Skin Cancer Diagnosis and Reconstruction

Mohs Micrographic Surgery, an advanced treatment procedure for skin cancer, offers the highest potential for recovery—even if the skin cancer has been previously treated. This procedure is state-of-the-art treatment in which the physician serves as surgeon, pathologist and, often, reconstructive surgeon. It relies on the accuracy of a microscope to trace and ensure removal of skin cancer down to its roots. This procedure allows dermatologic surgeons, trained in Mohs Surgery, to see beyond the visible disease, and to precisely identify and remove the entire tumor in several steps, or “stages,” leaving healthy tissue unharmed. This procedure is most often used in treating two of the most common forms of skin cancer: basal cell carcinoma and squamous cell carcinoma.

The cure rate for Mohs Micrographic Surgery is the highest of all treatments for skin cancer—up to 99 percent even if other forms of treatment have failed. This procedure, the most exact and precise method of tumor removal, minimizes the chance of regrowth and lessens the potential for scarring or disfigurement.

The best method of managing the wound resulting from surgery is determined after the cancer is completely removed. When the final defect is known, management is individualized to achieve the best results and to preserve functional capabilities and maximize aesthetics. The Mohs surgeon is also trained in reconstructive procedures and often will perform the reconstructive procedure necessary to repair the wound. A small wound may be allowed to heal on its own, or the wound may be closed with stitches, a skin graft, or a flap.

Often, especially in delicate areas such as the nose, lips, or eyelids, specialized skills may be required to provide the best possible chances for repair. In these instances, a preoperative consultation with a facial reconstructive surgeon may be arranged.

During the preoperative consultation, you will meet Dr. Nayak and discuss with him the steps that are likely to be involved in repairing the defect. Depending on your medical history, Dr. Nayak may also order some simple preoperative tests to maximize the safety of your planned reconstruction. Finally, Dr. Nayak’s staff will coordinate a repair date and time soon after your planned Mohs surgery.

For patients who have a preoperative consultation with Dr. Nayak before their Mohs procedure, repair is usually scheduled for 7:30am the morning after the Mohs procedure at Frontenac Surgery and Spine Care Center. This allows your Mohs surgeon maximal flexibility in removing the tumor, whether it requires one stage or several stages. It also allows for you to eat the day of your Mohs procedure, and only maintain an empty stomach for a short time—midnight to 7:30am the morning of your repair.
For patients whose wounds are unexpectedly large or complex, and therefore did not have a preoperative consultation, you will be seen in Dr. Nayak’s office at the conclusion of your Mohs procedure, and we will arrange for repair at the earliest possible operating room vacancy.

In either instance, your Mohs defect will be covered with a dressing that will remain on until the repair procedure, and generally need not be changed. Pain is usually minimal or absent with the dressing on, and antibiotics are usually unnecessary if repair is planned for the next day. However, patients with mitral valve prolapse or joint replacements should have antibiotics until the repair.

While most Mohs Surgery repairs are carried out in a single step, complex nasal repairs sometimes require two procedures, spaced 4 weeks apart. Dr. Nayak and his staff will help you arrange these surgical dates and all follow up appointments. They will also help you with any insurance precertification or predeterminations that may be necessary.