Mohs micrographic surgery is considered the gold standard treatment for removing certain common skin cancers, like basal cell carcinoma and squamous cell carcinoma. This highly effective technique involves surgically removing cancerous tissue layer by layer, examining each layer under a microscope until only cancer-free tissue remains.
Once the cancer is fully excised, reconstructive surgery is generally performed right away to close the surgical wound. However, in some cases, the reconstructive surgery may be delayed anywhere from several days to weeks after the initial Mohs procedure.
This article explores the reasons for and benefits of undergoing delayed reconstruction following Mohs surgery for skin cancer.
Delayed Mohs surgery refers to cases where the reconstructive surgery to repair the skin after Mohs excision is postponed for a certain period rather than being done the same day. Typically, the reconstructive surgery is delayed for 5 to 20 days after the original Mohs procedure that removed the skin cancer.
There are several potential reasons why a surgeon may recommend waiting to reconstruct the wound site:
Learn more about the benefits of delaying Mohs surgery reconstruction and schedule a consultation to discuss your personalized treatment plan.
Multiple studies have shown that delaying the reconstructive surgery after Mohs excision can lead to reduced complications and improved outcomes compared to immediate reconstruction done the same day.
Some of the benefits associated with postponing the reconstructive procedure include:
Benefit | Description |
Lower risk of graft failure | Delaying reconstruction allows time for the wound bed to become revascularized before grafting, improving survival of the skin graft. |
Reduced incidence of postoperative bleeding and infections | Waiting for initial healing helps minimize risks like bleeding and infections after reconstructive surgery. |
Decreased scarring | Delayed reconstruction may lead to less scarring and better cosmetic results. |
Better wound surface for grafting | After a few days, granulation tissue forms in the wound, providing a more ideal grafting surface. |
Allows swelling and bruising to subside | Postponing reconstruction gives time for post-op swelling and bruising to resolve, providing the surgeon with better operative visibility. |
More accurate assessment of defect | As the surgical site starts healing, the skin defect dimensions become more defined, facilitating optimal repair. |
Flexibility in surgical planning | The surgeon can take time to consider all repair options and decide on the best approach based on the unique location and size of each patient’s defect. |
Potentially shorter procedures | Patients may require less complex reconstructions since delaying surgery can prevent cancer recurrence at the wound edges. |
There are no definitive guidelines on the optimal timing for reconstruction after Mohs surgery. It depends on each patient's unique circumstances and considerations like the size and site of the surgical defect. However, research has shown delayed repair may be ideal in certain situations:
Postponing reconstruction for larger skin defects allows more time for surgical planning to ensure the best functional and cosmetic repair.
Certain delicate or high-tension areas like around the eyes or lips may benefit from delayed repair.
Staged surgery with delayed reconstruction for each site allows treatment of all growths for patients with multiple skin cancers.
Waiting 5 days or more has been shown to improve skin graft integration for reconstructive flaps and grafts.
Delaying surgery prevents potential cancer recurrence at wound edges, avoiding more complex repairs.
Immunocompromised patients or surgical sites prone to poor healing may warrant waiting to allow surgical margins to stabilize.
Larger Mohs defects removed over multiple stages are better reconstructed after a delay when the final size is definitive.
Ultimately, the Mohs surgeon will evaluate each patient and defect independently to decide if immediate or delayed reconstruction is most appropriate.
Contact us to schedule a consultation and determine if delayed Mohs surgery reconstruction is the right option for you.
If your doctor recommends postponing reconstructive surgery after your Mohs procedure, here are some tips to prepare for the delayed reconstruction:
Following your doctor’s pre- and postoperative instructions closely can help ensure you heal properly after each stage of surgery. Be diligent about wound care and avoiding infection in preparation for your second reconstructive procedure.
Undergoing a planned postponed reconstructive surgery after your initial Mohs procedure involves some unique aspects to be aware of:
1 | Time for the original Mohs surgical site to heal before the second surgery. This allows the wound to form granulation tissue to help the reconstructive graft, flap or stitches integrate and take. |
2 | Potential need for interim wound care like changing bandages to facilitate proper healing leading up to the reconstruction surgery. |
3 | A second round of postoperative wound care and recovery after the reconstructive procedure. This is necessary for protecting the repaired surgical site. |
4 | Possible temporary cosmetic changes like a concave divot appearance as the Mohs wound heals in preparation for surgical repair. |
5 | Excellent long-term cosmetic results from the reconstructed skin defect performed after a deliberate delay to allow for optimal surgical planning and wound bed preparation. |
6 | Reduced risk of surgical complications like graft failure, poor healing, bleeding, and infection thanks to staged procedures. |
While being patient through 2 recovery periods and additional time off can require perseverance, allowing a gap between your cancer removal and reconstructive surgery facilitates the best possible aesthetic and functional outcome.
The decision of whether to pursue immediate or delayed reconstruction following Mohs surgery for skin cancer is a complex one, depending on your unique case. That is why it is crucial to have a thoughtful in-depth discussion with your Mohs surgeon regarding the options and optimal timing for repairing your skin defect after cancer removal.
Here at Dermatology and Skin Health, Dr. Gary Mendese is a fellowship-trained Mohs specialist with extensive experience performing cancer excisions and both immediate and delayed reconstructive procedures. He will carefully evaluate your case and provide expert recommendations tailored to your needs regarding timing of your Mohs reconstruction.
With offices across southern New Hampshire and northern Massachusetts, we offer exceptional surgical care and comprehensive dermatology services. From skin cancer treatments to aesthetic rejuvenation, our patient-first practice strives to optimize the health, wellness and beauty of your skin.
To learn more about Mohs surgery and reconstructive procedures, book a consultation with Dr. Mendese online or call our offices near you.
Dover - (603) 742-5556
Newington - (603) 742-5556
Peabody - (978) 525-0100
Londonderry - (603) 742-5556
Bedford - (603) 742-5556
Discover individualized treatment to achieve the best possible results from your skin cancer removal and repair.
If your desired appointment type or preferred provider is unavailable online, kindly call (978) 525-0100 for Peabody, MA and (603) 742-5556 for all New Hampshire locations. Alternatively please feel free to send us your request via the patient portal, or via email at info@dermskinhealth.com
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