Is Plastic surgery required after Mohs Surgery?
Mohs surgery is a specialized procedure that is used to remove various types of skin cancers in critical areas of cosmetic or functional concern. The goal of Mohs surgery is to accomplish the complete removal of a skin lesion while preserving the maximum amount of healthy tissue. It is considered the most precise and best tissue-sparing method for the removal of basal cell and squamous cell carcinomas, the most common cancers in the United States.
Mohs surgery is considered the most effective technique for treating basal cell and squamous cell carcinomas with the following success rates as described by the Skin Cancer Foundation: Up to 99% for a skin cancer that has not been treated before and up to 94% for a skin cancer that has recurred after previous treatment.
After the Mohs procedure is completed, there is a defect in the area where the cancer was. Whether the defect requires plastic surgery depends on several factors including:
- The size of the defect
- The location of the defect
- The desires of the patient
There are various procedures that can be used to reconstruct skin defects after a Mohs procedure is completed. The larger the defect, the more likely it will require plastic surgery to reconstruct it. In certain areas of cosmetic and functional concern (lip, eyelids, nose, ear, hand, etc), smaller defects may require plastic surgery as well.
Plastic surgery to reconstruct defects after Mohs surgery involves recruiting local, regional, or distant tissues and rearranging those tissues in order to repair a wound or reshape an area of tissue. Although Plastic & Reconstructive Surgeons have traditionally been the specialists to perform plastic surgery of such defects, certain Mohs surgeons and ENT surgeons also have experience with such procedures.
The options for reconstruction after Mohs surgery range from allowing the body’s natural healing processes to fill in the defect without treatment to major reconstructive procedures requiring an operating room and general anesthesia. Any procedure, other than natural healing, is considered to be a type of plastic surgery regardless of who performs it. Therefore, many patients will require some form of plastic surgery after Mohs surgery. Whether a Plastic & Reconstructive Surgeon, Mohs surgeon, or ENT surgeon performs the procedure determines on the preference of the patient and Mohs surgeon and is determined on a case by case basis.
It is important for patients to have an understanding of the potential size and location of the defect that will be left after Mohs surgery is completed as well as the reconstructive plan to repair the defect. If referral to a Plastic & Reconstructive Surgeon is part of the plan, this will require a consultation with the plastic surgeon either prior to the Mohs procedure or very soon after. Either way, the patient should discuss the pros and cons of any possible treatment options offered and feel comfortable with the chosen procedure. Although many Mohs surgeons have long term relationships with Plastic Surgeons in their community, a good working relationship, and a long history of treating patients together with good results. However, if a patient does need to find a plastic surgeon to repair a Mohs defect, a good resource is found at https://www.plasticsurgery.org/news/blog/tips-for-choosing-a-plastic-surgeon.