Mohs Reconstruction (Skin Cancer)
A particularly common problem here in the mountain west is skin cancer. With so many sunny days each year as well as so many opportunities for outdoor enjoyment, it seems that almost everyone has either personal or indirect experience with some form of skin cancer. Reconstruction of facial defects following removal of skin cancers can be a challenging problem, but is something that Dr. Thompson specializes in and greatly enjoys. The pictures on this page are examples of various defects before and following reconstructive procedures. We provide these partly for your education, but also hopefully, as a strong motivator for appropriate skin care and protection.
Mohs Reconstruction is the term used to describe a reconstructive procedure of the face following a Mohs surgery to remove certain types of skin cancer on the face- where skin cancer most commonly occurs. Mohs surgery has an impressively high cure rate and through a Mohs reconstruction, the final esthetic outcome can be greatly improved. Dr. Thompson sees hundreds of cases each year with referrals from many dermatologists along the Wasatch front who have performed a Mohs surgery and seek repair for complex situations. If you have a sore or lesion that is painful and/or itchy and isn’t healing, consider visiting one of the following dermatologists for evaluation:
- Dr. Payam Tristani-Firouzi
- Swinyer-Woseth Dermatology
- Dr. Bradley Summers
- Dr. John Robison
- Dr. Joseph Jensen
If mohs surgery is required, Dr. Thompson would see the patient the same day following the cancer excision to discuss options and schedule the repair for as soon as possible. Our medical staff then contacts the insurance provider, if patient is insured, to verify benefits and obtain authorization if needed. If the repair is simple, the dermatologist may close at the same time unless the patient requests Dr. Thompson for the repair due to his specialty in the aesthetics of face.
Mohs reconstruction can be done in the office under local anesthetics in some cases and others must be done in a surgical center under general anesthesia. Some cases are optional and up to the preference of the patient. Repairs of facial cancer defects that have been created using the Mohs technique often utilize healthy adjacent skin flaps or skin grafts. Large areas occasional need to be repaired using free tissue transfer, ie skin, muscle, and/or bone from a different part of the body to fill the defect.
The process can be emotional, as well as physically, difficult as areas larger than expected are sometimes removed from the face. When patients, especially younger patients, come in for an initial exam following the cancer excision, there is often great concern that their facial features will ever be restored back to how they were prior to skin cancer. Through various Mohs techniques, Dr. Thompson is able to reconstruct large areas that overtime, show little to no sign of previous trauma. Sometimes multiple procedures are beneficial to obtain maximum results and speed the healing process. Steroid injections are sometimes used to bring swelling down, areas can be smoothed with dermabrasion, and occasionally a scar revision procedure is done, if needed, to repair previous scarring. Dr. Thompson also sees many patients with previous Mohs surgery specifically for scar revision as they were not happy with the aesthetics of the original scar.
Dr. Thompson stresses the importance of proper daily skincare to all patients, especially those with a history of skin cancer. Sunscreen with an spf of atleast 30 or higher with the ingredients zinc and titanium oxide (physical blockers) is important to apply daily, especially to areas of concern, and may need reapplication on days patients are getting multiple hours of sun exposure. With any incision, patients need to be vigilant about daily sunscreen use for at least one year for minimum scarring. Please see our skin care section for more details.