Mohs Defect Reconstruction

Mohs micrographic surgery, a procedure performed by dermatologists, removes certain types of skin cancer including basal and squamous cell carcinomas. Your dermatologist will remove the skin cancer layer by layer, evaluating each sample under a microscope to make certain that all of the skin cancer has been removed. Typically, your dermatologist can repair the skin defect left behind after removal of these skin cancers, but 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 are often located on the scalp, forehead, eyelid, nose, cheek, lip or ear.

Dr. Cooper has performed a variety of reconstructive operations after Mohs surgery to help countless patients restore their appearance and function so that they were able to fully recover, both physically and emotionally, from skin cancer.

Types of Mohs Reconstruction
After a thorough evaluation of your anatomy, your Mohs defect, and any associated health problems you may have, Dr. Cooper will recommend one of three methods of reconstruction: primary closure, local flap closure or 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. 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 a deformity if closed primarily, then Dr. Cooper may perform a local flap closure. This may involve rotating or advancing local tissue adjacent to the wound to close the defect. In the case of the nose, cartilage taken from the ear is sometimes also needed 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
Dr. 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 at the North Seattle Surgical Center or as an inpatient at Northwest Hospital. These procedures typically take between one and two hours to perform. Local anesthetic is usually used. Intravenous sedation may also be used to ensure patient comfort.