Mohs surgery is a precise technique for removing certain skin cancers, known for its high cure rate and tissue-sparing approach. This procedure, which involves cancer removal and immediate margin analysis, is performed by specialized dermatologic surgeons. Plastic surgeons do not generally perform the initial cancer removal. Their specialized training focuses on the subsequent repair of the resulting surgical defect, ensuring the best possible functional and aesthetic outcome for the patient.
The Specialized Role of the Mohs Surgeon
Mohs micrographic surgery is a highly specialized procedure used primarily to treat basal cell carcinoma and squamous cell carcinoma. It is often utilized in cosmetically or functionally sensitive areas like the face, ears, and nose. The technique involves the systematic removal of the cancerous tissue layer by layer, with an immediate, on-site microscopic examination of 100% of the surgical margins. This real-time analysis allows the surgeon to identify any remaining cancer cells and precisely map their location, ensuring complete removal while preserving the maximum amount of healthy tissue.
Mohs surgeons are dermatologists who complete an additional one to two years of specialized fellowship training. They are uniquely skilled in surgical excision, dermatopathology, and reconstructive surgery. Their training focuses intensely on interpreting frozen tissue sections under the microscope, which is the core difference between Mohs and traditional excision. This combination of surgical skill and pathology expertise makes the Mohs surgeon responsible for the definitive removal of the skin cancer.
The Plastic Surgeon’s Focus Post-Mohs Reconstruction
Once the Mohs surgeon confirms clear margins, a surgical defect, or wound, is left behind, which often requires reconstruction to restore the area’s appearance and function. The plastic surgeon’s expertise is specifically employed in closing complex wounds, particularly those that are large or located in intricate areas. Their training is centered on the artistry and precision required for aesthetic and functional restoration of the body’s tissues.
Plastic surgeons utilize a wider range of advanced reconstructive options compared to simple linear closures. These techniques can include sophisticated local or regional flaps, where neighboring tissue is moved into the wound to cover the defect. They also employ skin grafts, which involve transplanting a piece of skin from a distant site to close the open area. The goal is to hide surgical incisions within natural skin folds and reconstruct intricate structures like the nose, eyelids, and ears to achieve a seamless cosmetic result.
This specialization allows plastic surgeons to handle defects requiring significant manipulation of surrounding structures or replacement of components like cartilage. They provide expertise for the most challenging cases, particularly when the defect involves multiple tissue types. Their involvement is beneficial when the defect is so large that it risks altering facial features or function if not repaired using advanced reconstructive techniques.
Collaborative Care Coordinating Removal and Repair
The most effective treatment plan for patients with skin cancer often involves a coordinated effort between the Mohs surgeon and the plastic surgeon. This multidisciplinary approach ensures the highest rate of cancer clearance, handled by the Mohs surgeon, is paired with the optimal aesthetic and functional repair. In many practices, the two specialists work in the same facility, allowing for a seamless transition from cancer removal to immediate reconstruction.
The Mohs surgeon clears the tumor, and once the cancer-free status is confirmed, the patient moves directly to the plastic surgeon for closure. This joint approach is beneficial for large defects, those involving underlying structures, or areas where the aesthetic outcome is a primary concern. Immediate collaboration often allows patients to complete both procedures in a single day, streamlining their care and leveraging the unique strengths of each specialist.