Skin cancer is one of the most common forms of cancer in this country. There are three major types including basal cell carcinoma, squamous cell carcinoma, and melanoma. Dermatologists trained in Mohs surgery can excise the skin cancer with both precision and accuracy. Plastic surgeons usually take a standard margin for each type of skin cancer and check the margins with a “frozen section” where a pathologist looks at the excised skin cancer under the microscope to check for clear margins at the time of the surgery. Both Mohs surgery and the plastic surgeons’s excision techniques using standard margins have excellent cure rates for skin cancer. In cases where the Mohs surgeon performs the cancer excision, reconstruction is performed on the same day at a surgery center by a plastic surgeon. There are various techniques for reconstruction including primary closure, skin graft, and local flaps.

Primary closure is performed in cases where the defect or the wound left by the excision of the skin cancer is relatively small. If the defect is a circular wound, the circle is fashioned into an oval to achieve a linear closure.

A skin graft is used to cover defects which are relatively large in size. The skin is taken from an area of the body where there is enough laxity and the skin is expendable. The skin graft is applied to the defect and sutured into place. There is a “cushion”-type dressing placed over the skin graft which is sutured on for 5-7 days.

A flap is the process of covering defects with local tissue around the defect, based upon the use of geometric patterns and intrinsic skin laxity. It is more often performed than skin grafts or even primary closures, because it tends to heal in the most inconspicuous manner where the scars are not readily noticeable.

In Mohs surgery, the extent of the skin cancer defect will not be known until after the skin cancer is excised. So, at your initial consultation, Dr. Lee will go over with you the various surgical techniques which may be used to reconstruct the defect. Once the Mohs surgery is done, and Dr. Lee has a chance to examine the actual defect, he will be better able to discuss the exact procedure which will be performed. This discussion will take place just before you go off to the operating room at the surgery center.

Dr. Lee's postoperative instructions for skin cancer & reconstruction

1. When you awake from surgery, you will have surgical tape dressed directly over the suture line, and you may also have a gauze bandage over this surgical tape. Leave the bandage on for 48 hours. The outer bandage can be removed after 48 hours, but the surgical tape should remain over the suture line.
   
   
2. You may shower 48 hours after the surgery. You can sponge bathe before this 48-hour period, but keep the surgical area clean and dry. The surgical tape can get wet. If the surgical tape peels off after getting wet, this is ok. Just leave your suture line open to air and start applying Neosporin over the area twice daily. No baths or swimming. Showers are ok.
   
   
3. Call to make an appointment 7 days after your surgery. The sutures will be taken out at this appointment.
   
   
4. You can place cold-packs (or frozen peas) over the surgical area to keep the swelling down. If the surgery was over your face or scalp, keep your head elevated at all times. Use at least 2 pillows for sleep.
   
   
5. Do not lift objects over 5 pounds (heavier than a phone book) for 1 week.
   
   
6. Do not smoke or drink alcohol or take aspirin for at least 3 weeks before and after surgery.
   
   
7. Do not drive a car while you are on narcotic medication for pain.
   
   
8. Take medications as directed. Do not take aspirin, anti-inflammatory medications (Motrin, Ibuprofen, Alleve) or Vitamin E supplements for 2 weeks after surgery.
   
   
9. Keep your incisions out of the sun. Sun exposure will make your scars red, raised, and persistently irritated for a long period of time. Make every effort ot avoid the sun for up to 1 year following surgery. You can cover up the incision with sun screen (SPF 15 or above) or clothing.
   
   
10. Call with any questions or concerns. Dr. Lee is available through the office phone number 24/7. Don’t ever feel badly about calling