Mohs Surgery and Orbital Tumor
Skin Cancer Reconstruction – Mohs Surgery
With the cases of skin cancer diagnosed yearly exceeding the total of all other types of skin cancer combined, advanced and effective treatments have been developed to provide higher cure rates and improved outcomes.
Mohs micrographic surgery is performed by specially trained dermatologic surgeons to remove difficult or recurring skin cancer. Although it is a very efficient and effective treatment, Mohs surgery can leave large wound defects in prominent areas of the face causing disfigurement.
We utilize several techniques for reconstructing skin cancer defects. These defects can be from previous Mohs’ procedures or even trauma.
What is the recovery and healing process after Mohs surgery?
The extent of your wound is predicated on the size of your skin cancer and how much tissue needed to be removed. Generally, there are four possibilities:
- The wound is small enough it can heal with just a bandage
- The wound is closed with stitches
- Skin is shifted from an adjacent area to cover the wound (skin flap)
- Skin is taken from another part of the body, such as behind the ear, and is used to replace removed tissue
Wound healing and care instructions will be given to you, depending on what method was used.
Customized Approach to Rehabilitation
We have extensive experience in repairing and reconstructing wounds on eyelids and tissues around the face to restore an aesthetically normal and natural appearance. In our photo gallery, you can see several examples of patients who have undergone extensive reconstruction of their eyelids and the tissues around their face, in addition to the primary reconstruction.
Biological remodeling can also be used to expand and soften any scar tissue that may have formed as a result of surgery. This results in a very soft and natural appearance over time. The results are often dramatic and patients are able to resume normal function and appearance.
Frequently Asked Questions
Will Mohs surgery leave a scar?
Any incision in human skin leaves a scar: that’s simply a fact of life. But the advantage of Mohs micrographic surgery is that it enables the surgeon to preserve as much healthy tissue as possible, while still being able to verify that the cancer cells have all been removed. Dr. Douglas has extensive experience with Mohs surgery reconstruction and with subsequent options for minimizing scarring, such as skin grafting, the use of a skin flap, and using a modification or laser.
What can I expect after Mohs surgery?
Mohs surgery is two phases: the removal of the cancer and reconstruction.
The reconstruction can be quite varied depending upon whether it affects the eyelid or cheek etc. It is important to have a reconstructive surgeon who is focused on aesthetics to improve the outcome. There will be stitches to removed in 7-10 days and then the healing will start. Allow about 2-3 weeks for social functions.
Why do I need reconstruction surgery after Mohs surgery?
Once the cancer is removed, there is a skin deficit which if left to heal will scar and cause quite disfigurement. However with an aesthetic reconstruction there is significant improvement in the scarring and sometimes one cannot even tell there was a cancer.
What does the reconstruction process look like?
The first week after reconstructive surgery there is significant swelling and sutures in place. Once the sutures are removed the second week of healing is much better with decreased swelling and redness. You will be able to resume most normal activities in 2 weeks and social events in 2-3 weeks. Complete healing often takes 2-3 months and can require a modification or laser to improve any scarring, The results are often quite dramatic as shown in our before and after gallery.
See What Our Patients Are Saying
He is absolutely the best. I am so grateful to have been able to be treated by Dr. Douglas. Kind, compassionate and extremely knowledgeable. -Sarah W.
General Mohs Surgery FAQs
These are the situations where Mohs is especially useful:
- The skin cancer has recurred or there is a high risk of recurrence
- The skin cancer is located in areas where it’s important to maintain as much healthy tissue as possible: around the eyes, nose, mouth, hands, ears, feet, and genitals
- The skin cancer has borders that are hard to define
- The skin cancer is large
- The skin cancer is aggressive
The surgeo then applies a temporary bandage over your incision, and you head to a waiting room to wait while the removed tissue is sent to the laboratory for examination. This will usually take about one hour. It’s good to have a book or laptop to pass the time.
In the lab, your tissue is cut into sections and examined under a microscope. A map of the excised tissue is created to show what areas, if any, still have cancer cells. Then the doctor knows precisely where more tissue must be removed.
If there is still cancer present, another round of Mohs surgery is done. More tissue is removed, this time only in the area where cancer cells were still present. It is again sent to the lab and the process repeated.
This process is repeated until the tissue borders are all cancer-free.
- Temporary or permanent numbness surrounding the surgical areas, if small nerve endings are cut
- Temporary or permanent weakness of the surgical area if the tumor was large and a muscle nerve was severed
- Itching or shooting pain in the treatment area
- Development of a keloid scar (enlarged beyond the actual incision borders)
Other skin cancers that are best treated with Mohs surgery include:
- Large cancers in normally low-risk areas
- Those with difficult-to-see borders
- Those with certain microscopic growth patterns
- Those that have recurred after initial treatment
- Those that were not completely removed by other treatment methods