Post-Mohs Reconstruction, Body & Limbs

Post-Mohs Reconstruction

Post-Mohs reconstruction on the body is the repair of the wound left after a Mohs surgeon has removed a skin cancer from the trunk or a limb. It is most often needed following basal cell or squamous cell carcinomas on the back, shoulders, chest, arms or lower legs.

Mohs surgery is used less frequently on the body than on the face. It tends to be chosen for tumours that have come back, that have poorly defined edges, or that sit where sparing tissue matters, such as over the shin, the back of the hand or near the ankle. The defect left behind can still be substantial.

Regions behave differently. Wounds across the back and shoulders are pulled on constantly by movement and by the tension of thick skin, so scars there tend to spread. On the lower leg the skin is thin over the tibia, the blood supply is less generous and oedema is common, so healing takes longer and a graft is more often required.

What Mohs surgery is

Mohs surgery is a staged excision carried out by a Mohs surgeon, usually a dermatologist trained in the technique. The visible tumour is taken first under local anaesthetic, the specimen is mapped and examined under the microscope during the appointment, and where tumour is seen at an edge, another layer is taken from that specific area. The sequence continues until the examined margins are clear.

The division of roles is straightforward. The Mohs surgeon performs the excision and checks the margins during the procedure. Dr Maryam performs the reconstruction once that is done, either the same day or within a few days, depending on the size of the defect and theatre availability.

How it is diagnosed

The cancer is diagnosed before Mohs surgery, by biopsy and histopathology arranged through your GP or dermatologist, and the margins are cleared and confirmed by the Mohs surgeon during the procedure itself. Reconstruction is not cancer treatment. It is planned only after clearance has been reported, and recurrence remains possible after any skin cancer treatment, so ongoing review continues with the doctor who diagnosed it.

The reconstructive assessment looks at the wound and the limb or trunk around it: the size and depth of the defect, whether fascia, tendon or bone is exposed, circulation in the limb, swelling, diabetes, smoking, blood thinning medication, and how much you will be able to rest the area afterwards.

How the reconstruction is planned

The plan follows the defect, the tension around it and how well that site heals.

1. Review of the Mohs report, photographs or the open wound to establish exactly what has been removed.
2. Selection of a method: direct closure where there is enough laxity on the trunk, a local flap to bring in nearby skin, or a split skin graft, commonly taken from the thigh, for broader wounds on the leg or back.
3. Consideration of a staged approach where bone, tendon or cartilage is exposed, using a dressing or dermal template first and grafting once the base is ready.
4. Agreement on the anaesthetic and setting, from local anaesthetic in a day hospital to general anaesthetic, together with scar expectations, the risks involved and any restriction on work, driving or exercise.

Recovery and follow up

Recovery on the body is governed by movement, tension and swelling rather than by appearance.

• Wounds on the back, shoulder or chest are usually protected from lifting, reaching and gym work for around four to six weeks, as directed for your repair.
• Leg wounds and grafts often need elevation, short frequent walks and sometimes compression, and may take several weeks or longer to heal.
• Graft donor sites are dressed for a period of their own and typically leave a flat, paler patch of skin.
• Skin checks continue long term with your GP or dermatologist, because a further skin cancer is more likely once you have had one.
• Sun protection every day, with covering clothing, a broad brimmed hat, broad spectrum sunscreen and shade, and cover for the maturing scar.

Your care with Dr Maryam

Dr Maryam Seyedabadi is a Specialist Plastic Surgeon, MBBS FRACS, AHPRA MED0001341746, consulting at 2c Heeley Street, Paddington and operating across Sydney at St Luke’s Hospital in Potts Point, East Sydney Private Hospital, Sydney Day Hospital, The Skin Hospital in Darlinghurst and Double Bay Day Hospital. A referral allows a Medicare rebate to be claimed for these procedures.

She liaises with your Mohs surgeon on timing so the repair follows clearance promptly. What the reconstruction can achieve depends on the type, size, site and stage of the lesion and on how much tissue has been removed, and that will be set out for you before you consent. To arrange an appointment, call 1300 067 668.