mohs College Surgeons rely on their specialized Reconstructive Surgery training to repair the wound.
Choose a Fellowship Trained Surgeon for Facial Reconstruction Mohs Surgery
You want your Skin Cancer treatment to be performed with the highest standards of care and competency. The American College of Mohs Surgery is the only organization that requires its members to successfully complete an extensive fellowship that requires at least 1 full year of training and hands-on experience provided by highly qualified instructors after completing their years of residency training. Mohs Surgery is the optimal treatment for most types of Skin Cancer.
Options for Facial Reconstruction Following Mohs Surgery
While your Mohs Surgeon might be able to give you an idea of whether your reconstruction should take place immediately after surgery or be delayed until later, it’s impossible to know the magnitude of the Cancer in advance. After determining that the affected area is Cancer free and reconstruction is necessary, the Mohs Surgeon will review Skin Cancer Reconstructive Surgery options with you. Based on the size of the tumor, depth of roots, and location, one of the following options will be selected:
- Small, simple wounds may be allowed to heal by themselves (process known as secondary-intention healing).
- Slightly larger wounds may be closed with stitches in a side-to-side manner.
- Larger or more complicated wounds may require a skin graft from another region of the body or a flap, which closes the defect with skin adjacent to the wound.
- On rare occasions, the patient may be referred to another Reconstructive Surgical specialist.
Post-operative Management Following Mohs Surgery
Your Mohs Surgeon will arrange post-surgical check-ups after Mohs Surgery to monitor your recovery and promptly spot any possible Cancer recurrence. Since 2 out of 5 patients with a Skin Cancer will develop another within 5 years, follow-up is vital for early detection of any new lesions. Learn more about post-operative care following Mohs Surgery.
What Is Mohs Reconstructive Surgery?
After having Mohs Surgery to remove a Skin Cancer lesion, your Mohs Surgeon may perform a simple closure himself or you may recommend post-Mohs Reconstructive Surgery. This type of Reconstructive Plastic Surgery can be performed immediately after any Skin Cancer lesions are removed.
Your Options for Post-Mohs Reconstruction
It is important to understand that there is no one “formula” for performing post-Mohs Reconstructive Surgery since the locations, amounts, and types of tissues affected are different from person to person. However, certain techniques commonly used are:
- Flap techniques (The most commonly used technique in post Skin Cancer facial reconstruction).
- Bone Grafting (Bone is most often taken from the skull and shaped to be placed into the excision site).
- Cartilage Grafting (The most common donor site for cartilage is the ear, but rib cartilage may also be used).
- Tissue expansion (Tissue expanders are used for a small percentage of individuals).
- Skin Grafts (Skin Grafts are used infrequently for facial reconstruction).
Post-Mohs Reconstructive Surgery – How It’s Done
There are a few steps that are common for most people having post-Mohs Reconstructive Surgery. Prior to beginning the Mohs Surgery or administering Anesthesia, your Mohs Surgeon will ensure that you thoroughly understand the goals of the procedure as well as the possible risks. You will be asked to sign an informed consent form stating that you understand the reason for the procedure, as well as any possible complications which could occur.
You will also be given information for what you should do prior to the procedure. This may include avoiding any food or drink for a period of time, and sometimes your surgeon may have you shower the night before with a special soap. On the day of the procedure, your Skin Cancer may be removed either by a Dermatologist or by the Plastic Surgery who is performing your post-Mohs reconstruction.
Anesthesia is administered. Skin Cancer reconstruction may be performed under Local Anesthesia, Intravenous Sedation (also known as Managed Anesthesia Care (MAC) or “twilight sleep”), or General Anesthesia. Your doctor will recommend the best choice for you, based on what tends to work best for the procedure you are having, as well as any other medical conditions you may have. If your Plastic Surgeon is the one removing the lesion, it will be done at this stage. A small lesion with well-defined borders may be removed with a simpler surgical process referred to as excision.
The lesion is removed. This step may have already been completed in a separate procedure unless your Plastic Surgeon is also the one removing your lesion or is working with your Dermatological Surgeon as a team in a single procedure. Note: If your lesion was small with well-defined borders, a simple surgical process called excision may have been used to remove it. If it was larger without well-defined borders, Mohs Surgery was probably required.
The wound is closed. If your procedure has been a simple excision, this is a relatively straightforward process; if, however, more complex Mohs Surgery was required, there are a number of options to repair the resulting defect left behind after removal of the lesion. Regardless of the techniques used, your Plastic Surgeon will take care whenever possible to make sure that the resulting suture line is positioned to follow the natural creases and curves of your face, in order to diminish the appearance of your scar.
After surgery. You will be observed for a while after your surgery has been completed, and then given instructions for returning home. Some people, especially those who have a flap procedure, may be given a prescription for antibiotics to take at home. It is important to talk to your Mohs Surgeon about symptoms of infection and when to call. Most often your Surgeon will ask you to call if you develop a fever over 101° F, increasing redness, pain, or discharge. If you’re given antibiotics to take, make sure to finish them. One of the most important things you can do to reduce your chance of infection is to refrain from smoking, since smoking hinders healing after Plastic Surgery.
After Post-Mohs Reconstructive Surgery
It is important to note here that for approximately 15% of people, reconstruction after Skin Cancer excision must be performed in at least 2 stages. This is true mostly when certain types of flap techniques are used. The first stage creates and repositions the flap, and the second stage “sections” or separates the flap from its original location and blood supply. Consequently, once you have recovered and blood supply to the wound has been sufficiently established, a second surgery may need to be scheduled to complete reconstruction. Surgeries other than a flap technique may also require further procedures in order to achieve the desired cosmetic effect. It can be helpful to talk to your surgeon prior to your surgery about her expectations, and whether she believes the entire reconstruction can be done in one procedure, or if she expects that you will require more than one procedure.
Learn More About Reconstructive Surgery After Skin Cancer
If you want to find out more about Reconstructive Surgery after Skin Cancer removal, including how it’s done, your options, and what happens after surgery. Take some time to read about Facial Reconstruction after Skin Cancer Surgery. You may also wish to take a look at some before and after photos of reconstruction after Skin Cancer. If you have a weak stomach when viewing medical photos, you might want to skip this step, yet many people find it encouraging and comforting to see just how well facial features can be restored, even after significantly large Skin Cancers are removed.
Mitchell, R., Mendez, Schmitt, N., Bhrany, A., and N. Futran. Antibiotic Prophylaxis in Patients Undergoing Head and Neck Free Flap Reconstruction. JAMA Otolaryngology – Head and Neck Surgery. 2015. 141(12):1096-103.
Patel, S., Liu, J., Murakami, C., Berg, D., Akkina, S., and A. Bhrany. Complication Rates in Delayed Reconstruction of the Head and Neck After Mohs Microscopic Surgery. JAMA Facial Plastic Surgery. 2016. 18(5):340-6.
Skin Cancer and Reconstruction
Purpose: Discovering that you have Skin Cancer can be difficult news. When it is in a cosmetically sensitive area on your face, preserving normal tissue and restoring a natural appearance is essential. This can be done with standard excision or Mohs resection. Closure is then performed by a Mohs Surgeon who is trained in Facial Plastic Surgery procedures.
Procedure: The size and location of the defect will dictate the recommended closure and repair. The general principle of closure is to borrow extra, unnecessary tissue from other similar or nearby locations. All layers of the defect and all tissue types that are removed must be replaced. Skin Grafts and Cartilage Grafts harvested from other regions of the head and neck or body are often necessary. For defects of the nose, multiple surgeries may be necessary to provide optimal results. The procedure length varies from 15 minutes to 3 hours, depending on the nature of the defect. Generally, the closure can be completed under Local Anesthesia or Conscious Sedation. Together with Dr. Slupchynskyj, an appropriate Anesthetic plan will be developed.
Recovery: You should be able to return to normal activates the day of the procedure. An occlusive dressing may be placed after the surgery. Because wounds heal more quickly in clean, moist environments, wound care instructions will be provided. Sutures are removed within 7 days after the procedure.