Mohs Surgery Closure
Once Dr. Pennie and her surgical team remove your skin cancer tumor, the next step in the process is wound closure or reconstruction. A Mohs surgical wound is referred to as a defect (Cottrell & Raggio, 2023). Each skin cancer defect repair is different because the cancer tumors grow differently in everyone. You and Dr. Pennie will discuss your defect and the best dermatologic surgical closure for you.
Mohs surgery closure techniques
There are two basic types of Mohs reconstruction methods; primary intention and secondary intention (Al-Khamis et al., 2010). For a primary intention repair, Dr. Pennie will close the wound using sutures, flaps, or grafts for your Mohs surgery wound healing. Secondary intention allows the wound to remain open and heal from the bottom up, in a process known as granulation (UR Medicine, n.d.). In this case, Dr. Pennie will apply a pressure dressing instead of performing another surgical procedure. You will receive instructions about how to care for your site while you heal.
- Suture closure – stitches are used to close the defect leaving a clean line of stitches to minimize scaring and allow for the best cosmetic result.
- Flap reconstruction – skin from around the wound is used to create a covering for the defect. This is commonly used in larger or oddly shaped defects where a linear suture closure is impossible. Flap reconstruction is an excellent technique to prevent disfiguring scars.
- Skin grafting – healthy skin is harvested from a different site on the body and used to fill in the Mohs surgical defect. There are two types of skin grafts:
- Split thickness skin graft – a thin shave of healthy skin, usually taken from the thigh, is used to cover the wound
- Full thickness skin graft – an entire piece of healthy skin is taken from an area where the skin is looser, and a linear suture closure is possible. Common donor sites for full thickness skin grafts after Mohs surgery are the around the ear or the collar bone.
Secondary intention, or granulation healing from the bottom up, is used for smaller Mohs surgery defects, where closure is unnecessary. For example, if a tumor is small and invades some of the layers of the skin, allowing the wound to heal naturally provides the best outcome. In some cases closing these shallow defects could increase the risk of infection (Mayo Clinic, 2022)
- Al-Khamis, A., McCallum, I., King, P. M., & Bruse, J. (2010). Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006213.pub3
- American College of Mohs Surgery (Director). (2019). Mohs Surgery: The Most Effective Treatment for Skin Cancer. https://www.youtube.com/watch?v=F6TxdvjPk5I&t=11s
- American College of Mohs Surgery (Director). (2022). Postoperative Care for Mohs Surgery. https://www.youtube.com/watch?v=5XwWViMYclA&t=8s
- Cleveland Clinic. (2022, August 31). Mohs Surgery. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/13312-mohs-surgery#recovery-and-outlook
- Cottrell, J., Raggio, B. S.,. (2023). Facial Reconstruction for Mohs Defect Repairs. In Facial Reconstruction for Mohs Defect Repairs. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553099/
- Mayo Clinic. (2022, August 23). Mohs surgery. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/mohs-surgery/about/pac-20385222
- University of Rochester School of Medicine. (n.d.). Reconstruction Options—Mohs Surgery—Dermatology. UR Medicine. https://www.urmc.rochester.edu/dermatology/specialty/mohs/mohs-reconstruction.aspx
Schedule a dermatology appointment.
Only you and Dr. Pennie can decide the best closure type for your Mohs defect reconstruction. Your goals for healing include pain control, infection prevention, and the best cosmetic result. Discussing your concerns with Dr. Pennie is an important part of your journey to healing from skin cancer.
If you or a loved one are suffering from skin cancer and are unsure about your surgical options, call Bliss Dermatology today and schedule a consult with Dr. Pennie. With our team, you are in expert hands.
At a Glance
Michelle Pennie, MD
- Board-Certified Dermatologist
- Fellowship-Trained Mohs Surgeon
- Founder and Lead Dermatologist of Bliss Dermatology
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