Cancer Reconstruction in Everett, Washington
The MOHS Surgery Technique
The technique commonly known as MOHS Surgery or MOHS Excision is a method designed by general surgeon Dr. Frederick Mohs. It is now commonly performed by dermatologists and specialists in MOHS Surgery who have completed additional training in the MOHS technique. The technique involves a unique form of handling, processing and reading the tissue under the microscope to make sure that the margins of the excision are clear of any cancer cells. It is very reliable and uses very thin, small excisions in a step-wise fashion in order to spare the tissue surrounding the lesion. Normally the technique is used for squamous cell carcinoma and basal cell carcinoma of the face, and is best used in areas near important structures such as the eyelids, nose, and ears. The MOHS specialist can remove a layer of tissue, and then examine the layer under the microscope while the patient waits, and then remove more tissue as needed. The MOHS surgery can then be performed by a plastic and reconstructive surgeon or by the MOHS surgeon, depending on how complex the defect is.
A critically important part of MOHS reconstruction is selecting the type of reconstruction, whether it is split-thickness skin grafts, full-thickness skin grafts or local tissue flaps. Depending on the location and size of the defect, as well as individual patient factors, your surgeon will discuss with you the various options in your particular case. This is where it is useful to have a reconstructive plastic surgeon such as one of our surgeons in order to help select the appropriate method for you. Your surgeon will meet with you once you are referred by the MOHS specialist for reconstruction, prior to the MOHS procedure.
MOHS surgery is done using a variety of techniques which may include skin grafts. Skin grafts can be taken from discreet places that allow placement of new skin into the defect. It is important to carefully select the donor skin so that it is a similar thickness and color. The donor site where the skin is taken is typically closed in a straight line. The skin graft is placed on the open defect after MOHS surgery and is held in place with a dressing. Usually, the dressing is left in place for 5-7 days before it is removed by your surgeon in the office. The donor site where the skin graft is removed from is also dressed and is inspected in the office at the follow-up visit.
The use of local flaps involves making additional incisions which can often be placed in wrinkles of the face in order to move tissue without detaching it completely. There are many, many different types of flaps and it is important to discuss the details and selection of the flap, including the location of the incisions with your plastic and reconstructive surgeon.
Anesthesia in MOHS reconstruction
Anesthesia for MOHS surgery is usually a local anesthetic to numb the area around the reconstruction. Sometimes, if a larger area or multiple areas are being treated, it needs to be done in the outpatient surgery part of the hospital. Our surgeons believe that patient safety is critically important and it is often important to have an anesthesiologist present for sedation.
Revision MOHS reconstruction
Sometimes the reconstructive method chosen or the outcome of the reconstruction can be improved or adjusted. There are many options available for revision MOHS reconstruction. Sometimes, there are contour defects and divots, or depressed areas that are visible. Sometimes these can be improved with fat injections or other techniques in order to smooth out the contour of the reconstruction. This technique can be particular useful after thin skin grafts are used for reconstruction, such as in nasal reconstruction after MOHS surgery where the skin graft is thin when compared with surrounding nasal skin. Your surgeon can listen and discuss your particular case in detail during a consultation.