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Mohs surgery is a precise technique used to remove skin cancer layer by layer, checking margins as it goes. While this approach is effective at clearing cancer with minimal loss of healthy tissue, it can still leave a defect, particularly on the face, that needs repair once the cancer has been fully removed.
In many cases, the dermatologist who performs the Mohs procedure will refer patients to a plastic surgeon for this next stage, especially when the defect is in a functionally or aesthetically significant area such as the eyelids, nose, lips, or ears.
Options: Closure, Grafts, and Flaps
Once Mohs surgery has cleared the cancer, the defect that remains needs to be repaired, and the right approach depends on its size, depth, and location, as well as how much surrounding tissue is available to work with. Reconstruction options generally fall into a few categories.
- Direct closure. Where the defect is small enough and nearby skin has sufficient laxity, the edges of the wound can be brought together and closed directly. This tends to offer a simpler recovery and, in favourable locations, a fine-line scar.
- Skin grafts. For larger or deeper defects where the surrounding skin cannot be stretched to close the area directly, a graft using skin taken from another part of the body, often from behind the ear or above the collarbone for facial work, can be used to cover the wound.
- Local flaps. In many facial cases, a local flap, which uses nearby tissue along with its own blood supply, can offer a closer match in skin colour, thickness, and texture than a graft, while helping preserve the natural contour and movement of the area.
Dr Flood, as a FRACS-qualified plastic and reconstructive surgeon, assesses each defect individually rather than applying a standard technique, weighing up which approach is likely to give the best balance of function and appearance for your specific case. This decision also takes into account the original cancer’s location and any constraints noted by the dermatologist who performed the Mohs procedure. You can read more about facial skin cancer surgery more broadly, including options beyond Mohs-related reconstruction.
Risks and Healing Discussion
As with any reconstructive procedure, risks are an important part of the conversation before proceeding. These can include infection, bleeding, changes in sensation around the treated area, scarring that is more noticeable than expected, and, in some cases, the need for a further revision procedure to improve the result.
Healing time and final appearance are not identical from one patient to the next. They depend on factors such as the size and depth of the original defect, its location on the face, the reconstruction technique used, and individual healing tendencies, including how a patient’s skin typically scars. Some areas of the face also heal more predictably than others due to differences in blood supply and skin thickness.
Dr Flood discusses these risks and a realistic range of outcomes with you in detail before reconstruction begins, so that you have a clear picture of what the process may involve, rather than being met with unexpected results partway through recovery.
Recovery and Scar Expectations
In the initial days and weeks after reconstruction, some swelling, bruising, and sensitivity around the treated area are expected, and these generally begin to settle as healing progresses. Follow-up appointments are used during this period to monitor how the area is healing and to check in on pathology results where relevant.
Scarring is a normal and expected part of any reconstructive procedure, not a sign that something has gone wrong. In the early months, scars often appear firmer, redder, or more raised than they will eventually settle to, and this initial appearance is not the final result. Most scars continue to soften and fade over the months following surgery, though the extent and pace of this improvement varies between patients, depending on factors such as skin type, the location of the scar, and individual healing.
Patients are generally advised to be patient with this process and to follow any specific scar care guidance provided by Dr Flood, which may include sun protection and other measures to support healing, rather than judging the final appearance too early in recovery.
Referral Pathway
Most patients arrive at this stage through a referral from the dermatologist who performed their Mohs procedure. If you have been told reconstruction is needed but have not yet been referred, speaking with your dermatologist or GP about a referral for facial skin cancer surgery or reconstruction is a reasonable next step.
Questions to Ask
It can help to prepare specific questions ahead of your consultation, so you get clear, comparable answers rather than a general overview. Useful questions to raise with Dr Flood include:
- What reconstruction technique is being considered for my specific defect, and why is it the preferred approach over alternatives such as a graft or flap?
- What is the expected scarring likely to look like, and how might it change over the following months?
- How many procedures might be involved, and is there a chance further revision surgery could be needed later?
- What is the recovery timeline likely to be, including when swelling and bruising should settle and when I can return to normal activities?
- Are there any risks specific to the location of my defect, such as effects on sensation or function nearby?
- What follow-up appointments will be needed, and how will healing be monitored?
For general background reading, the Skin Cancer Foundation, Cancer Council Australia, and Healthdirect Australia all provide independent information on Mohs surgery and skin cancer more broadly.
Contact Us
If reconstruction after Mohs surgery has been recommended for you and you need specialist review, contact Dr John Flood’s practice for support coordinating the next steps.
