Mohs Surgery and Orbital Tumor

Skin Cancer Reconstruction – Mohs Surgery in Beverly Hills, CA

With the cases of skin cancer diagnosed yearly exceeding the total of all other types of skin cancer combined, advanced and effective treatments have been developed to provide higher cure rates and improved outcomes.

Mohs Micrographic Surgery Before and After

mohs surgery before and after

Mohs surgery is performed by specially trained dermatologic surgeons to remove difficult or recurring skin cancer. Although it is a very efficient and effective treatment, Mohs micrographic surgery can leave large wound defects in prominent areas of the face causing disfigurement.

We utilize several techniques for reconstructing skin cancer defects. These defects can be from previous Mohs’ procedures or even trauma. Dr. Raymond Douglas has extensive experience in performing the highly complex Mohs reconstruction surgery to repair the wound and retain the natural appearance of the facial features.

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What is the recovery and healing process after Mohs surgery?

The extent of your wound is predicated on the size of your skin cancer and how much tissue needed to be removed. Generally, there are four possibilities:

  • The wound is small enough it can heal with just a bandage
  • The wound is closed with stitches
  • Skin is shifted from an adjacent area to cover the wound (skin flap)
  • Skin is taken from another part of the body, such as behind the ear, and is used to replace removed tissue

Wound healing and care instructions will be given to you, depending on what method was used.

Customized Approach to Mohs Surgery Recovery

mohs surgery | Beverly HillsWe have extensive experience in repairing and reconstructing wounds on eyelids and tissues around the face to restore an aesthetically normal and natural appearance. In our photo gallery, you can see several examples of patients who have undergone extensive reconstruction of their eyelids and the tissues around their face, in addition to the primary reconstruction.

Biological remodeling can also be used to expand and soften any scar tissue that may have formed as a result of surgery. This results in a very soft and natural appearance over time. The results are often dramatic and patients are able to resume normal function and appearance.

Scar Therapy in Beverly Hills

After a detailed consultation and discussion of the available options for repair, Dr. Douglas will formulate an individualized treatment plan to improve the function and appearance of the area. He has pioneered many of the methods used by most surgeons today and has traveled nationally and internationally to teach other surgeons his techniques, as well as published and lectured on the topic.

Specifically, he uses an innovative strategy to reduce the accumulation of scar tissue while expanding the tissue simultaneously. Combining this scar therapy with reconstruction surgery can dramatically improve the appearance of scarring and give the most aesthetically pleasing result possible.

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Frequently Asked Questions

Does Mohs surgery leave a scar?

Any incision in human skin leaves a scar: that’s simply a fact of life. But the advantage of Mohs micrographic surgery is that it enables the surgeon to preserve as much healthy tissue as possible, while still being able to verify that the cancer cells have all been removed. Dr. Douglas has extensive experience with Mohs surgery reconstruction and with subsequent options for minimizing scarring, such as skin grafting, the use of a skin flap, and using a modification or laser.


What to expect after Mohs surgery

Mohs surgery is two phases: the removal of the cancer and reconstruction.
The reconstruction can be quite varied depending upon whether it affects the eyelid or cheek etc. It is important to have a reconstructive surgeon who is focused on aesthetics to improve the outcome. There will be stitches to removed in 7-10 days and then the healing will start. Allow about 2-3 weeks for social functions.


Why do I need reconstruction surgery after Mohs surgery?

Once the cancer is removed, there is a skin deficit which if left to heal will scar and cause quite disfigurement. However with an aesthetic reconstruction there is significant improvement in the scarring and sometimes one cannot even tell there was a cancer.


What does the reconstruction process look like?

The first week after reconstructive surgery there is significant swelling and sutures in place. Once the sutures are removed the second week of healing is much better with decreased swelling and redness. You will be able to resume most normal activities in 2 weeks and social events in 2-3 weeks. Complete healing often takes 2-3 months and can require a modification or laser to improve any scarring, The results are often quite dramatic as shown in our before and after gallery.

    Is the reconstruction just one single “procedure”?
    Typically the reconstruction is one procedure after the cancer removal. This can be done in the office or as an outpatient procedure. However occasionally (10%) of times it is necessary to do an additional procedure or do a staged procedure where an additional surgery is planned.

See What Our Patients Are Saying

He is absolutely the best. I am so grateful to have been able to be treated by Dr. Douglas. Kind, compassionate and extremely knowledgeable. -Sarah W.

Consultations

If you have been affected by skin cancer and are in need of reconstruction, please contact our office to schedule a consultation today. Dr. Douglas also offers online consultation for your convenience.

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General Mohs Surgery FAQs

What types of skin cancer can be removed with Mohs surgery?
Mohs surgery is used to remove the most common skin cancers — basal cell carcinoma and squamous cell carcinoma, but it can also be used on some cases of melanoma.
 
These are the situations where Mohs is especially useful:
  • The skin cancer has recurred or there is a high risk of recurrence
  • The skin cancer is located in areas where it’s important to maintain as much healthy tissue as possible: around the eyes, nose, mouth, hands, ears, feet, and genitals
  • The skin cancer has borders that are hard to define
  • The skin cancer is large
  • The skin cancer is aggressive
What can expect during the procedure?
Mohs surgery is done on an outpatient basis. Once the area has been anesthetized, The surgeon will remove the visible portion of the cancer along with a thin, underlying layer of tissue slightly beyond the borders of the visible cancer. This takes just a few minutes.

The surgeo then applies a temporary bandage over your incision, and you head to a waiting room to wait while the removed tissue is sent to the laboratory for examination. This will usually take about one hour. It’s good to have a book or laptop to pass the time.

In the lab, your tissue is cut into sections and examined under a microscope. A map of the excised tissue is created to show what areas, if any, still have cancer cells. Then the doctor knows precisely where more tissue must be removed.

If there is still cancer present, another round of Mohs surgery is done. More tissue is removed, this time only in the area where cancer cells were still present. It is again sent to the lab and the process repeated.

This process is repeated until the tissue borders are all cancer-free.

I don’t see anything after my biopsy. Do I really need to be treated?
Your biopsy may seem to have removed the skin cancer, but the problem is you can’t know what is going on with the borders. The original biopsy by the doctor was not intended to remove all of the cancer; it was simply testing to see if the growth was cancerous. While the main growth may have been removed, there are high odds that the exterior of the main growth still contains cancer cells and they need to be removed.
Is Mohs surgery a new treatment for skin cancer?
Mohs surgery gets its name from Dr. Frederic Mohs, who pioneered a procedure called chemosurgery for skin cancer back in 1936. Initially a zinc chloride solution was used to “fix” the excised skin tissue for study under the microscope, but the chemical caused serious discomfort to the patient. So, in 1953, Dr. Mohs tried the same technique of removing a minimal amount of tissue and examining it for remaining cancer, but he now eliminated the zinc chloride. This was called the fresh tissue version, and became Mohs surgery. The surgical method began to be adopted by the dermatology community starting in 1970. Today it is the gold standard for removing skin cancer with the least disfiguration, and the highest rates of success.
What are the possible risks or complications with Mohs surgery?
Mohs surgery is surgery, so it carries the same risks of excessive bleeding, possible infection, and continuing pain or tenderness around the incision site. There are other rare complications:
  • Temporary or permanent numbness surrounding the surgical areas, if small nerve endings are cut
  • Temporary or permanent weakness of the surgical area if the tumor was large and a muscle nerve was severed
  • Itching or shooting pain in the treatment area
  • Development of a keloid scar (enlarged beyond the actual incision borders)
What areas can be treated with Mohs surgery?
Because of its high cure rate, Mohs surgery is now recommended as the method of choice for high-risk nonmelanoma skin cancers. Cancers on the nose, eyelids, lips, ears, hands, feet, and genitals are all considered high-risk and Mohs is the recommended surgical method. Cancers on other areas of the face, scalp, neck, and shins are considered intermediate risk.
 
Other skin cancers that are best treated with Mohs surgery include:
  • Large cancers in normally low-risk areas
  • Those with difficult-to-see borders
  • Those with certain microscopic growth patterns
  • Those that have recurred after initial treatment
  • Those that were not completely removed by other treatment methods

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