We refer to the area where the skin cancer was, which is now a hole, as a Mohs defect. Mohs surgery reconstruction at our Woodbury or Eagan clinics may be undertaken immediately or delayed for one to several weeks depending on the size and location of the Mohs surgery scar.
In general, there are four treatment options for Mohs surgery scar repair. These options are as follows:
- Healing by secondary intention
- Skin grafting
- Local flaps
- Regional flaps
In some instances, Mohs surgery scars are not surgically treated and the defect heals by “filling in” or secondary intention. Whether or not this option is chosen is primarily dictated by the location, size and depth of the defect. The duration of time for healing by this Mohs surgery reconstruction varies, but typically takes 4-12 weeks. The advantage of this method is that no additional procedures are required, and usually minimal visibility of the Mohs surgery scar is evident. The potential disadvantages are a depressed, white or hypo-pigmented scar.
Skin grafting is a frequently employed technique. Typically skin from in front of the ear is used to fill the defect. This area is also the same location that an incision for a facelift is placed. The removal of skin from in front of the ear on one side of the face will not create facial asymmetry. It is very typical that skin grafting is delayed for one to two weeks or even longer so that a deep defect can fill in. Because the skin graft lacks a blood supply, survival of the graft is improved by having a healthy area to place the graft. By cleansing the defect with peroxide and applying Aquaphor® ointment frequently, one can obtain this. Periodic clinic visits are also used for cleaning the wound.
Local flap closure is another frequently utilized procedure. The technique for closure uses skin adjacent to the defect. Frequent types of flaps include: advancement flaps, bilobed flaps, rhombic flaps, and island pedicle flaps. The advantages are that similar tissue or skin is used to reconstruct the defect, and it is completed in a single treatment session. It does, however, frequently require minor additional procedures to minimize the appearance of the scar.
Regional flaps are used when larger defects are present and when multiple layers of tissue have been removed such as skin, cartilage and nasal lining. Typically, a minimum of two surgical procedures are required, with the first being the most involved and the second being relatively straightforward. Each procedure is separated by 6 to 8 weeks. Often, skin is borrowed from one area but is left attached to its origin. The site of origin provides the blood supply to the skin used to cover the defect. Once the rotated flap has had an opportunity to develop a blood supply from the surrounding tissue, the original blood supply is removed at the second surgical procedure.
The method of reconstruction of your Mohs surgery scar is dictated by the size, location and presence or absence of supporting soft tissues such as cartilage. We will make every effort to educate you on which method would be best for you. Whichever method is chosen for closure of your defect, it is not unusual that some minor modifications may be performed to enhance the overall appearance. Contact our Eagan or Woodbury clinics for a consultation.
Schedule a consultation with our staff to find out if it is right for you.