Skin Cancer Surgery. Help! There's a hole in my face!


Skin cancer is a fact of life, for those who have had any fun outdoors. For many people with a history of sun exposure and fair skin, it’s not a question of if, but when. So let’s talk about what happens when you have skin cancer.

Many of our patients have noticed a changing mole, a non-healing area or a chronic bleeding spot and presented to the dermatologist. A small sample of the tissue was then removed and sent to a pathologist for a diagnosis. The diagnosis is cancer.

At this point, a cure is the goal. One method for removing the cancer is Mohs micrographic surgery. It is our preferred method, especially for some of the more serious types of cancer such as squamous cell carcinoma. With this method, a shaving of the entire gross (visible to the eye) tumor is removed and processed, then immediately examined beneath a microscope. If some cancer cells remain too close to the edge of the specimen, a bit more is shaved until the microscope reveals a cure. The good news is this method is over 97% effective in curing the skin cancer. If the defect is sizable, the dermatologist sends the patient (usually this has been prearranged) to a plastic surgeon.

When the patient comes to us, where we are waiting to repair the area with an immediate plastic surgery repair. We evaluate the size and location of the defect, the natural skin lines in the area and design a repair that hides within the normal creases and folds. We sometimes use skin grafts to accomplish this but more commonly use “flaps”, which is a rearrangement of local tissue to close the defect. Many tiny sutures are used to distribute the tension of the repair evenly. Designing this repair properly takes the right training and experience. Early suture removal and thoughtful wound care result in a minimally noticeable result the nicely compliments the highly successful Mohs surgery.

Mohs patients are some of the most rewarding patient contacts I have. They are sometimes visibly shaken when they arrive, with a “hole in their face”. Those who are brave enough to look at it cannot imagine it ever looking normal again. But with the proper care, when the bandages are removed, they are smiling again.

Article by
Beverly Hills Plastic Surgeon