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Mohs Reconstruction

Repeated and prolonged exposure to ultraviolet light can be damaging to our skin. This can come from either sun exposure or tanning beds. The effects of these damaging rays are cumulative over our lifetimes. The more exposure we get, the higher are our chances of eventually getting some form of skin cancer. The fairer the complexion, the greater the risk of developing skin cancer.

There are three major types of skin cancer: basal cell, squamous cell, and melanoma.

The most common form is basal cell carcinoma.  The most dangerous form is melanoma.

While Dr. Velargo is skilled in the excision of skin cancers, the location of some skin cancers may be better treated with Mohs Micrographic Surgery.  Mohs surgery is a modified form of surgical excision that provides for an accurate assessment of the completeness of tumor removal and, as a result, has a very high cure rate and may be more tissue-sparing than conventional surgery.  It is performed by a fellowship-trained dermatologist, who is trained to microscopically evaluate the excised tissue him/herself.  The immediate microscopic evaluation ensures immediate cancer clearance.  Thus, Mohs surgery is usually reserved for those instances where it is very important to preserve normal skin (i.e., eyes, nose, lips, ears, etc.) or where other types of treatments have either failed or would not be as successful.

Following excision by the Mohs surgeon, Dr. Velargo then performs facial reconstructive surgery on the defect created.  This requires a team approach between Dr. Velargo and the Mohs surgeon.  A coordinated treatment plan is always made, and your excision and reconstruction are performed on the same day.

What happens during a Mohs Reconstruction?

Mohs Reconstruction surgery is typically performed under local anesthesia in Dr. Velargo’s clinic procedure room.  However, this surgery can be performed under a spectrum of anesthesia based on the patient’s health and comfort level.

Dr. Velargo will spend time with you in consultation to ensure that every effort is made to reach your goals in a realistic manner.  Dr. Velargo will analyze your defect and develop a unique plan for reconstruction.  He will have an open line of communication with both the Mohs surgeon and you.  When possible, Dr. Velargo will analyze the lesion prior to Mohs surgery so that a clear understanding of the reconstructive options is reviewed before any cuts are made.

When reconstruction is performed by simple closure, Dr. Velargo makes every effort to place the line of closure as nearly as possible in or parallel to one of the normal crease lines of the face.  All incisions are closed in a meticulous manner with tiny sutures.

Occasionally, it is necessary to shift surrounding tissue to fill a defect with local flaps, or rarely, even resort to skin grafting.

After the scars mature, skin resurfacing procedures such as dermabrasion or laser therapy may be indicated to smooth out the line(s) of closure.

What can I expect during recovery from a Mohs Reconstruction?

Patients seeking Mohs Reconstruction should be emotionally prepared to accept several facts:

  1. You will be exchanging a skin defect for a more aesthetically appearing (often inconspicuous) scar
  2. The final appearance of your scar will not be evident for 6 to 18 months
  3. More than one procedure may be required to obtain optimal results

Some swelling and discoloration can be expected with any surgical procedure. It can be minimized by applying ice over the operated area during the first 48 hours.

In most situations, Dr. Velargo places a tape dressing over the suture line to help protect it. Do not disturb the tapes. They will be removed during your “one week” post-operative visit.  If they start to peel, you may cut the edges, but do not pull them off.  Often Dr. Velargo will re-tape the incision sites for an additional week after he removes your sutures to further support the new healing scar.

When no tape has been placed over the suture line, you should clean the shave site or incision line of any crusting with hydrogen peroxide and apply Bacitracin ointment 3-4 times per day.

Dr. Velargo feels it is beneficial for you to tape the incision site at night or whenever you can for at least six months.  He will provide you with a roll of brown paper tape.  Pulling or exerting any tension on any scar seems to promote the formation of new unwanted scar tissue.  Properly applied cross-taping will relieve some of the tendency for additional scar formation, so he recommends you do it as much as possible.

Does insurance cover Mohs Reconstructions?

Most Mohs Reconstructions are covered by insurance.

 

Contact the New Orleans Center for Aesthetics and Plastic Surgery today to find out more about expert Mohs Reconstruction surgery.