The surgeon may undertake a simple closure themselves or recommend post-Mohs reconstructive surgery to the patient following Mohs surgery to remove a cancerous skin lesion. Reconstructive plastic surgery can be performed right after the removal of any skin cancer lesions.  

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) provide dermatology treatments to patients in Shiloh, IL; St. Louis, MO, and surrounding communities.

Reconstruction Options

There is no single “formula” for performing reconstructive surgery after Mohs as the location, amounts, and types of tissues impacted vary between patients. But some techniques that are commonly used are as follows:

• • Flap techniques: This technique is most commonly used in post-skin cancer facial reconstructive surgery.

• Bone grafting: The bone is usually taken from the skull and shaped to be grafted in the excision area.

• Cartilage grafting: While the most common donor area for cartilage is the ear, rib cartilage may also be used.

• Tissue expansion: Tissue expanders are used for a small number of patients.

• Skin grafts: Skin grafts are used for facial reconstruction, but their use is relatively less common.

How it’s Done

Some steps are common to a majority of patients undergoing post-Mohs reconstructive surgery. Before the surgery or administering anesthesia, the surgeon will ensure that the patient has a complete understanding of the goals and risks associated with the procedure.

The patient will need to sign an informed consent form stating that they understand the reason for the procedure as well as the potential complications may arise.

The patient will also be given instructions on what they need to do before the procedure, including details on avoiding any food or drink for a specific duration. At times, the surgeon may ask the patient to take a shower the night before the procedure using a special soap.

During the procedure, a dermatologist or the plastic surgeon performing the post-Mohs reconstruction may remove the skin cancer. The process may include the following:

Anesthesia is administered

The skin cancer reconstructive surgery may be undertaken with local anesthesia, IV sedation (also called managed anesthesia care, or MAC, or “twilight sleep”) or general anesthesia. The doctor will recommend the most appropriate anesthesia type for the patient, depending on what is most suitable for the procedure and any health conditions that the patient may have.

In case the plastic surgeon is the one removing the lesion, it will be done at this time. If the lesion is small with well-defined borders, the surgeon may remove it with a more straightforward surgical process known as excision.

The lesion is excised.

The lesion removal may have been undertaken in a separate procedure unless the plastic surgeon is excising the lesion or is working with the dermatological surgeon in a single procedure.

Note: A simple surgical process known as excision may be used to remove small, well-defined lesions. However, if the lesion is larger without well-defined borders, the patient will likely require Mohs surgery.

The wound is closed.

Simple excision is a relatively straightforward process. If the more complex Mohs surgery is necessary, there are various options to repair the defect that is left behind after the lesion excision.

Irrespective of the technique used, the plastic surgeon will try to position the resulting suture line such that it follows the natural creases and curves of the patients face to minimize the appearance of the scar.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) receive patients from Shiloh, IL; St. Louis, MO, and nearby areas for dermatology treatments.

If you would like to learn more about procedures and treatments at Metro East Dermatology & Skin Cancer Center by Board Certified Dermatologist Dr. Jamie L. McGinness please contact us here or call (618) 622-SKIN (7546)

Taking new patients in and around the greater St. Louis, Missouri and Illinois area: East St. Louis Missouri, Shiloh Illinois, Belleville, Millstadt, Saint Clair County, Madison County and more.

Reconstructive surgery provides patients who have had a growth removed with a way to restore the cosmetic appearance as well as functional structures that may have been damaged during the removal of malignant and benign growths.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) provide dermatology treatments to patients in Shiloh, IL; St. Louis, MO, and surrounding locations.

Reconstruction will Depend on the Extent of Growth Removal

The patient may require advanced reconstruction depending on the depth and location of the growth that has been removed, the amount of skin eliminated to ensure full removal, or the unavailability of sufficient adjacent skin (such as in sites around the ear or nose) to close the defect.

In such cases, the patient may require skin grafting, flaps, or other reconstructive techniques to restore the natural appearance and functionality of the area.

Patients concerned about a skin lesion or aberration should consult an experienced and skilled dermatologic surgeon.

A Key Focus

Ideally, the dermatologist should specialize in the treatment of skin cancer, particularly with Mohs surgery, which is a cutting-edge, highly effective surgical approach with up to a 99 percent cure rate!

An experienced dermatologist will not provide the patient with an “off-the-rack,” generic treatment plan. Rather, they will invest time to understand the patient and their health history to create a customized treatment plan which will offer them the highest chances of a successful outcome.

When is Reconstructive Surgery Necessary?

Patients who have undergone surgery to remove a cancerous or benign lesion will have a surgical defect requiring reconstruction to restore the area.

Irrespective of whether the lesion was removed using Mohs surgery or another surgical procedure, such as excisional surgery, the patient may require reconstruction. Sometimes the surgeon may allow the defect to heal on its own. A straight line of sutures is all that is necessary in many cases.

However, it may be challenging to seal the wound side to side with a straight line in cases where lesions are excised from sites with insufficient adjacent tissues, especially in prominent facial areas such as the ear and nose.

Skin grafting, flaps, or other reconstructive techniques may be required to repair the surgical defect in such cases.

An experienced dermatologic surgeon will understand the importance of outward appearance for the patient, especially regarding its effect on the patient’s confidence and self-esteem in social and professional situations.

A skilled skin surgeon will undertake reconstructive surgery to restore the appearance of the defect enabling the patient to regain the self-confidence that they have in their natural aesthetic appearance, even after complex surgery.

What Types of Reconstructive Surgery are Available?

The treatment of skin cancer is of utmost importance. However, reconstruction after the procedure is vital as well. Following the surgery to remove malignant cells, the dermatologic surgeon will offer the patient information on the appropriate techniques available to repair the surgical defect.

According to the depth, size, and location of the surgical defect, one of the following approaches may be chosen:

• Allowing the wound to heal on its own or second intention healing.
• Sealing the wound in a side-by-side manner using stitches.
• Using a skin graft (skin sourced from another location on the body) or a flap (using skin surrounding the wound) to address the defect.
• Referral to a reconstructive surgical expert for wound repair.

Following the excision of a cancerous or non-cancerous lesion, reconstructive surgery is an effective way to ensure that the patient appears and feels their best in the recovery phase.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) receive patients from Shiloh, IL; St. Louis, MO, and nearby areas for dermatology treatments.
If you would like to learn more about procedures and treatments at Metro East Dermatology & Skin Cancer Center by Board Certified Dermatologist Dr. Jamie L. McGinness please contact us here or call (618) 622-SKIN (7546)

Taking new patients in and around the greater St. Louis, Missouri and Illinois area: East St. Louis Missouri, Shiloh Illinois, Belleville, Millstadt, Saint Clair County, Madison County and more.

The treatment for all types of skin cancer is, unfortunately, not the same. An individualized approach is necessary to treat each type of skin cancer.

Some serious forms of skin cancer warrant a more invasive approach in which the malignant area must be removed surgically.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) provide dermatology treatments to patients in Shiloh, IL; St. Louis, MO, and surrounding communities.

Surgical Dermatology Treatments for Skin Cancer

Mohs Micrographic Surgery: The Gold Standard in Skin Cancer Treatment

Mohs micrographic surgery is a cutting-edge, targeted, and effective technique to surgically eliminate various types of skin cancer while causing minimal damage to the surrounding normal tissue.

This technique was originally developed more than 80 years ago, yet it is still widely considered as the most effective and successful treatment for Basal Cell Carcinoma (BCCs) and Squamous Cell Carcinoma (SCCs).

Mohs surgery has an unrivalled cure rate of up to 99 percent for skin cancer, which is significantly higher than other accepted cancer treatment techniques.

Excision Surgery: Surgical Removal of Growths and Lesions

While many skin growths may be harmless, they can also be unappealing, or even cause pain or other functional impediments. With some growths, such as malignant melanoma, it is of utmost importance to remove them due to the risk of metastasis and invasion of vital organs.

If the patient is concerned about the removal of a malignant lesion, or merely has a benign growth that is cosmetically unattractive or causes them discomfort, surgical removal is usually a definitive and successful treatment.

The patient may consider having a growth or lesion surgically removed, or “excised.” A majority of abnormal skin lesions can be removed using only local anesthesia during an in-office procedure.

Full excision surgery removes the tumor in its entirety. This procedure is often used for growths that have penetrated into the deeper layers of the dermis or cancerous tumors, such as melanomas. Depending on the location and depth of the tumor, the procedure may be performed using local anesthesia.

In the full excision procedure, the surgeon will cut an elliptical incision around the lesion, penetrating the fatty tissue underneath the growth to completely excise it.

Reconstructive Surgery for Restoration

Patients who undergo growth removal may consider reconstructive surgery to restore the aesthetic appearance and functional structures that may have been compromised during cancerous and non-cancerous growth removal.

A Slight Possibility

Advanced reconstruction may be necessary depending on the location and depth of the growth that has been excised, the amount of skin removed to ensure complete elimination, or lack of available surrounding skin (such as in sites around the ear or nose) to close the defect.

Skin grafting, flaps, or other reconstructive techniques may be used in such cases to restore the natural appearance of the area.

One of the below mentioned reconstructive surgery options will usually be undertaken, depending on the depth, size, and location of the surgical defect:

• Allowing the wound to heal by itself or second intention healing.
• Sealing the wound in a side-by-side manner using stitches.
• Using a flap (skin surrounding the wound) or a skin graft (skin sourced from another site on the body) to seal the defect.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) receive patients from Shiloh, IL; St. Louis, MO, and nearby areas for dermatology treatments.
If you would like to learn more about procedures and treatments at Metro East Dermatology & Skin Cancer Center by Board Certified Dermatologist Dr. Jamie L. McGinness please contact us here or call (618) 622-SKIN (7546)

Taking new patients in and around the greater St. Louis, Missouri and Illinois area: East St. Louis Missouri, Shiloh Illinois, Belleville, Millstadt, Saint Clair County, Madison County and more.

Actinic keratoses (AK) refer to scaly, rough lesions that usually develop on sun-exposed skin areas. The chances of AK development increase with age.

AKs are considered to be carcinomas in situ, which can progress to squamous cell carcinomas (SCC). AK treatment may be necessary for cosmetic reasons, symptom relief, or more critically, the prevention of cancer and metastasis.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) provide dermatology treatments to patients in Shiloh, IL; St. Louis, MO, and surrounding locations.

Cryosurgery

Cryosurgery with liquid nitrogen is the most commonly used modality for actinic keratosis treatment. Compressed nitrous oxide or carbon dioxide may also be used. Liquid nitrogen is either sprayed onto the lesions directly or applied via a cotton-tipped swab.

This is a highly effective procedure, with cure rates ranging between 75 and 99 percent. But using the correct technique is vital for effective outcomes.

Key Numbers

According to a study, a five-second treatment had a 39 percent cure rate, while treatment of over 20 seconds had an 83 percent cure rate.

Cryosurgery is usually an in-office procedure. It is typically well-tolerated and offers dramatic aesthetic outcomes. The possible side-effects include hypo- or hyperpigmentation, infection, hair loss, and scarring. However, serious responses rarely occur.

Cryosurgery is most suitable for the treatment of thin, well-defined lesions and may be used to address individual lesions or a tiny number of scattered lesions. Hyperkeratotic lesions prove to be more resistant to cryosurgery and should be debrided prior to treatment.

What to Expect

The doctor will inform the patient how to care for the wound following cryosurgery. A blister may develop in the treated site within a day, while a scab may form a few days later.

The doctor may instruct the patient to apply an ointment to the surface. Depending on the location of the actinic keratosis, the scab will peel off with a few weeks.

The patient can cover the scab with a bandage if their clothes rub the site. It is not advisable to pick at the scab or use make-up on the area until it has healed.

After Cryosurgery

The treated site will appear red soon after the procedure as well as blister and swell. The patient should not break open the blister if this happens. They may also see clear drainage on the treated site, which is normal. The treated region will take around seven to ten days to heal.

Cryosurgery rarely causes serious side-effects and does not typically leave behind a scar. It may cause discoloration in the treated site, and this may improve over several months or may be permanent.

The patient may also experience permanent hair loss in the area. While the loss of sensation in the treated site is rare, it may take up to 18 months to resolve if it does occur.

Aftercare for Cryosurgery

• Beginning the day after the procedure, wash the treated site gently with a fragrance-free soap and water every day.  
• Let the treated area remain uncovered. If the patient experiences any drainage, they can cover the site with a bandage.
• After the site heals, apply a broad-spectrum sunscreen with an SPF of 30 (or higher) to prevent scar development.
• The patient may have discoloration (redness, pinkness, or lighter or darker skin) at the treated area for up to one year after their procedure.

Board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) receive patients from Shiloh, IL; St. Louis, MO, and nearby areas for dermatology treatments.  
If you would like to learn more about procedures and treatments at Metro East Dermatology & Skin Cancer Center by Board Certified Dermatologist Dr. Jamie L. McGinness please contact us here or call (618) 622-SKIN (7546)

Taking new patients in and around the greater St. Louis, Missouri and Illinois area: East St. Louis Missouri, Shiloh Illinois, Belleville, Millstadt, Saint Clair County, Madison County and more.