Should a skin graft after Mohs be performed by the dermatologist that performed the procedure or a plastic surgeon? My father had Mohs & I am concerned about having the dr. who performed the Mohs do the skin graft. I just feel it should be done by a plastic surgeon since it is a large crater on the tip of his nose. Also, a little uncomfortable with the facility my dad chose. Dr. was great, but office a bit run down. Dad is older, so is leaning towards going back to the same Doctor.
Should a Skin Graft After Mohs Be Performed by Dermatologist or Plastic Surgeon?
Doctor Answers 4
Reconstruction After Mohs Surgery
Fellowship trained Mohs surgeons are trained extensively in surgery and advanced reconstructive techniques, including skin flaps and skin grafts. Physicians that complete this training program possess all the qualifications needed to repair a surgical site after a cancer is removed by the Mohs technique. My recommendation, however, is go to the person you feel most comfortable with. You should have confidence in the physician who is treating your dad, and feel confident that they will give you the best result.
That is a very good question. When Moh's surgery is the best for my patients, I typically have the Moh's surgeon do the removal of the tumor and the patient returns to my office for the reconstruction. In the 1970's and 1980's the Moh's surgeons did typically do their own reconstructions, but sent them to a facial or general plastic surgeon for reconstruction. Over the years, most Moh's surgeons have learned how to close most of the defects the result from the Moh's excision of the tumor.
Who Should Perform Repair after Mohs Surgery
The best answer is to pick the doctor that you and your father feel will give the best result.
In my opinion if you pick a Mohs surgeon, it is best to pick a doctor who has completed a fellowship in Mohs surgery and is a member or fellow of the American College of Mohs Surgery. These doctors have completed a fellowship after their residency in Mohs micrographic surgery which includes study and experience in Mohs surgery, dermatopathology and recontstructive surgery.
If you pick a plastic surgeon, make sure that the doctor has a lot of experience in nasal reconstruction. Not all plastic surgeons in private practice perform a large variety of repairs on the nose so talk to the doctors about their experience and how they would decide on the necessary repair.
As a general rule, I don't plan on performing a graft after Mohs surgery. I think about several options since I don't know how large or how deep the surgical defect will be. The choice is made after I examine the surgical defect. So pick the doctor who has the most experience in nasal reconstruction and who you and your father feel will do the best repair. After the cancer is removed that doctor should evaluate the wound and determine whether it is best to repair by side-to-side repair, flap, graft or secondary intention (i.e. allowing the wound to heal by itself). Good luck.
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Skin Grafts from Mohs Surgery
Any dermatologist who is a Mohs surgeon has been trained extensively on skin grafts - that's a large part of it. And to be totally honest, many plastic surgeons and dermatologists just don't work well together. So it's hard. If you find an office that has this set up, with both doctors on site and working extensively together, then that's great. I just don't know very many offices like this. Skills are more important than a pretty office, so worry about the expertise of the doctor, not how plush the office is.