Reconstruction after removal of skin cancer (mohs surgery)

Skin cancer reconstruction in the San Francisco Bay Area (including San Jose, Oakland and Walnut Creek)

Clearly, the dangers of uv radiation are well-known. The number of people who bake themselves in the sun is decreasing (though not eliminated). Unfortunately, we are still paying the price for damage done 20, 30 or more years ago. In this case, the damage I speak of may be wrinkles or discoloration of the skin. However, in the worst case, it can be skin cancer, such as basal cell or squamous cell carcinoma, or even worse, melanoma.

Basal and squamous cell carcinoma are two of the most common cancers of the skin, and indeed, of the entire body. I see younger and younger patients with basal cell carcinoma, for example, for plastic surgery repair of the area after removal of the cancer by a dermatologic cancer specialist, or mohs physician. (Melanoma is not amenable to mohs surgery, for reasons beyond the scope of this blog).

What kinds of things can one expect when diagnosed with basal cell or squamous cell carcinoma of the skin? Well, the most important issue is to have it removed by a competent dermatologist (if you live in the San Francisco Bay area, or Seattle area, feel free to contact me for recommendations). In many cases (though not all) this means a dermatologist trained in moh’s surgery, a technique that minimizes the quantity of tissue removed and has higher cure rates than traditional excision techniques.

What does this have to do with a facial plastic surgeon? I often work in partnership with moh’s physicians to repair the defect after skin cancer removal. Of major concern to many skin cancer patients is the repair. How will it look afterwards? Often, the defect is complicated or on a portion of the face that is quite visible (such as the nose, cheek, or lip). In these cases, I am often asked to participate. It is important for patients to realize that the cancer does not follow the ‘rules of aesthetic surgery’. It does not limit itself to less noticeable areas or shadow lines of the face. The defect created by the mohs doctor by removing the cancer thus represents a unique challenge in each patient. Anywhere there is an incision, there will be a scar. The trick is to make the scars as inconspicuous as possible. Matching skin color, texture, and levels is paramount, and this is often done in stages (i.e., may require more than one surgery). I tell my patients that no guarantees can be made with regard to outcome, and that the postoperative healing period is a ‘journey’, and that it can take a year (or more) to get to the final destination. Getting to that destination requires a partnership between physician and patient. I find these partnerships one of the most gratifying aspects of my practice, as do my patients.

I have been fortunate to have trained with some of the pre-eminent facial repair surgeons in the world, and have built up a large experience with facial repair myself over the years. I, in turn, have been able to pass this knowledge on to my fellow physicians at a course in Facial Plastic Surgery that is internationally recognized for its excellence. I find this type of work both challenging and rewarding, and hope to continue to help heal patients with facial skin cancers in the years to come.
For more information, visit http://stanfordface.com/mohsrepair.html