A man in his later 60’s with a lentigo maligna melanoma of the lower lip. A lentigo maligna melanoma can sometimes be much larger than expected. He was treated in combination with the Mohs surgeon who performed modified Mohs, sometimes called “slow mohs”. In normal Mohs surgery the dermatologist maps the lesion and performs a frozen section of the edges. Frozen section cannot be done on pigmented lesions because it distorts the view- the same mapping technique can be done but the sections are sent out for permanent path with a rapid turn around. The techniques takes days rather than hours and is typically done over the 5 days before planned reconstruction. In this way, the reconstruction is able to proceed with clear margins. In this man’s case the defect was limited to the central vermillion ( pink part) of the lip. Because this is thought to be caused by chronic sun exposure of the lower lip, it is good, if possible, to excise the remaining sun exposed vermillion and roll the non sun exposed vermillion from inside the mouth to reconstruct the lip. This is sometimes called a “vermilionectomy / lip shave with mucosal advancement procedure”
This was done here, and he is seen after the modified Mohs and again, 6 weeks after surgery. Scars are typically at their thickest and reddest at 6 weeks, but he already has a “normal” appearance. The lip feels a little stiff to him at 6 weeks but he can whistle, and the scar will now continue to soften and improve over the next 6 months or more. A good solution to a sometimes difficult problem.
Cosmetic & Plastic Surgery Specialist
"I treat my patients like I would treat
- Jonathan D. Hall, MD, FACSmembers of my own family."
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