What is Skin Cancer?
Skin cancer is the most common cancer in the United States and worldwide affecting approximately 1 in 5 Americans by the age of 70. Skin cancer is the abnormal growth of skin cells that most often develops on skin exposed to the sun.
The skin is the body’s largest organ and is composed of several layers. The two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells—
- Squamous Cell Carcinoma:Thin, flat cells that form the top layer of the epidermis.
- Basal Cell Carcinoma:Round cells under the squamous cells.
- Melanoma Carcinoma:Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.
Squamous Cell and Basal cell carcinomas are the two most common types of skin cancer, which begin in the squamous and basal layers of the skin. Both can usually be cured, but they can be disfiguring. Melanoma Carcinoma, the third most common type of skin cancer, begins in the melanocytes.
Most cases of skin cancer are caused by overexposure to ultraviolet (UV) rays from the sun, tanning beds, or sunlamps. UV rays can damage skin cells, altering the DNA. In the short term, this damage can cause a sunburn. Over time, UV damage adds up, altering the DNA and leading to changes in skin texture, premature skin aging, and sometimes skin cancer.
What is Mohs Surgery?
Mohs surgery is an advanced technique used for the treatment of common skin cancers such as: Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma. Mohs surgery microscopically maps out the path of your skin cancer with precision while removing cancerous cells in the tissue one layer at a time. Each layer is then examined under a microscope and the surrounding areas are checked for cancerous cells until all margins come back negative of cancer.
Mohs surgery is usually performed by a dermatologist, under local anesthesia as an outpatient procedure. The goals of this treatment are to remove the cancer, minimize the chance of it returning while preserving as much healthy skin as possible. Depending on the extent of the cancer, Mohs reconstruction surgery aka repairing the wound may be necessary.
Is Mohs Surgery Always Needed?
Treating all skin cancers with Mohs surgery is not necessary and reserved for skin cancers that are at high risk of recurrence, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal tissue is important such as the face.
Mohs surgery has been refined into the most precise and advanced treatment for skin cancer, yielding success rates of up to 99%. As a result, it is considered the gold standard treatment for high-risk skin cancers.
What is Mohs Reconstruction?
Removing skin cancer with Mohs surgery can be a lifesaving procedure. However, after this complex skin cancer removal there is often a defect left behind. Mohs reconstruction surgery attempts to restore both the look and function of your skin after undergoing Mohs surgery.
This important procedure is just as valuable as removing the cancer itself. If done right, majority of people who have Mohs reconstruction feel as though they are fully healed with minimal scarring. Mohs reconstruction is best when performed by a highly skilled plastic surgeon as it involves great precision and care.
Is Mohs Reconstruction Always Needed?
Historically, skin cancer treatment has been accompanied by the persistence of noticeable scarring. This is especially relevant for patients with skin cancer extending over a wide surface area or very deep. When skin cancer develops in a highly visible area, such as the hands, arms, or face, the potential for post-treatment scarring is often significant. Many patients express concern about how they will look after undergoing their skin cancer removal procedure.
The expertise of a highly trained plastic surgeon is often necessary to precisely and effectively reconstruct the skin tissue. Aesthetics and proper functionality are pivotal to many facial areas affected by cancer, such as the lips, nose and eyes. For this reason, it is essential to choose a surgeon who is experienced in restoring form and function to these areas.
What is Different About Mohs Reconstruction with Dr. Rahban?
Normally, a dermatologist performs the Mohs surgery to remove the skin cancer, leaving behind a defect to be treated. The defect can be repaired by a variety of different doctors:
- Option 1: Dermatologist performs the Mohs surgery and does the reconstruction immediately thereafter. The skillset of a dermatologist is different then that of a plastic and reconstructive surgeon.
- Option 2: Dermatologist performs the Mohs surgery and the on-call plastic surgeon or ENT closes your wound immediately after. In this instance, you don’t get to meet with the plastic surgeon in advance or have much say in the preoperative decision making.
- Option 3: Dermatologist performs Mohs surgery and it’s pre-planned that Dr. Rahban perform the Mohs reconstruction. This option alleviates the anxiety of having to make last minute decisions on the spot, and eliminates any uncertainties of who the surgeon is that will be performing this crucial procedure.
Dr. Rahban takes a different, more personal approach and allows ample time to discuss and review reconstruction options. He meets with the patient first and performs the reconstruction as its own surgery, done separately. While this may feel like an extra step, it will allow for the most customized technique and optimal results.
Dr. Rahban uses what is known as the Reconstruction Ladder - an approach that begins with the most simple methods to close and reconstruct, then moves into the more complex techniques.
Mohs Reconstruction Ladder:
Closure technique matters. Several different methods can be used to repair your surgical wounds in increasing complexity and skill. The various techniques are tailored to each individual case. The methods from simplest to most complex are:
- Healing by Granulation: Sometimes, the wound is left to heal on its own or granulate and can lead to very good results. The decision to do this versus performing a repair depends on the wound's size, shape, and location and whether you are open to having the scar revised at a later time should you need to. It’s important to note that areas of the face won’t heal as well without reconstructive intervention. Nasal skin, for example, is thick and overlies a cartilaginous framework, leading to contour irregularities and contracture if left to heal on its own. Surgical closure is necessary for optimal aesthetic and functional results in some instances.
- Primary Wound Closure: This closure method involves suturing the edges of both sides of the wound, creating an optimal cosmetic result. Dr. Rahban’s meticulous nature, combined with his multi-layer closure technique, ensures minimal scarring and excellent aesthetic outcomes.
- Skin Grafts Skin grafts use a piece of skin from another area of your body (ie. Behind or in front of the ear, the clavicle or arm, etc.) to cover the wound, similar to a patch. Common donor sites include the following:
- Behind or in front of the ear
- The clavicle
- The arm
Dr. Rahban carefully selects the skin to have a similar tone and texture to the area that needs to be repaired and reconstructed. This is important to prevent distortion when closing an area, especially on the eyelids, nose, and lips.
However, when a skin graft is placed, it doesn’t have a blood supply connected to it like a skin flap. The graft is fed by the surrounding skin, absorbing nutrients through the base of the graft until new blood vessels grow into the grafted skin from the surrounding area. Proper post-operative care is critical when this method of closure and repair is chosen to ensure optimal healing.
- Skin Flaps A skin flap is a piece of tissue close to the wound that is attached to a blood supply. When mobilized and placed over the recipient site to aid in repair, the flap moves and stretches the skin from the surrounding area to cover the surgical wound. Flaps only need a blood supply to stay viable and heal.
While closing a wound after Mohs surgery with a skin flap is highly effective, whether the method can be used depends on the following:
- The location and size of the wound and availability of surrounding donor tissue
- Whether letting the skin heal on its own, pulling the skin together in a straight line, or skin grafts aren’t feasible options
Recovery After Mohs Reconstruction
Once the surgery is complete, you may go home on the same day with a family member or friend. There will be a dressing on the treated area to help protect the wound and reduce swelling.
Swelling will increase over the following two or three days, then begin to reduce over the next two weeks. Patients can typically return to many of their normal activities within a couple of days. However, do not do anything strenuous including exercise until the sutures are removed and you have clearance from Dr. Rahban. This is usually about one week.
Your skin will continue to heal over the following weeks. Depending on the size of the area, it will take between a month and two months for the wound to heal completely.
Why Choose Dr. Rahban for Mohs Reconstruction?
Mohs reconstruction determines what your face will look like after the trauma of cancer tissue removal. When you’re undergoing Mohs reconstruction, it’s crucial to have the most highly-trained, talented surgeon to perform your reconstruction.
Dr. Rady Rahban is a world-renowned, board-certified plastic and reconstructive surgeon in Beverly Hills. His meticulous focus and attention to detail, combined with his compassionate nature, set him apart.
For many years, Dr. Rahban has offered reconstructive surgery for cancer and trauma patients. He is recognized internationally for his professional integrity and artistic sensibilities, achieving truly exceptional outcomes in the most challenging of cases.
Please call today to schedule a consultation with Dr. Rahban to learn more about Mohs reconstructive surgery.