If cartilage is exposed on my ear after Mohs, is skin graft needed for health or cosmetic reasons? Can I opt out of skin graft?

The answer to your first question really depends on the size of the defect, and location of cartilage exposed.  A small area of exposed cartilage will likely do very well being left open and healing by secondary intent (allowing the body to grow skin over a defect).  Larger defects can do well with healing by secondary intent as well; however, they will usually take longer to heal, and may expose the uncovered cartilage to the possibility of infection.  A skin graft places a covering of skin over a defect, and, given good healing, will generally result in a better cosmetic outcome over a large exposed cartilage defect.  While you can always opt out of a skin graft, you would do best to discuss your reconstructive options with your Mohs surgeon or plastic surgeon doing your reconstruction.  He/ she will advise you of your reconstructive options based on your health, cosmetic expectations, and their experience.  Best of luck.

Thank you for your question.  As an experienced Mohs surgeon, I believe that a skin graft on the ear after surgery is the best option to achieve not only a nice cosmetic result, but to also prevent a possible infection. However, it truly depends on the location and the size of the skin cancer.  It is absolutely your choice whether to have a skin graft or to allow the wound to heal naturally with second intention.  All the risks benefits should be explained to you prior to the procedure so you can make the determination as to what is right for you.  Best, Ariel Ostad MD PC