Post-Mohs Facial Reconstruction Sydney

Post-Mohs Reconstruction

Post-Mohs reconstruction is the surgery used to repair the wound that remains after a skin cancer has been removed by Mohs surgery. On the face it is most often needed after a basal cell or squamous cell carcinoma on the nose, eyelid, lip, ear, cheek or forehead.

These sites matter because facial skin is thin, mobile and doing a job. A defect on the lower eyelid can alter lid position and tear drainage, one on the nasal rim can affect the airway and the shape of the nostril, and one crossing the lip can pull the lip margin out of line. The area removed is often larger than the mark you could see, because the tumour extends further than the surface suggests.

Dr Maryam works alongside the Mohs surgeon rather than in place of them. Her part of your treatment begins once the excision is complete and the margins have been reported clear.

What Mohs surgery is

Mohs surgery is a staged excision performed by a Mohs surgeon, usually a dermatologist with specific training in the technique. The visible tumour is removed under local anaesthetic, the specimen is mapped and examined under the microscope during the same appointment, and if tumour cells are seen at an edge, a further layer is taken from that point only. This is repeated until the examined margins are clear, which spares as much normal tissue as possible on the face.

To be clear about who does what: the Mohs surgeon performs the excision and checks the margins during the procedure. Dr Maryam performs the reconstruction afterwards, either later the same day or within a few days, depending on the defect and theatre availability.

How it is diagnosed

The cancer itself is diagnosed beforehand, by biopsy and histopathology arranged through your GP or dermatologist. Margins are then cleared and confirmed by the Mohs surgeon during the procedure. Reconstruction does not treat the cancer, and it is planned only once that clearance has been reported. Recurrence remains possible after any skin cancer treatment, so continued review with the doctor who diagnosed it stays part of your care.

At the reconstructive consultation the assessment is of the defect rather than the tumour: its size and depth, which structures are involved, the quality and laxity of the surrounding skin, your general health, whether you smoke, and whether you take blood thinning medication.

How the reconstruction is planned

Planning works outwards from the defect and the structures around it.

1. Review of the Mohs report and photographs, or of the open wound, to establish what has been removed and what needs replacing.
2. Selection of a method: direct closure where the skin allows, a local flap that moves adjacent skin with its own blood supply, or a full thickness skin graft taken from in front of or behind the ear or from the neck, where colour and texture are a closer match.
3. Consideration of staged repairs for larger nasal or eyelid defects, such as a forehead flap or a cartilage graft, completed over two or more operations some weeks apart.
4. Agreement on the anaesthetic and setting, from local anaesthetic in a day hospital through to general anaesthetic, along with scar position, the risks involved and the possibility of a later revision.

Recovery and follow up

Most people are up and about quickly, though the face takes time to settle and early appearances are misleading.

• Oedema and bruising around the eyes, nose and cheeks are usual in the first week and generally ease over about two to three weeks.
• Facial sutures are commonly removed within roughly a week, while grafts stay dressed for longer as they take.
• A flap or graft may look raised, firm or mismatched at first, and scars usually continue to soften and fade over about a year.
• Ongoing skin checks with your GP or dermatologist, since having had one skin cancer raises the chance of another.
• Daily sun protection with broad spectrum sunscreen, a broad brimmed hat and shade, including cover for the new scar while it matures.

Your care with Dr Maryam

Dr Maryam Seyedabadi is a Specialist Plastic Surgeon, MBBS FRACS, AHPRA MED0001341746, consulting at 2c Heeley Street, Paddington in Sydney and operating 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 coordinates timing with your Mohs surgeon so the repair follows clearance without unnecessary delay. What the reconstruction can achieve depends on the type, size, site and stage of the lesion and on how much tissue has had to be removed, and this is discussed with you before you consent. To arrange an appointment, call 1300 067 668.