5 Things to Know About Reconstruction after Moh’s Surgery

Reconstruction after Moh’s Surgery is a very common procedure which closes open defects on the face and body left from the micrographic removal of skin cancer. Moh’s surgery is commonly used to completely remove skin cancers, such as basal cell carcinoma, squamous cell cancer, melanoma and dermatofibromas. Moh’s surgery does limit the size of the open wound by precisely removing the cancerous tissue, but these skin cancers commonly widely infiltrate into the surrounding tissues despite the area appearing normal to the eye. This makes the size of the open wound after the procedure somewhat unpredictable before the Moh’s procedure and may make the need for reconstructive surgery after the tumor removal unpredictable too.

  1. Reconstruction after Moh’s Surgery can be performed the same day of the excision. Many Moh’s specialist can predict the need for reconstruction based on the initial size and location of the skin cancer. With careful planning and communication with both the Moh’s surgeon and the reconstructive plastic surgeon, a day in which the Moh’s surgery is performed in the morning and then the closure is planned in the afternoon can be realistic. Variables which can make this difficult, are the need for multiple rounds of Moh’s surgery to completely remove the cancer and the availability of the operating room if not reserved before the procedure. Typically in these cases, the closures can be performed the next day by the reconstructive surgeon.
  2. The procedure can be done in the office or in the operating room. The closure of certain simple defects after Moh’s surgery can be performed in the office under local anesthesia by either the dermatologist or the plastic surgeon. Typically smaller open wounds in uncomplicated areas can be closed with simple manipulation of the local tissue to achieve a straight-line closure with stitches.
  3. The complexity of the reconstruction depends on size of the area. Small open areas for Moh’s procedures can be closed easily though this does relate to the area of the defect. Large areas on the trunk or limbs may be covered with skin grafts, but often they can be closed with rotation or pedicled flaps. Large areas of the nose may need three dimensional reconstruction with a forehead flap and a lining flap, in order to maintain form and function of the nose. The larger the area of the Moh’s defect the less straightforward the repair.
  4. The complexity of the reconstruction depends on the location of the defect. The most common areas for Moh’s procedures are typically common areas of skin cancer, including the nose, ears and forehead. Unfortunately, these areas do not tolerate straightforward  repairs for open areas 5 mm or more. For Moh’s defects of the face, eyelid, cheek, lip, ear and nose: reconstructive surgery with either a flap or graft are often indicated. The type of reconstruction is based on the size of the defect in this area, but the majority of open areas in these regions require reconstructive surgery by a plastic surgeon.
  5. Reconstructive surgery after Moh’s surgery may require additional procedures. Simple repairs after Moh’s surgery may need very limited care after the stitches are removed. Scar care is important for any incision and Dr. Trussler will guide you on his active scar care regimen. For some flaps and grafts used to fill in open areas, dermabrasion and laser resurfacing may be needed to flatten and blend the new skin into the surrounding area. These are commonly in-office procedures. Pedicle flaps often require a division and insetting procedure where the pedicle composed of skin and blood vessels is divided and the living flap is completely sutured to the open wound. This is commonly done at the 3 week point and is a short out-patient procedure, where fine touches can be made to the contour of the flap. Some residual scarring and donor site areas can be revised at the 6 month to one year point if needed on certain areas.

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