Should I Request a Plastic Surgeon for Mohs Reconstruction?

My Mohs Surgeon does his own reconstruction. Should I request a plastic surgeon? I have Basel Cell Carcinoma between my eye and my nose, and I have yet to have my pre-surgery consultation with the surgeon.

Doctor Answers 19

Should I request a Plastic Surgeon do the repair after Mohs surgery

The correct answer is you should pick the person who you think is going to give you the best result. As mentioned by many others a well-trained and experienced member of the American College of Mohs Surgery should be able to perform just about any necessary reconstruction, but if you think that a plastic surgeon is going to give you a better result, pick a plastic surgeon. That's not to say the plastic surgeon will provide the smallest scar or the best cosmetic result. Both Mohs surgeons and plastic surgeons are going to leave a scar. You can't repair a wound without leaving a scar. It may be the most beautiful scar in the world. But if somewhere deep in your brain you think another specialty or another particular doctor would have given you a better result, you might not be satisfied with the most beautiful scar in the world. So be true to yourself and pick who you think is the best to do the repair. The vast majority of my patients are repaired by myself and are extremely satisfied with the results. But if a patient ever "wonders" whether they should see a plastic surgeon, I encourage them because in five years I want them to be satisfied with their results.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Your Mohs surgeon can help you decide on the optimal reconstruction after Mohs surgery

In the US, the majority of reconstructions done after Mohs removal of a skin cancer in this country are done by the Mohs surgeon, typically immediately after the skin cancer removal. Fellowship-trained Mohs surgeons are usually dermatologists who have done a full year of training after residency devoted primarily and specifically to Mohs surgery and the reconstructive techniques necessary to repair the defects. Mohs surgeons, plastic surgeons and other specialists (facial plastic surgeons and oculoplastic surgeons) share the same techniques in reconstruction, some with special expertise in certain areas (e.g. eyelid). Each Mohs defect and patient is unique but both training and specific experience are the best predictors of a good outcome. In my practice as a Mohs surgeon, I repair the majority of my defects and have literally done thousands of these reconstructions with local flaps, skin grafts, and other repair techniques. I work with colleagues in other specialties when they can provide something additional that will benefit the patient (e.g. general anesthetic for larger cases or more anxious patients or reconstructions that cannot be done well in the Mohs setting under local anesthesia). In your case, you can ask about the experience and training of your Mohs surgeon and might ask to see pictures of their work with similar cases. If you decide to work with a different specialist for repair, you should make sure that that specialist got good training in Mohs reconstruction (not always the case) and that they do enough of these to have a good feel for the reconstructive options. A surgeon doing mostly breast reconstruction, for example may not always be your best choice for reconstruction of your Mohs defect. No matter who does it, you need to be aware that there will be a scar of some sort that will evolve with time and will be dependent not only on the surgeon but on factors like the presence of complications, or the type of defect and repair needed. I like seeing patients in consultation prior to surgery so that I can explain the likely reconstructive options and show photographs so that the patient has the best possible understanding of what's likely to be involved. You should use your consultation to become well-informed as well!

Daniel Berg, MD
Seattle Dermatologic Surgeon
3.7 out of 5 stars 3 reviews

Mohs and reconstructive surgery

This is a very common question. If you are being treated for Mohs surgery by a physician who is a member of the American College of Mohs Surgery, then they have formal training in the reconstructive surgery and often do more reconstructive surgery for skin cancer than most plastic surgeons. Plastic surgeons are extremely talented but even within plastic surgery, the best plastic surgeons focus on a few procedures (ie some do only face lifts and some do only body work), so the truth of the matter is that skin cancer reconstructive surgery is not a large part of many plastic surgeons' practices. I perform over 99% of my own Mohs reconstructions and the outcomes are as good as any plastic surgeons work. More importantly, I perform the Mohs reconstruction immediately following Mohs surgery which is more convenient for my patient AND also more cost effective as well. I have a gallery of before and after examples of my own work for my patient's to see. I would advise you to have this discussion with your Mohs surgeon, they can discuss with you the pros and cons of each approach. 

Omar Ibrahimi, MD, PhD
Stamford Dermatologic Surgeon
4.8 out of 5 stars 26 reviews

You might also like...

Should I Request a Plastic Surgeon for Mohs Reconstruction?

Thank you for your question. The answer is YES! A board certified plastic surgeon is well versed and has much more extensive training in reconstruction of facial deficits, especially after the removal of cancer, than any other specialty.

Wesley T. Myers, MD
Conroe Plastic Surgeon
5.0 out of 5 stars 5 reviews

MOHs reconstruction

 What an excellent question!  Mohs reconstruction is a term that has come into vogue recently. Simply speaking you're talking about whether you should seek the care of a plastic surgeon when you  have a defect on your face. I think the obvious answer is yes. Although a lot of dermatologists  have gained considerable experience closing the defects that they leave after removing in cancer on the face I feel that a board-certified facial plastic or board-certified plastic surgeon are definitely the best at dealing with these defects. If you had a large traumatic defect on your face and were in the ER. Would you consider calling a dermatologist?  The answer is no .  When seeing your dermatologist insist that a plastic surgeon close your wound.  It is the only way to get the benefit of their experience and training. 

Oliver P. Simmons, MD, FACS
Columbia Plastic Surgeon
5.0 out of 5 stars 10 reviews

Plastic Surgeons Are Best For Mohs Reconstruction

I sure would !
Board Certified Plastic Surgeons  are trained in surgery for a minimum of 6 years after medical school. 
See the below link on how to select the most experienced surgeon 

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Eyelid Reconstruction after Mohs Surgery for Skin Cancer

Fellowship-trainined MOHS surgeons are dermatologists who have received additional training in treating skin cancers.  Most of them are also very well trained in repairing defects in most parts of the face. However, eyelid skin cancers are challenging to repair especially when they involve the lid margin, eyelashes, and the tear duct drainage system.  You may want to consult with an Oculoplastic Surgeon to help in the reconstruction of the defect after the MOHS procedure has been performed. I regularly work closely with fellowship-trained MOHS surgeons in coordinating the removal of the eyelid skin cancer (through MOHS) and then having the patient come to my surgery center for the final repair of the defect, which can be performed through various techniques depending on the size and other variables that are discussed in a consulation. Hope this helps and good luck.

Christopher I. Zoumalan, MD, FACS
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 102 reviews

Repair of MOHS around the eyelid

Reconstruction of the eyelid after MOHs require techniques that reduce the possibility of lid malpositions such as ectropions or eyelid asymmetry. If the lesion is small and there is excess skin, closure of the wound without adjacent tension will likely not result in lid malposition. However, if there is exisiting laxityof the lower eyelid and if the closure imparts tension such that the lid moves away from the eye, reconstruction using free skin grafts or myocutaneous flaps might be recommended. It is important to discuss these issues with your MOHS specialist and he or she will provide excellent advice and direction for the reconstruction.

John Pak, MD, PhD
Chicago Oculoplastic Surgeon
5.0 out of 5 stars 8 reviews

Reconstruction following MOHS surgery

Reconstruction following MOHS surgery can be adequately repaired by well trained MOHS dermatologic surgeon.  However, in the particular area that your skin cancer is located in - between the eye and nose, the skin cancer may involve the tear drainage system or other periocular structures.  In this case, you may want to consider an oculoplastic surgeon who is well versed in the tear drainage system and periocular structures to repair your defect.  Appropriate reconstruction is necessary in this specialized area to obtain a good functional and cosmetic result.

Keshini Parbhu, MD
Orlando Oculoplastic Surgeon
3.9 out of 5 stars 10 reviews

Mohs reconstruction options

Following Mohs surgery nearly all of the reconstructions are performed by your Mohs surgeon assuming that they are fellowship trained and a member of the Amercian College of Mohs Surgery.  The key word is College and not Society as there are several gorups out there with similar names. Only members of the Mohs College have been required to spend an additional year after board-certification performing  over 500 Mohs cases, becoming experts in complex reconstruction of grafts and flaps, and have experience with the most challenging skin cancer cases. Therefore, finding a fellowship trained Mohs surgeon will provide you with a good starting point.  So once you have looked them up in the mohs college directory online, you should ask during your consultation to see examples of their work in reconstruction.   Lastly, a great Mohs surgeon will always be open to working with a local plastic, facial plastic, or oculoplastic surgeon should the patient prefer this route. The most important thing for you and your Mohs surgeon is that whatever decision you make, you should be 100% comfortable with your choice beforming the operation begins.

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.