By Robert H. Gotkin, MD, FACS
Dr. Gotkin is director of plastic surgery at Cosmetique Dermatology, Laser & Plastic Surgery, LLP, is a board-certified plastic surgeon specializing in cosmetic and reconstructive facial surgery and breast and body contouring. On the staff of prestigious hospitals in Manhattan and Long Island, NY, Dr. Gotkin is a member of the American Society for Aesthetic Plastic Surgery, the American Society of Plastic Surgeons and is a Fellow of the American College of Surgeons. He is the co-author, along with his wife, Deborah S. Sarnoff, M.D., of the best-selling book Instant Beauty: Getting Gorgeous on Your Lunch Break.
Q: I have a basal cell cancer on the side of my nose. My plastic surgeon has recommended that I get Mohs surgery to have it removed, and then he would perform the corrective plastic surgery the same day. Doesn't my nose need time to heal first?
A: No. Your plastic surgeon is correct on two counts. The first is the recommendation to have the basal cell carcinoma removed by the Mohs technique. I always say to my patients, "Why would you want me to remove the skin cancer?" It's like operating blindfolded. With the aid of the microscope and the Mohs technique, the Mohs surgeon has the benefit of confirming that the tumor has been traced to its roots and removed in its entirety. Once the tumor has been removed completely, the reconstructive plastic surgery can be performed with the assurance that there is no skin cancer left behind.
Your plastic surgeon is also correct in advising that reconstruction should occur on the same day as the Mohs surgery. In this situation, the wound is fresh, not contaminated by being open to the environment, and healing has not started yet.
The problem with waiting is that the early stages of healing bring inflammation to the tissue; the later stages of healing bring scarring. In either case, the reconstructive plastic surgery is more difficult and the results compromised. Consequently, the best cosmetic results occur in wounds that are reconstructed immediately following completion of Mohs surgery.