Best Mohs Reconstructive Surgery Clinic in San Francisco
After your entire cancer has been removed using Mohs surgery, you will have a wound in the skin. Some patients may require additional plastic and reconstructive surgery procedures to restore the appearance and function of the site were the cancer was removed. This process is called reconstructive surgery after Mohs.
What is Post-Mohs Surgery Reconstruction?
The goal of reconstruction after Mohs surgery is to close, stitch, or repair the wound formed by removal of cancerous tissue in the skin, while maintaining function and aesthetics of the treated area. This process is typically done immediately after the Mohs procedure on the same day.
When choosing a physician for reconstructive surgery after Mohs, it is important to consider that a board-certified and fellowship-trained Mohs surgeon is your best option for optimizing both functional and aesthetic results with reconstruction after your Mohs surgery. This is because this type of reconstructive surgeon has been trained specifically in both Mohs surgery and complex post-Mohs plastic and reconstructive surgery, and is the most likely reconstructive surgeon to have performed the highest volume of this specific type of reconstructive plastic surgery where a defect or hole, sometimes a large and complex one in a specific area, has to be repaired in a functionally and aesthetically pleasing manner. This is compared to a general or facial plastic surgeon who although may be well-trained in body or facial plastic surgery, often primarily specializes in purely cosmetic surgery such as nose jobs, breast augmentation, or facelifts where the goal is primarily to beautify an anatomic structure such as a nose or to lift a face, without first having to repair a defect of missing tissue or a large hole in the nose or face. The type of surgery specialist you want to reconstruct your wound should be one who performs dozens of this procedure every week, rather than once every few months.
What the Process Looks Like
After removal of your skin cancer using Mohs surgery, your surgeon will immediately assess the wound or defect in the skin and will choose the best plastic and reconstructive technique to close or repair the wound. The specific technique chosen will depend on many factors, such as the size, location, depth, complexity of the wound, its proximity to other surrounding facial features, as well as the patient's individual needs. The following are some the reconstructive techniques your surgeon will consider to repair your wound.
Second Intention Healing
Our skin has a remarkable ability to heal. Sometimes a wound is left to heal by itself without any stitches, if it is a small and/or shallow wound. This option is called healing by second intention. This can take 4-6 weeks but this option, in the right area, can lead to an excellent result.
Layered Linear Closure
The next simplest way of closing skin is stitching it side-to-side in a straight line. On the face the stitches stay in place for 6-8 days. If the skin will not close side-to-side, your surgeon may need to do a more complex closure method called a graft or a skin flap.
Skin Flap
A skin flap borrows skin from next to the wound and moves it over to fill the wound. This is often reserved for deep wounds or wounds that cannot be closed by simply stitching the edges of the wounds together.
Skin Graft
A skin graft is a piece of skin that is removed from a site away from the wound, usually from around the ear, above the collarbone or the front of the thigh, and stitched to the edges of the wound, covering the wound like a patch.
Referral to Another Specialist
On rare occasion, the surgical wound after your cancer has been removed may be in a location that makes it difficult to stitch up while you are awake and under local anesthesia. In these cases, you may be referred to a plastic surgeon or eye surgeon for wound closure on a separate day, that is done under heavy sedation or general anesthesia. At the California Center for Dermatology, we have a stellar network of skilled plastic surgeons and eye surgeons to whom we may refer you if surgery is needed under sedation or general anesthesia.
What Happens During Skin Cancer Reconstructive Surgery
The reconstructive surgery process after Mohs begins with your surgeon evaluating the wound left behind after your cancer has been completely removed with Mohs surgery. Your surgeon will measure the size, shape, depth, and location of the wound, and will consider all the factors that may affect the final result of your surgery, such as the size and proportion of your facial features, and your wound healing ability. Your surgeon will discuss with you the preferred technique for reconstructing your wound, and will give you the opportunity to ask questions. Your wound and surrounding skin will then be cleaned with an antiseptic solution, marked with a surgical pen for the planned reconstruction, and numbed with a local anesthetic. Using innovative plastic and reconstructive techniques, your surgeon will then repair your wound, most often with stitches. Following the surgery, you will be given specific post-operative care instructions to promote proper healing and reduce the risk of complications. You will be seen anywhere from one week to one month after reconstructive surgery to ensure you are healing properly.
The recovery process varies depending on the extent of the surgery and the patient's overall health. After the surgery procedure, you may expect some swelling, redness and bruising at the surgery site and around the incision. For skin cancers around the eye and mouth, your eye and lips may be puffy and swollen. This is common and resolves after a few days with ice. You may also experience some discomfort or pain after the procedure. This is usually best treated with a combination of ibuprofen and Tylenol. Your surgeon will discuss the best method to treat post-operative pain after the Mohs procedure. and formation of scar tissue.
What are the Benefits and Risks?
The main benefit of reconstruction after Mohs surgery is to restore the function and natural aesthetic of the body part where your skin cancer was removed. This usually means surgically fixing a disfiguring hole left by cancer removal in the skin on the face, in a manner that avoids both facial disfigurement, and loss of function at the treatment site.
As with any surgical procedure, there are potential risks, including bleeding, infection, poor wound healing, and breakdown of your wound due to rupture or "popping" of your stitches. Expect to have some scar tissue in the area of the body where the cancer cells were removed. Your surgeon will pick a reconstructive option that minimizes the formation of scar tissue as much as possible. After you have healed, there are many cosmetic options that your surgeon may recommend to further minimize the appearance of a scar. This will be discussed with you on the day of the procedure, or at your follow-up visit.
There may be damage to the nerves that supply sensation to the area of removed tissue. This is usually temporary, and resolves after several weeks to months. These risks overall are generally low but can occur, and the surgeon will take necessary precautions to minimize them. It is very important to follow all post-operative instructions carefully in order to minimize these complications. Sometimes, if the cancerous tumor is extensive and perhaps has grown into a structure such as the bone on the scalp where surgery is no longer possible, Dr. Carlson will discuss additional treatment options such as radiation therapy or immunotherapy, and her office will help navigate and coordinate referrals to these specialists for consultation and further management.
Before and After Photos of Reconstruction
Take a look at our gallery of before and after photos from both the Mohs procedure, and reconstruction of the wound post-Mohs.
Mohs surgery with wound on top of ear, and immediate flap reconstruction of the ear
Cancer removal with Mohs surgery above eyebrow with flap reconstruction. Results are at 1 week and 1 month after surgery
Mohs surgery defect on eyelid, with immediate eyelid flap reconstruction. Final result at 3 months after surgery
Wound on nose after Mohs surgery, with combined skin graft/layered linear reconstruction. Final result at 2 months after surgery
Open wound after Mohs surgery, with immediate flap reconstruction
Mohs surgery with second intention healing. Final result at 3 weeks after surgery
Wound on nose after Mohs surgery with immediate flap reconstruction
Wound on nose after Mohs surgery with layered linear reconstruction
Wound on nose and upper lip after Mohs surgery, with immediate flap closure. Note perfect realignment of lip border
Wound on nose after Mohs surgery, immediate flap reconstruction with stitches, and final result at 1 month after surgery
A Dermatologist that Provides Outstanding Patient Care
At the California Center for Dermatologic Surgery, our patients within and beyond the San Francisco Bay Area greatly benefit from the highest level of training, sound clinical acumen, expert surgical skill, and warm, personable care of our Mohs and reconstructive surgeon, Dr. Ekama Carlson. Dr. Carlson is double-certified in Dermatology and Mohs Micrographic Surgery by the American Board of Dermatology, fellowship-trained in Micrographic Dermatologic Surgery, and has exceptional expertise in all aspects of cutaneous oncology and complex reconstructive surgery after Mohs. Dr. Carlson treats all types of skin cancer, including high risk tumors in unusual parts of the body. Dr. Carlson's approach to skin cancer treatment is timely and complete removal of skin cancer with individualized reconstruction after Mohs surgery with surgical options that are in tune with the patient's needs, lifestyle, and goals, while offering the best functional and aesthetic outcome.
Our Office Serves the Entire Bay Area Including Oakland, Berkeley, Marin County, the Peninsula and Beyond
Dermatologist Dr. Ekama Carlson in San Francisco offers Mohs Surgery, reconstructive surgery and all types of dermatologic surgery treatments for skin cancer. Dr. Carlson also offers laser treatments, skin care products and many other cosmetic enhancements to improve the appearance of scarring. Dr. Carlson serves all of San Francisco, the Bay Area and Beyond. Schedule an appointment with us today for exceptional skin cancer care for you and your loved ones.