Skin cancer excision creates a tissue defect that may require surgical repair. Each of the many reconstructive techniques is used for different types of skin cancer defects. The surgical repair can be done by the Mohs dermatologist or may require reconstruction by a plastic surgeon. Certain defects do not require surgical repair at all as the body heals itself. Careful planning is necessary to achieve great results and to avoid problems.
Planning for surgical repair of skin cancer removal starts many days before Mohs surgery. Either the Mohs dermatologist or the reconstructive plastic surgeon make the determination of what kind of reconstruction will be required. Predicting the extent of the cancer defect and the reconstructive technique takes experience. Accurate prediction makes for good planning and allows patients to plan their lives accordingly.
Decisions prior to skin cancer reconstruction may include:
- What kind of pre-operative medical work-up is required (internal medicine evaluation, stopping blood thinners, cardiology testing)
- What type of surgical setting is needed for reconstruction (office surgery, outpatient surgery center, or hospital)
- What type of anesthesia is required (local anesthesia, light sedation with oral meds, IV sedation with anesthesiologist, or general anesthesia) - deeper anesthesia requires fasting
- Coordination of Mohs dermatologist's and reconstructive surgeon's schedule (same day or within a few days). At Skin Cancer And Reconstructive Surgery Center, we routinely do same day Mohs excisions and reconstructions. Delay of up to 10 days between Mohs excision and reconstruction is medically acceptable if unexpected issues arise.
- What kind of recovery is expected and for how long?
- Will there be several reconstructive stages?
- Are there contingency plans for the unexpectedly large defect?
- What is the cost to the patient?
- Are there options to Mohs excision and reconstructive surgery?
The specific reconstructive plan is based on several factors:
- the defect itself - size and location
- the patient - skin type, age, medical conditions, expectations of result
- the financials - certain reconstruction are labor-intensive (expensive), other reconstructions may achieve 80% of result for 20% of the cost.