A 5 month follow up on a challenging case with a large defect of the nose after Mohs surgery for a Basal Cell Carcinoma that had been present for more than a year. He did not wish to have a 2 or 3 stage forehead flap and so we started with a large skin/fat composite graft from his cheek with the idea that if we did not like the result he could always return for the more complex procedure. He is shown just after Mohs surgery and again, 5 months after the skin/fat composite graft. The result is acceptable and should continue to fade a little with time.
A 72 yo woman with a lentigo maligna melanoma/ melanoma in situ of her left temple and forehead with a large defect after modified Mohs excision by the dermatologist. I reconstructed her with a full thickness skin graft from the left neck. She is shown just after modified Mohs and again, 18 months after surgery. The color match of the neck skin is good on the forehead and the scar just above her collarbone on the left is difficult to see.
An 82 year old man with a large defect of his forehead and his temple following Mohs excision of 2 separate basal cell carcinomas. An inverted T-plasty was performed on his forehead under local with IV sedation and a portion of the skin that was excised as the superior portion of the t-plasty was used as a full thickness skin graft to his temple. He is shown before Mohs, Just after Mohs and again, 6 months after reconstruction.
A man in his late 60’s with a lentigo maligna melanoma of his right lower eyelid and a recurrent squamous cell carcinoma of his left cheek. He was pretreated with Aldara, an immune sensitizer to decrease the size of his lentigo maligna melanoma. He is shown 14 months after Full thickness skin graft to his right lower eyelid after modified Mohs excision, using his upper eyelid skin as a donor site. Enough skin could be harvested from his upper eyelids, improving their appearance and giving the perfect thickness and color of skin to match his lower eyelid. Two months later he had his recurrent SCCA excised with Mohs surgery.
He is also shown 1 year after Mohs excision of his left temple SCCA, with the defect being repaired with an extended Mustarde’ Cervical- facial flap. A large flap is developed from the left cheek, like a facelift flap, and the incision is continued in front of and then below the left ear, advancing the neck and cheek skin into the defect. The skin matches in color and texture, and continues to grow his normal beard.
A retired man in his later 60’s with a lentigo maligna melanoma of his lower lip. He is shown just after modified Mohs excision and again, 4 months after excision of the remaining sun exposed vermillion of the lower lip and vermillion advancement. The modified Mohs allowed us to clear the margins of his tumor with the smallest possible defect. Excision of the remaining sun exposed vermillion of the lower lip decreases his chance of developing another sun related malignancy there. The vermillion advancement takes non sun exposed vermillion from inside the lip and moves it forward. The scar will thicken for 6 weeks and then softens over the next 2 years. At 4 months his lip is soft and mobile and the scar is difficult to see from even a close distance.
A woman in her early 80’s with a defect of her nose after Mohs excision. She is shown just after Mohs surgery but before reconstruction with a Rieger type flap. She is shown again, 4 months after repair. Scar has faded nicely and the skin matches in color and texture.
A woman in her mid 70’s with a large defect of her nose after Mohs excision of a basal cell carcinoma. She is shown just after Mohs and again, 1 year after a v-y Rieger flap of her nose performed under local with iv sedation as an outpatient.
An interesting case of a man in his early 80s with a squamous cell carcinoma of his chest. I sent him to our local Moh’s surgeon for excision and then planned his repair. The key was to design the rhomboid flap so that it would not distort the location of his nipple and leave him with significant asymmetry. He is shown after Mohs and again, 2 1/2 months after flap repair under local with IV sedation at the hospital. The scar will typically now fade over the next 2 years. He can take his shirt off at the pool without feeling deformed.