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.
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.