Skin Cancer Reconstruction After Mohs Surgery
Author: Michael Ondik, MD (Montgomery County ENT)
Skin cancer is a very prevalent problem. The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. These cancers are typically treated by excising the area containing the skin cancer. In certain areas such as the face, hands and feet, it is essential to remove the skin cancer while removing as little normal skin as possible. Mohs surgery is a technique performed by specially trained dermatologists which can help preserve normal tissue while removing the cancer. The resulting defect from the Mohs surgery may be repaired by an Ear, Nose & Throat Surgeon (ENT) using specialized Facial Plastics techniques to produce the most cosmetic scar possible.
Skin cancer can present in a variety of manners. In general, squamous cell may appear as rough or red scaly patches and basal cell carcinomas will appear as a pearly or waxy bump or a scar-like flat, firm, pale area. Both types of cancers can appear as a non-healing ulcer or scab.
Melanoma, the third most common form of skin cancer, usually appears a dark mole-like lesion that may bleed or itch. One technique to help identify melanomas versus a benign (or non-cancerous) mole is known as the ABCDE rule:
A – Asymmetry: Benign moles tend to be symmetrical
B – Border: Benign moles tend to have smooth, regular borders
C – Color: Benign moles tend to have a uniform color
D – Diameter: Benign moles tend be have a diameter of less than 6mm
E – Evolving: Benign moles tend to look the same over time and not change
What to Expect at Your Otolaryngologist Office Visit:
If you have a lesion on your face or neck suspicious for a skin cancer, your ENT will first have to biopsy the area to determine if it is a cancer. A biopsy is a short procedure to remove either all or a portion of the lesion so it can be sent to the lab for examination. Your doctor with inject a local anesthetic into the area and either cut out or shave off the lesion. Depending on the size of the lesion a biopsy may be sufficient to remove the entire lesion, but often another procedure will be required to remove any remaining lesion (see next section below).
If the biopsy proves to be a skin cancer then the remaining lesion and surrounding area will need to be excised to ensure that no skin cancer remains. Your ENT may excise the cancer and close the defect or you may have the cancer treated by a Mohs surgeon in which case your ENT may be involved repairing the defect. There are several methods to close skin cancer defects. Small defects can usually be closed by slightly lengthening the defect into an elliptical shape and then stitching the edges together. Other defects may require additional incisions next to the defect to move adjacent skin in a technique known as a local flap. Depending the on the size, depth and location of the defect, a skin graft may be used. A graft is skin that is taken from another area (perhaps from behind the ear) and used to fill the defect. Particularly large or complex defects may require a regional flap in which skin is borrowed from another area of face (for example, cheek skin can be transferred to the nose). This is typically a two-stage procedure in which the patient will come back in a couple of weeks for a second final procedure. Finally, some cancer defects areas can be left to heal on their own without any suturing.