Skin cancer is the most common form of cancer in America, affecting 2 million people each year. Skin cancers appear most frequently on the head or neck and are treated by surgically removing the cancer.
What is Mohs Surgery?
A specialized surgery, called Mohs Surgery, is used to preserve as much healthy tissue as possible while ensuring that all of the cancer has been removed. The cure rate of skin cancers removed using Mohs surgery is in excess of 99% but the resulting disfigurement can have a very negative impact on quality of life going forward.
This stellar success rate is due to the method of excision. The Mohs surgeon removes the cancer and a very thin border of what appears to be healthy tissue. This tissue is immediately microscopically examined by a pathologist. If the margins are clear of cancer cells, the surgery is concluded. If cancer cells are found, the technique is repeated until the sample is clear.
Mohs skin reconstruction methods
With this technique, the pathologist confirms the absence of cancer during surgery. This allows Dr. Correa to confidently begin the reconstruction process usually the same day or the following day. Dr. Correa provides Mohs reconstruction for his as soon as possible following the removal of the cancer. In this way the wound heals more perfectly as it is without contamination and can more readily bond with a new surface.
Reconstruction techniques include:
- Primary closure – used where there is adequate tissue to suture the wound and where there is an opportunity to hide the scar in a fold of the skin.
- Skin grafts – used when there is not enough tissue to stretch over the wound. Donor skin is taken from another area of the body and used to close the wound.
- Micro vascular free tissue transfer – tissue from another area of the body is detached and transplanted to the recipient site and the blood supply is surgically reconnected to blood vessels adjacent to the wound.
- Local flap – tissue is freed and rotated or moved in some manner from an adjacent area to cover the defect, yet remains attached to the body at its base. This tissue has blood vessels that enter into the flap from the donor site.
Most Mohs skin reconstruction can be repaired in a single procedure if the area to be treated is relatively small. Sometimes multiple procedures are needed to achieve a better cosmetic result or to improve function.
Both the Mohs surgery and the reconstructive surgery that immediately follows are usually done under local anesthetic or using intravenous sedation, or twilight sleep. Patients can return home to rest and recover once their procedure is completed, and once they have been discharged by Dr. Correa. Patients should arrange to be driven to and from their procedure, even if only a local anesthetic is used.
The care of the wound site is the most important part of recovery. It must be kept clean and not subjected to jarring or any unnecessary motion while healing. There are different requirements concerning the various forms of Mohs skin reconstruction surgery. Follow these instructions carefully to ensure you get the best possible result without complications.
There will be some swelling at the wound site, which should begin resolve within a few days. Swelling can be minimized through medication and the proper application of cold packs. Pain can be managed with either prescription medication or the recommended over-the-counter medication. Dr. Correa provides his patients with in-depth instructions concerning aftercare and is always available to answer any questions that arise.
Bathing and hair care must be done carefully to avoid contaminating the wound. The treated areas may lack sensation for some time so caution should be used concerning hot water and using a blow dryer for hair. Different procedures have different restrictions concerning bathing but generally, showering can resume within 48 hours as long as care is taken to keep any dressings dry. Any dressings or sutures will be removed by Dr. Correa on your follow up visits.
Be sure to avoid bending down for three days. Sleep in an elevated position, either in a recliner or with several pillows under your shoulders and head. This will minimize swelling and help your body heal.
Patients can return to work when Dr. Correa has confirmed the wound is healing well and that the work will not cause complications in healing. This is generally within a few days following surgery.
About Dr. Correa
As a highly skilled facial plastic surgeon, Dr. Correa delivers high quality Mohs reconstruction. He is devoted to helping his skin cancer patients retain their self-esteem through the application of the most current cutting edge reconstruction techniques discovered. This is accomplished by teaming up with the Mohs surgeon and any other medical specialists involved in your care.