Doctors can use stitches to close small incisions, but large ones may need to be repaired using reconstructive procedures.
Reconstruction can be performed the same day as Mohs surgery because doctors can immediately confirm whether the entire tumor has been removed. For standard surgical excision, reconstruction is delayed until pathologists can verify the borders are cancer free. In most cases, reconstruction is performed by the Mohs surgeon under local anesthesia.
The surgical approach depends on the tumor location and how much surrounding tissue was removed. For an area of skin that isn’t too deep, doctors may use a skin graft, or a small portion of the top layers of healthy skin. It’s usually taken from an area of your body where missing skin wouldn’t be noticeable, such as the inner thigh.
To fill in and close a larger or deeper opening of the skin, doctors may use a local flap, or a piece of nearby skin, which can include underlying fat and muscle. It is moved while it’s still attached to its current blood supply. Cartilage, the firm, white tissue that helps give structure to parts of the body such as the ears and nose, may also need to be moved during reconstruction.
Skin flaps are often left in place for several weeks as the surgical site heals. In a second surgery, they are contoured to match the appearance of the surrounding healthy skin and tissues. For example, areas of the nose can be repaired with a local skin flap from the cheek and cartilage from the ear. Doctors perform another surgery to remove any extra flap tissue and carefully reconstruct the shape of the nose with minimal scarring to the face.
Sometimes, if a large skin cancer needs to be removed, doctors may use free flaps of skin, fat, or muscle from a distant part of the body, such as the back or abdomen, to fill in areas where the cancer has been removed. These tissue flaps are called “free” because they are detached from their blood supply. Blood vessels are reattached at the site of repair.
After surgery, our physicians help scars heal properly. For example, they can carefully tape incisions after surgery and leave this tape in place for several days, to prevent scarring. If a scar becomes raised or red, doctors can inject the area with steroids, which helps flatten the tissue and remove the redness. Lasers can also treat discoloration.