Mohs and Reconstruction Surgery

Jesse Miller Lewin, MD, FACMS is the System Chief of the Division of Dermatologic & Cosmetic Surgery and the Program Director for the Micrographic Surgery & Dermatologic Oncology Fellowship Program.  He leads a team of trained specialists to offer you the most effective treatment for skin cancer. Mohs micrographic surgery (MMS) combined with reconstruction, as needed, is most often used on cosmetically sensitive areas of the body, particularly the face. Mohs surgery ensures complete cancer removal, while minimizing the amount of healthy tissue lost and maximizing the functional and cosmetic outcome.

Compared to other procedures, Mohs is particularly effective in treating patients with high-risk, complex, and recurrent cancers, offering the highest cure rate. Other indications for this procedure include large tumor size, unclear clinical margins, aggressive histologic patterns, and immunosuppression. The procedure provides cure rates approaching 100 percent for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), therefore exceeding the cure rates for traditional surgical excision, radiation therapy, electrodessication and curettage, cryosurgery, photodynamic therapy, and topical chemotherapeutic agents.

In this advanced surgical procedure, the physician uses a microscope to trace the cancer down to its roots. The physician functions as the oncologic surgeon, the pathologist, and the reconstructive surgeon.

Reconstruction Following Mohs Surgery

At the completion of Mohs surgery, the doctor will verify under the microscope that all of the skin cancer has been successfully removed. The chance of the same skin cancer returning at this location is very low (less than one percent). Unfortunately, you will be left with a surgical wound, and there are several options for healing depending on the location, size, and depth of the defect.  In some instances, the surgeon will allow the surgical wound to heal on its own, a process known as secondary intension healing. Some areas of the body, such as the ear or scalp, heal extremely well without any need for additional surgery, stitching, or extensive post-operative wound care. For other instances in which the surgical wound is too large or deep to heal on its own, plastic or reconstructive surgery may be required. Some skin cancer surgeons have training in complex plastic or reconstructive surgery and can perform the procedure immediately or within a few days following the Mohs skin cancer removal; others may request that the reconstruction be performed by another board certified reconstructive surgeon they trust. In either instance, options for reconstruction include:

  • Primary closure, in which the skin of the Mohs surgical wound is pulled together and sutured closed with minimal changes to the structures surrounding the wound
  • Grafting, in which skin from another area of the body is used to cover up the wound created by the Mohs surgery
  • Flap reconstruction, where nearby skin is moved to conceal the wound created after the Mohs technique  

In all of these cases, stitching is needed to close the wound and will require follow-up appointments (to assess skin healing and any scar formation) and at-home wound care.