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Mohs Defect Reconstruction

Mohs Defect Reconstruction

Mohs surgery is a procedure performed by dermatologists to remove certain types of skin cancer.  The procedure was originally developed by Dr. Frederic Mohs, a general surgeon in Wiconsin.  The skin cancers most commonly removed are basal cell carcinomas and squamous cell carcinomas.  Your Mohs dermatologist will remove the skin cancer layer by layer evaluating each sample under a microscope to maker certain that all of the skin cancer has been removed. Oftentimes your dermatologist can repair the skin defect left behind after removal of these skin cancers.   Sometimes the defect is too large or it may be located in a cosmetically sensitive area. For these defects, plastic surgeons are usually consulted.  These defects often involve the scalp, forehead, eyelid, nose, cheek, lip, or ear.

Drs. Sattler and Cooper’s goals with surgical reconstruction of Mohs defects is to restore your appearance and function so that you may fully recover from your skin cancer, both physically and emotionally.

Types of Mohs reconstruction

            After a thorough evaluation of your anatomy, your Mohs defect, and any associated health problems you may have, Dr. Sattler or Cooper will recommend one of three methods of reconstruction: primary closure, local flap closure, and skin grafting.

            Primary closure:  if the defect is small enough and in an area that would not adversely affect surrounding anatomical structures, such as the eyelids, then Dr. Sattler or Cooper may free up the skin edges around the defect and close the defect with sutures placed in multiple layers.

            Local flap closure: if the defect is too large or adjacent to an anatomical structure that may cause deformity if closed primarily, then Dr. Cooper or Sattler may perform a local flap closure.  This may involve rotating or advancing local tissue adjacent to the wound into in order to close the the Mohs defect.  In the case of the nose, cartilage taken from the ear is sometimes also needed in order to restore structural and functional integrity.  Examples of flaps commonly performed include the paramedian forehead flap, nasolabial (or melolabial) flap, bilobe flap, and rotational/advancement flaps such as the cervico-facial flap.

            Skin graft closure:  Sometimes due to the shallow nature of the defect, a skin graft may be recommended.  A skin graft involves taking skin from another area and transplanting it into the Mohs defect and securing it there with sutures. The donor site, the area from which the skin graft was taken, is then closed primarily.

Individualized Approach

            Drs. Sattler and Cooper will discuss with you the options available to repair your Mohs defect.  He will also discuss the risks and benefits of each approach with you in detail.  Depending on the complexity of the procedure and patient preference, the operation will be performed as an outpatient or occasionally as in inpatient.  These procedures typically take between 1 and 2 hours to perform.  Local anesthetic is usually used, but sometimes intravenous sedation is used as well for patient comfort. 

Our Mohs facial reconstuction surgery photo gallery can be viewed here.

Before and after photos on this website are of actual patients who have given permission for their photos to be published. Individual results may vary. No guarantee or prediction of outcome is implied.

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