Skin Cancer Reconstructive Surgeon

Reconstruction after MOHS Surgery for Skin Cancer

WARNING- Some of the pictures below are graphic in nature

Skin cancer is very prevalent throughout the Texas region especially in Houston. Our affinity for the sun and outdoor activity expose us to many of the harmful UV rays that cause skin cancer. Basal cell cancer and squamous cell cancer are two common types of skin cancer that are removed using Mohs surgery. Unlike the rest of the body, the face is a focal point of attention that is not easily hidden from view. For this reason, many patients choose to have their surgical defects, created from skin cancer removal, repaired by a facial plastic surgeon.

After Mohs surgery, there is a missing area of skin on the face or neck that is called a “defect”. This defect can be reconstructed by your Mohs surgeon, or if more complex, by Dr Etai Funk, a facial plastic surgeon. There are many factors that need to be considered when repairing a defect after Mohs surgery. The location, size, orientation, and depth of the defect are essential in formulating a reconstructive plan. Dr Funk has extensive experience repairing facial defects created by MOHS surgery. He works closely with highly qualified MOHS surgeons in order to coordinate the best possible care for his patients.

MOHS Reconstruction Overview

Goals To repair the defect created after Mohs surgery and recreate a normal appearance to the face with minimal appearance of a scar while preserving function and avoiding distorting any surrounding facial features.

The Procedure There are several different types of flaps or grafts that may be used for repair. The type of repair necessary is determined once defect is examined.

Recovery Most patients can go back to work the day after the procedure. Some people opt to take more time off depending on the type of repair performed. You will be given specific wound care instruction prior to leaving the office in order to allow for the best possible healing and outcome.

 This patient had a large defect of her upper lip after skin cancer was removed using Mohs.  An advancement flap was performed leaving the scar in her smile line with an excellent result.  

This patient had a skin cancer removed using Mohs Micrographic surgery.  This defect exteneded to the rim of the nostril and would have led to valve collapse and breathing problems.  Ear cartilage was used to support the valve in addition to a cheek flap to cover the defect.

Skin graft after Mohs surgery for skin cancer.   Skin graft underwent dermabrasion.

Why do I need a facial plastic surgeon after mohs surgery?

Your defect may be too large or complex for your Mohs surgeon to close. He or she may feel that you will obtain a better result with a facial plastic surgeon whose efforts are concentrated solely on repairing your defect and not removing the cancer. 

Fortunately, the majority of skin cancers are treatable with removal. Often times a surgeon or dermatologist will treat a skin cancer by excising it. MOHS surgery is a popular method for removing skin cancer. The advantage of MOHS surgery over standard excision, is that the edges of the removed cancer are carefully examined under the microscope at the same time as when you are having the cancer removed. This allows the MOHS surgeon to be certain that the entire cancer was removed without leaving any of the "roots" behind. Success with MOHS surgery has been reported to be 99%. The benefit of MOHS surgery in an areas such as the face or nose, is that the amount of healthy tissue removed is kept to a minimum without comprimising the removal of the cancer.

This patient had a large defect of his lower eyelid and cheek which required a large advancement flap to close. 

How is skin cancer reconstruction performed?

MOHS reconstruction is performed utilizing different types of grafts and/or flaps to close the defect. The type of repair performed depends on the size and location of the wound.

 Forehead flap for skin cancer on nose.

What is a skin graft?

A skin graft is graft of skin taken from another area of the body and placed as a free graft over the defect site. Skin grafts are important for color and texture match and therefore the donor site needs to be chosen appropriately. Skin grafts require a bolster or dressing that holds the graft in place while it establishes a blood supply. After the bolster is removed, skin grafts may at first appear depressed or discolored, but will soon become less conspicuous over time. Skin grafts are useful to repair certain types of skin cancer or traumatic defects. Other examples of grafts are cartilage grafts.

 Temple reconstruction for skin cancer after Mohs Micrographic Surgery.

What is a local flap?

A local flap move the tissue surrounding a defect into the defect utilizing the skin laxity of the surrounding area. There are many different types of flaps that can be performed to repair skin cancer defects. These include transposition flaps, interpoolated flaps, island flaps, and advancement flaps.

Eyelid reconstruction after skin cancer removal with Mohs.

What type of reconstruction is best for me?

Dr Funk will discuss the different option for reconstruction with you during your initial visit. However, the final decision will not be made until after the Mohs surgery when the defect has been made.

Reconstruction of the ear after skin cancer removed.

Does insurance cover MOHS reconstruction?

Yes. Most insurance companies will cover reconstruction after MOHS micrographic surgery.

Upper lip reconstruction after Mohs surgery for skin cancer.  

When can I return back to work?

Most patients prefer to take several days off after the procedure. However, you may return back to work as soon as the next day. If a larger flap is performed, you may want to take more time off of work depending on your profession. You should discuss this with your doctor depending on your type of work and the procedure performed.

Patient with skin cancer after Mohs surgery and after nasal reconstruction.

Patient with upper lip skin cancer (top), after Mohs surgery (middle), and after lip reconstruction (bottom).  

Patient before and after Mohs (Left and center).  Reconstruction with Forehead flap (Right).  

Patient with upper lip cancer (left), after Mohs surgery (center), after lip reconstruction (right).

Forehead flap for reconstruction of nose after skin cancer removal.   

Reconstruciton of eyelid and cheek after Mohs surgery for skin cancer.

 Nasal reconstruction after Mohs surgery for skin cancer using an advancement flap.

Reconstruction after Mohs surgery for skin cancer.

Lip reconstruction after removal of skin cancer using Mohs surgery.

Nasal reconstruction after Mohs surgery for skin cancer with a skin graft.

Other reconstructions

Etai Funk is a Houston plastic surgeon specializing in the face. He is a board certified, fellowship trained, facial plastic surgeon. He practices in Houston, Texas treating patients from Katy, Memorial City, Memorial, The Woodlands, Spring Cypress, and Sugarland.  Dr Funk also sees many international patients for plastic surgery in Houston and from all over the US.