Mohs Reconstruction
Mohs reconstruction is a procedure performed after Mohs surgery to restore the form and function of areas previously affected by skin cancer. After cancerous cells are removed from the skin via Mohs surgery — an often lifesaving procedure designed to eradicate skin cancer with tissue-preserving techniques — patients may be left with a large wound or damaged skin tissue. This can be especially concerning if highly visible regions, such as the face and/or hands, were the targeted site(s) of Mohs surgery. With Mohs reconstruction, our extensively trained and board-certified craniofacial plastic surgeon, Dr. Eric Payne, can rehabilitate the affected area(s) to produce a more aesthetically appealing result. This can often help patients achieve a more positive self-image and an improved quality of life. In most cases, Mohs reconstruction can be just as pivotal to a patient’s health and well-being as their initial Mohs surgery.
What is Mohs Surgery?
Mohs surgery was first developed in 1938 by general surgeon Frederic E. Mohs to treat skin cancer. Considered the most advanced and effective treatment for skin cancer, Mohs surgery can be very effective in removing cancerous tissue. The technique can remove two types of skin cancer: basal cell carcinoma and squamous cell carcinoma. Mohs surgery involves obtaining an immediate frozen section pathology examination, which is completed by the person performing the surgical excision (to determine if cancer is present). During surgery, microscopic pieces of tissue are removed and evaluated to determine if cancer is present. This process is repeated as necessary, using very small amounts of tissue each time, until cancer is no longer detected. Some patients require multiple small excisions to remove all their cancerous lesions.
Although Mohs surgery minimizes damage to the surrounding tissues, in many cases patients will still require some reconstructive surgery to repair the areas that were treated—especially if they were located in cosmetically sensitive places. This restoration is referred to as Mohs reconstruction.
Which Areas of the Body May Require Mohs Reconstruction?
This type of surgery is typically performed for skin cancer on the face due to the necessity of large excisions that may leave a patient severely deformed. The eyelids, nose, ears, and lips are all commonly treated with Mohs surgery and, therefore, Mohs reconstruction. In addition to the face, the hands are another area commonly affected by skin cancer that can benefit from Mohs reconstruction after Mohs surgery. Essentially, any region of the body can be repaired with this method, but the technique is primarily performed where removal of tissue would be highly visible. These areas also happen to be the most common locations for skin cancer to develop since they receive more sun exposure.
When is Mohs Reconstruction Performed?
Mohs surgery is performed in one day, with reconstruction either taking place on the same day or the next day. The cancer excision from Mohs surgery may leave a wound that must be covered with skin grafts, local skin tissue, or distant skin flaps. Typically, a plastic surgeon familiar with skin grafting and skin flaps can create the best reconstruction to achieve the most ideal appearance.
What are the Different Approaches to Mohs Reconstruction?
Every patient is unique and your treatment plan will be tailored to your individual needs. The best approach for your Mohs reconstruction will be determined based on factors like the size of the wound and your individual rate of healing. The various approaches to Mohs reconstruction include:
- Primary closure: The wound is closed directly, either by allowing it to heal naturally and/or by assisting the healing process by applying sutures.
- Local flap closure: Larger wounds or defects that exist in proximity to healthy tissue are closed using surrounding flaps, or sections of skin tissue that are still connected to their blood supply.
- Skin grafting: Wounds that cannot be closed with a flap can be healed using a graft of healthy skin from elsewhere on the body. This graft is used to cover damaged tissue in a band-aid-like fashion.
- Structural grafting: This approach is meant to rebuild the framework of a structure, and usually reserved for damaged areas that affect the underlying cartilage, such as the ears or nose. A structural cartilage or bone graft is taken from another location and utilized in the reconstruction of the defect.
- Distant flap closure: In some instances, local flaps are not possible and a distant flap — which includes healthy skin, fat, and possibly muscle — is used with the blood supply to reconstruct the defect. This type of reconstruction requires microsurgical techniques in certain cases.
Some small repairs may not require reconstruction at all and can be left to heal on their own. Larger or more complex wounds may require skin grafts or a local or distant flap, which is a larger piece of tissue relocated from one area and utilized to close an open injury. Post-operative care is very important, and Dr. Payne will go over aftercare details and recovery instructions so you can have a good understanding of what to expect.
What is Recovery After Mohs Reconstruction Surgery Like?
Most patients can return home the same day as their Mohs operation, and you will likely have a bandage on the area(s) that were treated. Any instructions you need, such as when and how to clean your wound, will be provided prior to leaving the hospital or operating facility. If you ever have a question about your care or progress, we encourage you to reach out to our team. You will have regular follow-up visits to monitor your health and to ensure the best possible outcome.
Additional Mohs Reconstruction FAQs
Is Mohs reconstruction covered by insurance?
Mohs reconstruction, along with Mohs surgery, is often covered partially or in full by medical insurance companies. Our friendly office team would be happy to help guide you through the insurance process as well as your other financial options. For all out-of-pocket costs, Dr. Payne accepts financing from trusted third-party lenders like CareCredit® and Prosper® Healthcare Lending.
Will I have a scar after Mohs reconstruction?
While it’s common for all surgical procedures to leave a scar to some extent, Mohs reconstruction is designed to enhance the appearance of areas previously treated with Mohs surgery. Dr. Payne is very meticulous about minimizing the appearance of scars whenever possible. Any post-operative scarring can often lighten and fade somewhat over time, especially if wound care instructions provided after your Mohs reconstruction are closely followed.
Is Mohs reconstruction completed in one procedure or in stages?
Depending on the extent of surgical work necessary, Mohs reconstruction may require multiple stages to achieve the best possible cosmetic outcome. Minor defects can likely be corrected in one operation while more complex wounds may need more than one procedure to repair. The timeline of your Mohs reconstruction is determined by the nature of your cancer, where your Mohs surgery was performed, and the size of the resulting wound.
Who is a candidate for Mohs reconstruction?
Mohs reconstruction can benefit patients who are healthy, who don’t smoke, and who would like to cosmetically improve area(s) affected by skin cancer removal surgery. Good candidates are often individuals who require nasal and facial reconstruction after treatment for their basal cell carcinoma or squamous cell carcinoma.
How long is a Mohs reconstruction procedure?
Mohs reconstruction can be completed in the span of one hour to a few hours depending on the techniques necessary to restore the damaged area(s) and the complexity of your procedure. Dr. Payne will be able to gain a better sense of your needs after an initial consultation, where he can evaluate the extent of surgery necessary. He can subsequently inform you of what to expect with regard to the anticipated length of your procedure. Furthermore, patients who have minor skin defects may be able to undergo their reconstruction under local anesthesia, while those with more complex wounds will likely require general anesthesia.
Dr. Payne is an experienced surgeon who will work with you and the dermatological Mohs surgeon to give you the best outcome. Please contact our office for a consultation.