Skin cancer is very prevalent throughout the Texas region especially in Houston. Our affinity for the sun and outdoor activity expose us to many of the harmful UV rays that cause skin cancer. Basal cell cancer and squamous cell cancer are two common types of skin cancer that are removed using Mohs surgery. Unlike the rest of the body, the face is a focal point of attention that is not easily hidden from view. For this reason, many patients choose to have their surgical defects, created from skin cancer removal, repaired by a facial plastic surgeon.
After Mohs surgery, there is a missing area of skin on the face or neck that is called a “defect”. This defect can be reconstructed by your Mohs surgeon, or if more complex, by Dr Etai Funk, a facial plastic surgeon. There are many factors that need to be considered when repairing a defect after Mohs surgery. The location, size, orientation, and depth of the defect are essential in formulating a reconstructive plan. Dr Funk has extensive experience repairing facial defects created by MOHS surgery. He works closely with highly qualified MOHS surgeons in order to coordinate the best possible care for his patients.
**WARNING- Some of the before and after pictures are graphic in nature**
MOHS Reconstruction Overview
Goals To repair the defect created after Mohs surgery and recreate a normal appearance to the face with minimal appearance of a scar while preserving function and avoiding distorting any surrounding facial features.
The Procedure There are several different types of flaps or grafts that may be used for repair. The type of repair necessary is determined once defect is examined.
Recovery Most patients can go back to work the day after the procedure. Some people opt to take more time off depending on the type of repair performed. You will be given specific wound care instruction prior to leaving the office in order to allow for the best possible healing and outcome.
Your defect may be too large or complex for your Mohs surgeon to close. He or she may feel that you will obtain a better result with a facial plastic surgeon whose efforts are concentrated solely on repairing your defect and not removing the cancer.
Fortunately, the majority of skin cancers are treatable with removal. Often times a surgeon or dermatologist will treat a skin cancer by excising it. MOHS surgery is a popular method for removing skin cancer. The advantage of MOHS surgery over standard excision, is that the edges of the removed cancer are carefully examined under the microscope at the same time as when you are having the cancer removed. This allows the MOHS surgeon to be certain that the entire cancer was removed without leaving any of the "roots" behind. Success with MOHS surgery has been reported to be 99%. The benefit of MOHS surgery in an areas such as the face or nose, is that the amount of healthy tissue removed is kept to a minimum without comprimising the removal of the cancer.
MOHS reconstruction is performed utilizing different types of grafts and/or flaps to close the defect. The type of repair performed depends on the size and location of the wound.
A skin graft is graft of skin taken from another area of the body and placed as a free graft over the defect site. Skin grafts are important for color and texture match and therefore the donor site needs to be chosen appropriately. Skin grafts require a bolster or dressing that holds the graft in place while it establishes a blood supply. After the bolster is removed, skin grafts may at first appear depressed or discolored, but will soon become less conspicuous over time. Skin grafts are useful to repair certain types of skin cancer or traumatic defects. Other examples of grafts are cartilage grafts.
A local flap move the tissue surrounding a defect into the defect utilizing the skin laxity of the surrounding area. There are many different types of flaps that can be performed to repair skin cancer defects. These include transposition flaps, interpoolated flaps, island flaps, and advancement flaps.
Dr Funk will discuss the different option for reconstruction with you during your initial visit. However, the final decision will not be made until after the Mohs surgery when the defect has been made.
Yes. Most insurance companies will cover reconstruction after MOHS micrographic surgery.
Most patients prefer to take several days off after the procedure. However, you may return back to work as soon as the next day. If a larger flap is performed, you may want to take more time off of work depending on your profession. You should discuss this with your doctor depending on your type of work and the procedure performed.