Details: A woman in her middle 80s is shown just after the removal of a Basal Cell carcinoma of her left nasal tip by Dr. Grande of Mohs surgery and again, 5 months after repair by Dr. Hall with a shin-fat composite graft.
Discussion: a full-thickness skin graft can work well on the upper nose but does not match the skin color or texture well on the lower nose. A skin–fat composite graft leaves the fat on the graft and often looks like a “scab” in the first 2 months but the deep layers are taken and then after it heals generally leaves a good result and allows the patient to avoid a more extensive flap procedure. Her skin fat composite graft was harvested from in front of her ear.
Details: A woman in her mid 50’s shown immediately after Mohs excision of a large Basal Cell Carcinoma of her nose by Dr. Grande and then again, 8 months after a full-thickness skin graft from the neck skin just above the collar bone by Dr. Jonathan Hall.
A woman in her late 50s with a large defect in her upper lip following Mohs excision of basal cell carcinoma. The defect is a little too large to be easily closed with a flap from the medial cheek. She is shown just after Mohs and again, 10 months after a full-thickness skin graft from her neck skin just above the collarbone “supraclavicular”. She has a reasonable result after surgery and is not noticed from a conversational distance. It developed some mild “post-inflammatory hyperpigmentation”, ie., it became a little darker in the sun. But is easily covered with a little makeup.
A man in his early 80s was shown just after Mohs surgery for the removal of a squamous cell skin cancer in his right ear. He is shown again, 6 weeks after a reduction in otoplasty. His ear is re-shaped and made smaller- repairing the defect and restoring a normal contour of the ear. Even though the ear is now smaller, it is not deformed because it has a normal contour and we don’t look at both ears at the same time. He passes the “little girl test”. The little boys and girls don’t poke their mother and ask “what happened to that man” ie, he doesn’t look deformed.
A man in his early 60’s who had a basal cell carcinoma of the nose. The defect after mohs surgery was 1.7 cm and on the large side to perform a local flap. Typically looks like a big scab at 2 weeks. By 6 weeks the scab comes off and the deep layers are healed. He is shown before and again, 11 months after a skin-fat composite graft.
A woman in her 70’s who is 6 months after composite skin-fat graft reconstruction of a post-Mohs defect of her lower nose
Discussion. A full thickness skin graft can work well on the upper nose but does not typically match the texture and color of the kin on the lower nose. A composite skin-fat graft which includes the fat, typically gives a much better match in the lower nose, as is seen here.
A man in his early 80’s with a large defect of his left ear following Moh’s excision of a squamous cell carcinoma. The ear was reduced and reshaped (“reduction otoplasty”) to give the ear a smaller but still normal appearance. Although the ear is smaller, we do not typically view both ears at the same time and it does not appear deformed. He passes the “little girl” test. The little boys and girls don’t ask their mother “what happened to that man?”
He is shone after his moh’s surgery and immediately after reconstruction.
A man in his early 70’s after mohs surgery to remove a basal cell carcinoma of his ear leaving him with a defect of the conchal bowl and ear canal. He is shown just after mohs surgery and again, 6 weeks after a revolving door flap. This takes a flap based on the blood supply behind the ear and rotates it like a revolving door to repair the defect. The Donor site is usually able to be closed behind the ear. This is an elegant solution for a defect in this part of the ear.
A woman in her mid 60’s show is seen immediately after Mohs excision of a basal cell carcinoma of the left inferior eyelid. She is shown before and again, 2 months after eyelid reconstruction with a Tenzel Semicircular flap and lateral canthus reconstruction with a periosteal flap under local with IV sedation.
Scars will typically fade and improve over the next year or longer.