Removing a skin cancer solves one problem and creates another: a wound that needs to heal as well as possible, both medically and cosmetically. For small cancers in low-risk areas, a straightforward layered closure handles this without much discussion. For larger cancers, cancers on the face or other anatomically complex areas, or cases where Mohs surgery has removed significant tissue, reconstruction requires more thought and more technique.
Reconstruction is considered part of the treatment, not a separate concern. The goal isn’t just to close the wound — it’s to restore form and function as naturally as possible, minimize scarring, and leave the patient looking as close to how they looked before as the situation permits.
Reconstruction options
Primary closure — bringing the wound edges together and suturing in layers — is appropriate when the defect is small enough that surrounding skin can be advanced to cover it without distorting nearby structures. For facial surgery, this involves planning the incision orientation to align with natural skin tension lines and minimize scar visibility.
Local flaps use tissue from adjacent to the defect to cover it. Because this tissue is from the same anatomical area, it matches in color, thickness, and texture far better than skin from elsewhere on the body. There are numerous flap techniques — transposition, rotation, advancement, interpolation — each suited to specific anatomical locations and defect characteristics. Selecting the right flap for the situation is a matter of both training and experience.
Skin grafts take tissue from a donor site elsewhere on the body — typically behind the ear, the scalp, or the inner upper arm for facial reconstruction. Grafts are useful when local tissue isn’t available or sufficient, though they match the recipient site less precisely than local flaps.
Secondary intention — allowing the wound to heal open without surgical closure — produces acceptable outcomes in certain anatomical locations, particularly concave areas of the face where the healed result can actually be quite good. It avoids additional surgical morbidity in the right context.
Timing
For Mohs surgery patients, reconstruction is planned and performed on the same day, once the surgeon has confirmed clear margins. This is one of the advantages of Mohs — the surgeon knows the exact size, shape, and depth of what needs to be reconstructed before planning the repair. In some cases — very large or complex defects, or situations where a plastic surgery referral would better serve the patient — reconstruction may be staged separately. We’re straightforward about when that’s appropriate.
Frequently asked questions
Do I need to see a plastic surgeon for reconstruction?
Not necessarily. Dermatologic surgeons with fellowship training in Mohs surgery have specific training in cutaneous reconstruction and routinely perform complex repairs on the face and other anatomically demanding locations. We’ll tell you honestly if a referral would produce a better result for your specific situation.
What will the final scar look like?
Scars look their worst at three to six months, when they’re often pink, slightly raised, and firm. They improve substantially over the following year as the collagen remodels. The final result at 12 to 18 months is generally significantly better than it appeared at three months. We give specific scar care guidance and follow up to monitor healing.
How long is recovery?
It depends significantly on the type and location of reconstruction. Most patients can resume normal activity within one to two weeks. Heavy exercise, significant sun exposure to the area, and activities that strain the repair should be avoided for longer. We give specific guidance based on what was done and where.