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What Happens During Post-Mohs Reconstructive Surgery

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Updated July 08, 2009

Your Options for Post-Mohs Reconstruction

After having Mohs surgery to remove a skin cancer lesion, your Mohs surgeon may perform a simple closure himself or may instead choose to refer you to a plastic surgeon for your post-Mohs reconstruction surgery. 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 patient to patient. However, certain techniques which are commonly used include:

  • Flap techniques (the most commonly used technique in post skin cancer facial reconstruction)
  • Bone grafting (Bone is taken from the skull and shaped to be placed into the excision site.)
  • Cartilage grafting (The most common donor site is the ear, but rib cartilage is also used.)
  • Tissue expansion (used in a small percentage of cases)
  • Skin grafts (used infrequently for facial reconstruction)

How It’s Done

  1. Anesthesia is given. Skin cancer reconstruction may be performed under local anesthesia, intravenous sedation, or general anesthesia. Your doctor will recommend the best choice for you. If your plastic surgeon is the one excising the lesion, it will be done at this stage. A small lesion with well-defined borders may be removed with a simpler surgical process called excision.

  2. 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.

  3. 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 ensure that the resulting suture line is positioned to follow the natural creases and curves of the face, in order to minimize the appearance of your scar.

After Surgery

It is important to note here that in approximately 15% of cases, reconstruction after skin cancer excision must be performed in two 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. Therefore, 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.

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, check out this article about Facial Reconstruction After Skin Cancer Surgery. Or see before and after photos of reconstruction after skin cancer.

Sources:

Interview with Board Certified Facial Plastic and Reconstructive Surgeon, Andrew Jacono, MD, New York, NY, conducted on June 2, 2009.

Skin Cancer and Your Plastic Surgeon, Patient Information Sheet, American Society of Plastic Surgeons.

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