I have chosen a Mohs surgeon, and she has given me a list of plastic surgeons they work with to do the repair (I have basal cell carcinoma morpheaform on my cheek). What questions should I be asking re: choosing the best doctor?
How Can I Evaluate Which Plastic Surgeon to Choose to Perform my Mohs Surgery Repair?
Doctor Answers (13)
Choosing the Best Doctor for Reconstruction
Since your Mohs surgeon is giving you the names of several plastic surgeons, I assume that you or she is not comfortable with her performing the reconstructive surgery. That's fine, but in particular Mohs surgeons who have completed a fellowship in Mohs surgery through the American College of Mohs Surgery and are members of that organization are generally well trained to perform the repair. If you or she would prefer a plastic surgeon, I would recommend that you ask her for guidance to narrow the list and then meet one or two of the doctors and discuss their training and experience. You want somebody who performs a great deal of reconstruction after skin cancer surgery. Different doctors have different degrees of experience performing repairs. Some plastic surgeons may focus primarily on cosmetic procedures such as facelifts, breast augmentations, etc and do little reconstruction and some perform a larger number of reconstructions following skin cancer surgery, etc. Remember, whoever performs your surgery will leave a scar. You can't perform surgery on the skin without leaving a scar. You want somebody who is well trained and experienced in hiding the scar as well as possible. You want to pick who you think will give you the best scar the first time around. Good luck.
Mohs Surgery and Repair
The best resources for referrals and recommendations are from the doctors who are doing the referrals themselves. None of us want to refer a patient or family member to someone who will not do the best job possible. A well trained and experienced Mohs surgeon is probably doing 90% or more of his/her own repairs and will reserve the referrals to plastics or oculoplastics when they know the repair will be extensive or require multiple steps to recreate a facial structure. Start off with a Mohs Surgeon who is a Fellow in the ACMS and go from there.
How Can I Evaluate Which Plastic Surgeon to Choose to Perform my Mohs Surgery Repair
I would seek out a board certified Facial Plastic Surgeon and then ensure that they perform alot of Mohs reconstruction. You will also want to ask how often they repair defects in the area where you will need repair (nose, lip, eyelid, cheek, etc). You should also look at before and after photos on their website or in their office photo books. Your dermatologist might also give you some advice regarding who does the best work for the type of defect you need repaired. I hope this information is helpful.
Stephen Weber MD, FACS
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How can I evaluate which plastic surgeon to choose to perform my Moh's Surgery repair?
Experience should not be measured solely by the age of the surgeon or how many years s/he has been in practice. Checking the education and training is more valuable - a Board Certified MD plastic surgeon who was accepted to and completed an integrated plastic surgery residency, in today's day and age, are excellent choices. Those are the top students who have superior training at top institutes. Plastic Surgery is NOT a fellowship...it is a residency. Those surgeons who have actually successfully completed additional fellowship training beyond the plastic surgery residency are also passionate about that area and will likely have the most recent, innovative, and up to date techniques. These are usually the younger surgeons, who are still readily willing and competent to continue to strive for the newest material and remain up to date on literature and conferences.
You must decide for yourself who you are most comfortable with and confident with who will meet your goals and expectations. Cost may differ just on expertise and the aforementioned additional training ad what that additional expertise training has afforded to his/her patients. Hope that this helps! Best wishes!
Choosing a Mohs Surgeon
Thank you for your question. Some Mohs surgeons elect to perform their own closures after excision of the tumor, and some elect to have the closure done in conjunction with an outside surgeon. Typically, if a surgeon is referring a patient after cancer excision for wound closure, they have worked with that specific surgeon before and are happy with the collegial relationship and cosmetic results (and hence the referral). As a patient, I would recommend visiting and meeting with potential plastic surgeons that the Mohs surgeon may consider sending you to for closure, so that you are also comfortable with their bedside manner and recommendations for aftercare. I hope this helps.
Removing skin cancers - Los Angeles
I often work alongside other skin cancer specialists to remove and reconstruct defects from skin cancer excision. Find a qualified surgeon whom you trust and have a good rapport with. Raffy Karamanoukian, Los Angeles
How do I choose a Plastic Surgeon to perform a complex Moh's Closure?
This is a great question. I work extensively with Moh's surgeons correcting all kinds of complex defects on the face. Moh's surgeons generally perform excisions all over the body and close most of the wounds themselves. The good Moh's surgeons will get a plastic surgeon involved early when to defect is going to be large or complex because the closure will often be better and more comfortable for the patient. I generally meet with the patient prior to the critical removal to get the "lay of the land" and talk about the potential surgery or number of surgeries that might occur after the Moh's.
So how do you choose a plastic surgeon. First step is make sure they are board certified in Plastic Surgery.
Once you know they are Board Certified find out where they will perform surgery. Hospital or office? Is the facility certified? Will you be asleep? You want to have surgery in a safe environment.
When will the surgeon close the defect? I close all of the defects referred to me usually within a couple of hours of the referral. If not already scheduled, I cancel or move cases to make sure the patient is taken care of expeditiously. You shouldn't have to wait a long time to have the repair. If the Moh's surgeon has a good relationship with the plastic surgeon then timing of closure should be pretty straight forward.
Your plastic surgeon should have extensive experience with closing Moh's defects. I love Moh's surgery closure because the larger ones can be quite challenging and as a surgeon you must be nimble and have a broad experience for choosing a closure that will end up being the best choice for the patient. Make sure your surgeon is experienced with multiple modalities of closure; from skin grafts to complex regional or free flaps.
Many Plastic Surgeons publish on the subject of closure of mohs defects. This is a good sign that they see a lot of Moh's patients.
Ask to see pictures of their closures. when patients come in and are scared of what the defect might look like and what are the options I talk over pictures and video of other closure I have performed (with permission). This will give confidence for the patient and let you rest a little easier. Below is a video of an eyelid closure following Moh's.
Finally make sure you are confortable with the plastic surgeon. Complex moh's repairs can be difficult and may take more than one surgery to refine the scar and result. You need to have a good relationship as you go through the process.
Best of luck with your Moh's and closure! I hope this helped.
Interview some BCPS byVillar
An experienced, well trained, Board Certified Plastic Reconstructive Surgeon is usually your best chance for the most options. Some dermatologists performing Mohs are taking on wounds that are beyond their capabilities, not because they are bad doctors, but because they are medical specialists, focusing on a sub-specialty of pathology. In todays world, no specialist will master his own specialty in his entire lifetime. The knowledge base is too big and outpacing us every day. It would be unfair to expect a dermatologist to master the art of surgery and plastic reconstructive surgery. The prudent patient will arrange for a plastic surgeon to repair the defect after the Mohs dermatologist has removed the cancer. This is logistically inconvenient, but in the patient's best interest as a general rule. A Mohs Fellowship is good, but no substitute for Plastic Reconstructive training.
Which surgeon to choose to repair Mohs surgery defects
The cheek is a relatively straightforward area to repair after Mohs surgery, unless the defect gets close to the nose, lips, or eyelid. Larger defects (3+ cm) are also more difficult to repair.
Ask you Mohs surgeon directly which of their referrals they think is the best reconstructionist. When asked directly, they will likely give the nod to one surgeon out of the list.
Plastic surgery repair after Mohs surgery
Thanks for your question.
It is important to choose a surgeon who is comfortable repairing the area that will have Mohs surgery. There are usually 4 variables that dictate the type of reconstructive procedure that will be performed
- size of defect
- shape of defect
- location of defect
- depth of defect
Your plastic surgeon should discuss all these criteria with you and take you through the reconstructive ladder of options. It would be a good idea to ask for before and after pictures of other patients with defects that are in similar locations to look at.
Best of luck
Sachin Parikh, MD