Q: I was just seen by a dermatologist who diagnosed me with a basal-cell cancer near my nose. I was told that I needed Mohs surgery and that I should have a plastic surgeon close my defect. Is it ever OK to just leave the incision open and let it close by itself?
A: The simple answer is yes, it can close by itself. But if it would heal faster and look better why would you?
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Mohs surgery is a technique in which a dermatologist removes all the cancer cells microscopically. By doing this, the patient is free to do an immediate reconstruction without fear of leaving any of the tumor cells. Many years ago, before reconstructive techniques were available, many patients were advised to let the primary excision heal over a period of time. This technique would often give satisfactory cosmetic results, but it would take weeks and maybe months for it to completely heal.
In more recent times, dermatologists and facial-plastic and plastic surgeons have worked in concert to give the patient a better experience. Often times, the defect that is left behind is much bigger than the patient or the doctor thought it would be. The defect is dictated by the extent of the microscopic tumor margins.
Once the Mohs surgery is completed, the patient is free to immediately go to a facial-plastic or plastic surgeon for immediate reconstruction. Often times, the reconstruction is just a matter of mobilizing skin flaps and closing them primarily. In many cases, the defect is so big that free flaps or bigger facial flaps are needed to close the incision.
With a very experienced facial-plastic or plastic surgeon teaming with a dermatologist who is experienced in Mohs surgery, most defects can be closed satisfactorily with great results. The most important thing prior to having a Mohs surgery is to plan for reconstruction if it’s needed.