I would hope a professional MOHs surgeon would know when a plastic surgeon should do repair.
My uncle had other MOHs procedures at penn, on his face, cheek, and the MOHs derm did the suturing, no repair needed, but clearly his nose needed more extensive work.
A friend’s husband went to penn this year, and derm did repair.
Recently, he had another MOHs procedure done locally, and results look nice, on his cheek.
I would call the offices, and ask about their process. Nice that you have 5 in your area.
I did take the recommendation of the Mohs surgeon regarding the plastic surgeon. Her advice was, “Let’s see what we need to do to remove the BCC…if it’s one pass, probably no reconstruction needed. If more, we’ll see.” As i said, thought the BCC presented as a small (smaller than a pencil head) whitehead, it took four passes and I think I ended up with a wound about the size of a penny (I wouldn’t look). It was a holiday, so she covered it and I saw the surgeon the next day. He did the grafts in the office (hospital-based faculty practice) and actually sewed the dressing to my face. I went back three days later to remove the initial dressing, then three more times for follow-up. It has healed nicely and is not obvious to anyone but me, and then only when I look closely at the side of my nose. The cartilage graft reproduced the curve, so no one else notices…or at least that’s what they tell me! I recommend a skilled MOHS surgeon (derm or otherwise) followed by a plastic surgeon who does reconstructive facial surgery.
One of the FAQs says start with the dermatologist who does Mohs, and that she/he should be able to recommend a plastic surgeon for closing when it involves the face.
Mohs (rhymes with doze) was invented in my home town and that’s how the clinic here handles it for basal and squamous areas on the face.
Thanks Runnersmom and Madison…you’re posts are VERy helpful as to how to have this done. I called one of the MOH’s derms that was on the website that Zooey gave me. He only does MOH’s surgeries and is about 45. I feel more comfortable already in that is all he does (skin cancers). I’ve called and they will have to call me back to make an appt. I will tell him that I’d like to see a plastics person and I’m sure he can recommend one to me. I was just at a loss as to the proper steps on how this should be done.
Runnersmom…when you say you had a wound the size of a penny, what does that mean. On the top of the nose, it was that large? And how deep did it go? Did you just have a gaping hole before reconstruction?
She (the MOHS derm) basically had to remove the side of my nose to get clean margins. She took four passes, as I said, and I ended up with an open wound. She covered it with gauze and to be honest, I have no idea what it looked like. I saw the plastic surgeon less than 24 hours later and he removed that dressing. He offered me a mirror, and I declined. I trusted him to do the reconstruction necessary, and he was confident he could do it right then. Since my body seemed to absorb the lidocaine during the MOHS procedure (I must’ve needed at least 4 additional injections during the procedure), I asked about doing it in an OR. He would have made room in his schedule for me the next day, but assured me that it would be better to just do it right then. I can’t say it was comfortable to have the skin graft taken from my hairline and a cartilage graft taken from my ear, and then endure him sewing it all in place, but it was better to just get it over with. He had a great assistant and good music, so the time went pretty quickly. The location was on the curve of the side of my nose, and had I not had the cartilage graft, it would’ve looked flattened on one side. Now it’s pretty unnoticeable. You’ll be fine in the hands of doctors who do this daily.
Runnersmom…so it sounds like the thing to do is make sure the Moh’s doc and plastic surgeon are communicating the PL is ready to take over in 24 hours to stitch up the wound or do any reconstuctive surgery. I would also not care to see what it looked like…the whole thing is upsetting and that would probably add tremendously to the anxiety.
There are plenty of Google images but once you look you can never un-see! My Moh’s guy had me look. I knew there were three passes but I was surprised at how deep it went. I wondered why it hadn’t hit the opening underneath but he explained that the white I saw was the cartilage. TMI
Update: I went see the certified MOH’s dermatologist this morning (only a few in my general vicinity and this is all he does). He’s the guy! You know how you can just tell, that gut feeling? He said that he thought it looked more like 2 types of sebaceous gland issues, but we can’t really know for sure until a biopsy…a scrapping one. He said that if I wanted to go to the plastic surgeon that was fine, but he has done tens of thouands of them. It would be just with the curve of my skin.
I’m going to have him do the biopsy I think, what do you think? My thoughts are he does nothing but skin cancer, has done thousands of these and this thing is really small right now. He did say the plastic surgeon i went to (the young and cocky one) was good.
So you don’t yet know for sure that it’s even cancer? If you like this guy go head and have him do a biopsy. Make sure he does it so if it is not cancer he has taken as little as possible. Then if it’s BCC he can go back and do Mohs.
Why? Somebody who has being specializing in this for, say, ten years could certainly have done tens of thousands of them. The actual time the doctor takes to do one is just a few minutes. I’ll bet they can do 20 in a day, if not more. When I had mine done, it was a very efficient operation, and was clearly set up for this specific procedure.
I have had at least a dozen biopsies on my face. None left a conspicuous or lasting scar. I had one done five weeks ago in the middle of my forehead (the spot turned out to be benign) and you can barely see the mark.
In my experience, they always do a biopsy first, and then, if the spot turns out to be something that requires further treatment, they go ahead and schedule that. It would be weird to have significant surgery without a biopsy first to get a definitive diagnosis.
Hmmm, Hunt. When I had mine (years ago) there were a total of around seven of us, and he only did them one day a week. Maybe it has become a lot more mass production, but on the other hand, there seem to be a lot more trained Mohs derms now. Back then, he was the only guy in the area who did them. (Had he not been the only guy available, I probably would have gone to someone else since he was somewhat of a jerk with a very poor bedside manner.)
I guess if that is what someone does full-time it would be possible. Is that how it works now?
Re the initial biopsy before surgery – mine always get sent out of the doctor’s office to a pathology service that specializes in dermatology. I always ask for a copy and toss it in my file.
I had a biopsy done at a dermatologists office. She called me within a week or so to tell me that it was cancer (basal cell). She gave me the name of a surgeon that did both the MOHS and the reconstructive surgery all at the same appt. Really appreciated that.
My cancer was in the inner corner of my left eye right where it met the side of my nose. It took two passes to get clear margins. Then we went straight into the reconstructive part. He took skin grafts from behind my ear and attached it the site. I think I had 50 of the tiniest stitches ever made. It looked really ugly for awhile but was not too painful. It’s been a year now since my surgery. Unless you’re really looking for it, you’ve never notice the skin graft.
Good Luck conmama. It will be over and done pretty quickly. Not as painful as you would think. The stitches were the worst for me and it wasn’t that bad.
It looks kinda scary at first at but heals pretty quickly. All the best to you.
