Mohs surgery was first developed in 1938 by a general surgeon Frederic E. Mohs for treating skin cancer. The two types of skin cancer removed are basal cell carcinoma and squamous cell carcinoma. The procedure involves obtaining immediate frozen section pathology examination done by the person performing the surgical excision (to determine if cancer is present). This guides the surgical excision to confirm clear margins with the smallest margins necessary for complete excision. In other words, microscopic pieces of tissue are removed and evaluated to see if cancer is present. This is repeated as needed, using very small amounts of tissue each time, until no more cancer is detected. Some patients require multiple small excisions to remove all the cancer. After treatment, our extensively trained craniofacial and plastic surgeon, Dr. Eric Payne, can help restore the affected area to a more aesthetically appealing result in a procedure called Mohs reconstruction.
What is Mohs reconstruction?
Considered the most advanced treatment for skin cancer, Mohs surgery can be very effective in removing cancerous tissue. 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 like the face and hands. This restoration is referred to as Mohs reconstruction.
What areas of the body may need Mohs reconstruction?
Typically this type of surgery is done for skin cancer located on the face because large excisions would leave the person severely deformed. The eyelids, nose, ear 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?
The procedure is done in one day with the reconstruction either the same day or the next day. The cancer excision leaves 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 help create the best reconstruction to give the best appearance.
What are the different approaches to Mohs reconstruction?
Every patient and treatment plan is unique, and the best approach for your Mohs reconstruction will vary depending on your needs. Other factors, like the size of the wound and your individual rate of healing, will be taken into consideration. Some small repairs may not require reconstruction at all and may be allowed to heal on their own. Larger or complex wounds may require skin grafts or a local or distant flap, which is a larger piece of tissue relocated from one area and used to close an open injury. Post-operative care is very important, and Dr. Payne will go over the details and instructions so that you can be well-prepared.
What is recovery like after Mohs reconstruction surgery?
Most patients can return home the same day as their Mohs operation, and you will likely have a bandage on the area or areas that were treated. Any instructions for you, such as when and how to clean the wound, will be given prior to you 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.
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.