Skin cancer reconstructive surgery is a specialized surgical procedure. It aims to restore the skin’s appearance and function after skin cancer removal, enhancing affected areas. It is performed after the removal of skin cancer lesions to reconstruct and close the surgical wound. While minimizing scarring and preserving the aesthetics and functionality of the affected area.
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What is Mohs Surgery?
Mohs surgery, also known as Mohs micrographic surgery, is a highly specialized and precise procedure. It is performed by a Mohs surgeon, who is a specially-trained dermatologist. It is primarily used to treat certain types of skin cancer, such as basal cell carcinoma and squamous cell carcinoma. Its primary benefit is preservation of as much normal tissue as possible, while providing for complete removal of the skin cancer. This is especially important in the face, where there is more complexity and less skin than in the rest of the body.
What is Mohs Reconstructive Surgery?
Mohs reconstructive surgery is a surgical procedure performed after Mohs surgery to repair the defect left from the removal of the skin cancer. Every procedure is unique and tailored to the specific defect size and location. In most cases, the patient’s own skin and cartilage (when needed) are used for the repair. The goal is to restore as much form and function as possible to the area that had the skin cancer. Dr. Russell performs Mohs reconstructive surgery, and will coordinate with your Mohs surgeon so that your repair can be completed as soon as possible after the Mohs surgery.
Mohs Reconstructive Surgery Patient Photos
Mohs Reconstructive Surgery Before and After Patient 1:
Dr. Joseph Russell recently had a follow-up with this lovely patient, 6 months after performing a reconstructive procedure using a cervicofacial advancement flap to restore her facial appearance. The patient had faced a melanoma diagnosis on her cheek, a type of skin cancer that often necessitates the removal of larger tissue margins, resulting in more substantial facial defects compared to most other skin cancer types.
The patient is overjoyed with the outcome and even describes it as a “miracle.” In truth, Dr. Russell feels profoundly blessed and grateful to have found his calling in performing these life-changing surgeries for his patients, recognizing the opportunity to make a meaningful difference in their lives.
Mohs Reconstructive Surgery Before and After Patient 2:
This patient had a lengthy history of sun exposure, which ultimately led to the development of a skin cancer on his nose. His Mohs surgeon successfully removed all traces of the cancer, but the procedure resulted in a significant loss of skin from his nose. In order to address this issue, Dr. Joseph Russell skillfully employed a dorsal nasal flap for reconstruction, strategically shifting skin from the upper nose and the area between the eyebrows downward.
The after photos, taken approximately 2 months following the procedure, reveal nearly imperceptible scars that will continue to fade with time. The patient is now delighted to resume all of his outdoor activities, albeit with diligent sunscreen application to safeguard his skin from further damage.
Mohs Reconstructive Surgery Before and After Patient 3:
Dr. Joseph Russell frequently employs a bilobe flap technique to effectively reconstruct smaller defects at the tip of the nose. This technique involves creating a rectangular section to fill the void in the nose, while a triangular segment takes its place, with the skin edges from the triangle meticulously sutured in a straight line. Although it may appear to involve multiple incisions on the nose, this method yields excellent healing outcomes, as demonstrated in the before and after photos.
The patient initially harbored concerns about appearing abnormal after seeking Dr. Russell’s assistance following a skin cancer removal procedure by her dermatologist. However, she is now thrilled with the final outcome, and what’s even more remarkable, her grandson had no inkling that anything had transpired with her nose, highlighting the natural and aesthetically pleasing results achieved.
Mohs Reconstructive Surgery Before and After Patient 4:
Dr. Joseph Russell recently conducted a follow-up appointment with a patient, marking the 2-month milestone since performing a forehead reconstruction procedure. The patient had presented with two skin cancers in close proximity, likely stemming from long-term sun exposure. The excision of these cancers had resulted in two substantial holes in his forehead, each roughly the size of quarters.
In a meticulously executed procedure, Dr. Russell utilized a flap of skin harvested from both the patient’s forehead and the scalp area behind the affected regions to reconstruct his forehead.
The results have been so successful that it’s now difficult to discern that any surgical intervention had occurred. The patient, who had just retired when the skin cancers were discovered, can now put this chapter behind him and fully relish his well-deserved retirement.
Mohs Reconstructive Surgery Before and After Patient 5:
Dr. Joseph Russell highlights the message that even when faced with a very large skin cancer, there is hope for a return to a normal appearance.
In the case of this patient, who had lost a substantial portion of her right cheek during the removal of an extensive skin cancer, Dr. Russell employed a reconstructive technique. He raised the remaining skin of her entire cheek and skillfully shifted it to fill the resulting defect.
A particularly important consideration in such procedures, especially when performed near the lower eyelid, is the risk of the lower eyelid being pulled down. To mitigate this risk, Dr. Russell implemented sutures during the surgery to tighten the patient’s right lower eyelid, effectively preventing it from drooping.
This precautionary measure proved highly successful, and the patient is now elated to have a normal-looking cheek once again.
What are the Goals of Mohs Reconstructive Suregery?
Mohs reconstructive surgery is focused on repairing and restoring the area where the skin cancer was removed. After the cancer is entirely excised, there may be a wound or defect that requires closure to preserve both function and aesthetics.
The goals of Mohs reconstructive surgery typically include:
The specific reconstructive technique used can vary widely based on the size and location of the defect, as well as the patient’s individual needs. These procedures are typically performed by plastic surgeons or dermatologic surgeons with expertise in Mohs reconstruction.
The goal is to achieve the best possible outcome while ensuring both the removal of cancer and the restoration of the affected area.
How Mohs Reconstructive Surgery is Performed
Evaluation and Planning
Consultation: The process begins with a consultation between the patient and the surgeon. During this discussion, the surgeon assesses the size and location of the surgical wound. They will then discuss the patient’s goals, and determines the most appropriate reconstructive approach.
Assessment of Tissue: If necessary, the surgeon may evaluate the available healthy tissue surrounding the wound. This helps to determine the best method for closing it. This assessment takes into account factors such as skin elasticity, texture, and color match.
Primary Closure: In cases where the wound is small and the surrounding skin is elastic enough, primary closure may be possible. This involves suturing the wound closed with carefully placed stitches.
Local Flaps: For larger or more complex wounds, local flaps may be used. This technique involves repositioning nearby healthy tissue to cover the wound, ensuring a more natural appearance and function.
Skin Grafts: A skin graft may be employed. Especially in situations where there is a shortage of healthy tissue in the immediate vicinity of the wound. During a graft procedure, a piece of healthy skin is taken from another area of the body and transplanted to cover the wound.
Complex Reconstructions: In some cases, especially when dealing with facial skin cancer, more complex reconstructive procedures may be necessary. These may involve multi-layered closures or the use of techniques like cartilage grafts or tissue expanders.
Anesthesia: Before the reconstructive procedure begins, the patient is administered local anesthesia to ensure comfort during the surgery.
Reconstruction: The surgeon carefully reconstructs the area, paying close attention to detail to achieve optimal aesthetic and functional results. This is accomplished by using the chosen technique (primary closure, local flap, skin graft, or a more complex method).
Suturing: Once the wound is satisfactorily closed, the surgeon sutures the incisions using fine, precise techniques to minimize scarring.
Monitoring: After the procedure, the patient is closely monitored to ensure proper healing and to address any postoperative concerns.
Scar Management: The surgeon may provide guidance on scar management techniques, such as scar creams or silicone sheets, to optimize the appearance of the surgical scar.
Mohs reconstructive surgery is performed with a keen focus on achieving the best possible outcome, both functionally and aesthetically. The goal is not only to effectively treat the skin cancer but also to ensure that the patient is left with minimal scarring. With natural-looking results, particularly in highly visible areas like the face.
Surgeons who perform Mohs reconstructive surgery are typically experienced in various facial reconstructive techniques. They can tailor the approach to each patient’s unique needs.
Who are Good Candidates for Mohs Reconstructive Surgery?
Candidates for Mohs reconstructive surgery typically include individuals who have undergone Mohs surgery to treat skin cancer. And have a resulting wound or defect that requires repair.
Good candidates often exhibit the following characteristics:
Mohs reconstructive surgery is ideally suited for candidates who seek not only the complete eradication of cancer but also meticulous wound closure and the restoration of form and function.
Schedule Your Consultation
Are you ready to explore your path to rejuvenation and discover the transformative possibilities of facial plastic and reconstructive surgery? Dr. Joseph Russell MD, our board-certified expert, is here to guide you.