What is Mohs Reconstruction?
Learning that you have skin cancer and require Mohs surgery and reconstruction is a scary process. It is helpful to understand the process and how effective it is for certain skin cancers. We will discuss the process of Mohs Surgery and Mohs Reconstruction in this article.
Mohs Surgery
The technical name for Mohs surgery is Mohs micrographic surgery. It is considered to be the most precise technique for the removal of basal cell and squamous cell carcinomas, the most common cancers in the United States. The precision of the technique allows for it to provide the most tissue-sparing results meaning that the minimal amount of tissue will be removed. The goal of Mohs surgery is to completely remove the skin lesion while maintaining the maximum amount of normal healthy tissue. According to the Skin Cancer Foundation, cure rates are up to 99% for lesions that have not been treated before and up to 94% for lesions that have been previously treated.
Mohs surgery is most commonly used to remove skin cancers on the face but can be used for body cancers in certain circumstances. It provides a significant improvement over traditional skin cancer surgery when it is indicated. Mohs surgeons are specially trained in the Mohs surgery process. The ability to remove the least amount of healthy tissue possible is most important in areas of cosmetic concern such as the face. The less skin that is removed, the better the final aesthetic result will be.
Sometimes, after Mohs surgery the defect is too large to heal on its own. Mohs surgeons may then perform plastic surgery to close the defect using adjacent skin or a skin graft or they may refer you to a Plastic & Reconstructive surgeon for Mohs Reconstruction. Critical areas requiring specialized reconstruction include the nose, eyelids, cheeks, forehead and ears
Mohs Reconstruction
Mohs reconstruction is the process of repairing the defect left after Mohs surgery to restore function and/or aesthetics to the area. There are three main ways that defects are closed after mohs surgery:
“Natural” Healing
In certain areas, If the area is small, it may be allowed to heal naturally. The body will repair the defect from the base up similar to what happens with a scrape or abrasion. When performed in the correct circumstances, natural healing can provide a good cosmetic result. However, If used when inappropriate, the area may have significant resulting scarring and retraction with an unaesthetic appearance.
Primary Closure
Sometimes the edges of tissue in the area of the defect can be re-approximated and closed directly. In order to accomplish primary closure, the tissues adjacent to the defect need to be undermined in order to mobilize them. Once mobilized, the edges can be sutured together closing the defect. This is referred to as primary closure. This is the same technique used to close lacerations and surgical incisions. Once the edges are re-approximated, they are usually held in position with sutures (stitches) but sometimes skin glue or staples can be used. If the primary closure is performed correctly and not under tension it can result in a good cosmetic result.
Adjacent Tissue Rearrangement
When defects are too large for natural healing or primary closure, tissues from other areas need to be moved into the area to fill the defect. The most common technique used to accomplish this in Mohs reconstruction is adjacent tissue transfer. This technique utilizes the principles of geometry to rearrange adjacent tissues allowing them to stretch from one area to close the defect. When correctly performed, the wound is filled with adjacent tissue and is closed without tension.
The Division of Mohs Reconstruction at Cimisurgical is dedicated to the reconstruction of defects after mohs surgery. See Before and after photos here.
Examples of Adjacent Tissue Transfers
