What is Plastic Surgery Reconstruction after Moh’s Surgery?

by W. Thomas McClellan MD FACS    McClellan Plastic Surgery

I often get stopped in the hospital, on the street, or even in StarBucks to look at moles. Patients want to know if a mole is dangerous and what they should do about it. Can I remove the mole? Should they see their dermatologist? What is the best option?

I will address the skin cancer as a whole in another blog post but wanted to talk specifics about Moh’s Surgery, reconstruction of the resultant defect, and the importance of a close knit team in order to get optimal results.

Moh’s surgery is essentially a “real time” evaluation of the complete surgical margin as the skin cancer is removed from the patient. The Moh’s physician is a specialized dermatologist who removes the skin cancer tissue and also acts as the pathologist reading the “slide” under a microscope. This method has a cure rate of about 97%. Moh’s excision of skin cancer is most commonly performed on structures that hold critical value and where excessive resection of tissue is detrimental. Examples of these locations include the eyelid, nose, ear, and cheek.

Here is a Wikipedia link to read a more in depth description of Moh’s Surgery Moh’s Surgery Wikipedia

So why and how does a plastic surgeon get involved in Moh’s resection of skin cancer? If the defect resulting from skin cancer excision is small or uncomplicated then the Moh’s surgeon might perform the closure. However many times the defect may be larger than expected, involve a critical structure, or be quite complex. Occasionally general anesthesia, a brief hospital stay, multiple surgeries might be required. This is where I, as the plastic surgeon, get involved with the patient.

The relationship between the Moh’s Team and the Plastic Surgery Team is critical. Getting the wound repaired expeditiously is better for the result and patient. In other areas of the country, outside Morgantown West Virginia, a patient may wait days or even weeks before the wound can be closed by a plastic surgeon. I try to see the patient as soon as possible and bend my schedule to get the wound closed in the best manner and shortest time frame for the patient.

I have worked extensively with Dr’s Hancox and Carlisle, Moh’s Surgeons at Mountain State Dermatology, for years. This symbiotic relationship allows patients to be seen before  the cancer removal near a critical structure. Meeting the patient prior to resection allows me to discuss surgical options, create the best individualized surgical plan, show the patient examples of their particular surgery and recovery process, and demonstrate potential results they might have following surgery.

In addition the relationship allows same day scheduling of resection and repair of the skin cancer. So the patient can have the resection of the skin cancer at the Moh’s office and then travel to the hospital for the complex repair under the comfort of anesthesia. A same day process affords the patient the best of both worlds in resection and repair. The combination of these services, at this high level, is not offered anywhere else in our region!

Please see a few of my publications and videos on skin cancer reconstruction following Moh’s Surgery.

Forehead Reconstruction A to T flap after Moh’s Surgery

Eyelid Reconstruction Paper after Moh’s Surgery

Limberg Flap Following Skin Caner Resection

Hughes Flap for near Total Lower Eyelid Loss after Moh’s

Bone flap for Lower Eyelid Loss after Moh’s

 

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