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The video gives a recap on Mohs and is helpful in showing options often used for closing Mohs defects after surgery.
A range of skills come together in Mohs surgery. The consultant who carries this out will have specialist training and experience in tissue analysis and in plastic surgery, to successfully close the wound.
There can be cases where calling on an in house, or external plastic surgeon will be required but they are uncommon. The Mohs surgeon treating you can often provide a fine result, they know the wound and their patient.
Normal Outcomes
Surgery by nature leaves a scar, although given a reasonable time to heal this can be minimal, as in the examples below:
We understand concerns that a day one view can bring, feeling you look like someone emerging from a battle. A feeling that can be enhanced by the amount of stitching but the reason for this is to achieve the best outcome.
As in the video, wounds can be lengthened, or skin cut and drawn over, to ultimately create less obvious scarring. Also to preserve function and comfort, rather than your skin feeling stretched.
Optimising the appearance of your skin after Mohs is normal practice, a key element of choosing this type of surgery.
Unusual Cases
Mohs uses real time microscopic evaluation, to ensure all cancerous cells are removed, whilst preserving the maximum amount of tissue.
An area of skin and a degree of flesh underneath are all that is usually required, although there can be cases where cartilage is removed. In relatively few situations, there could be a need to remove bone.
As with the majority of cases, your Mohs surgeon may still be the best person to assess need and carry out closure. Equally, they will know when specialist plastic surgery skills should be applied.
This could include cartilage grafting, perhaps with an ear, or rib providing donor tissue. Bone grafts can be taken from different locations, incuding the skull and carefully shaped to fit into the excision site.
If large skin grafts are needed due to the extent of the cancer, they can be safely carried out by a plastic surgeon. Often a day or two after initial surgery, or later where tissue expansion is used to create additional skin.
Individual Care
We should emphasise that the majority of Mohs surgery involves no more than the consultant surgeon closing the wound on the day of surgery.
There can be cases where they will ask you to return a day, or two later for final closure but this is unusual. The need for separate plastic surgery is less common, for cartilage, or bone grafts even rarer.
Letting you know about these possibilities still makes sense and your consultant would discuss them before surgery, if they were likely to arise.
For most of our patients, Mohs surgery is a half day procedure at our in house facility. Giving a high cure rate and an excellent aesthetic result.