Surgical Reconstruction After Mohs Surgery | Skinner Dermatology

Removing skin cancer is only the first part of the story. Once the cancer is gone and margins are confirmed clear, the wound left behind must be closed — and how it is closed matters enormously for both function and appearance.

Dr. Skinner is fellowship-trained in cutaneous oncology and reconstructive surgery. The same physician who removes your cancer is the same physician who closes the wound — in the same appointment. You never need a separate plastic surgeon referral for most reconstructive needs.

The Goal of Reconstruction

Every reconstruction decision is guided by a core principle: restore the area to its natural form and function with the least visible scar possible. This means considering:

Tissue movement — how neighboring skin can be repositioned to close the defect with minimal tension

Relaxed skin tension lines — natural lines and wrinkles that hide scars when used strategically

Cosmetic subunits — facial regions with defined boundaries (nose, eyelid, cheek, lip) that guide reconstruction decisions

Functional anatomy — protecting eyelid function, nasal airway, and lip movement

Blood supply — ensuring the reconstructed tissue has reliable circulation for survival

Types of Wound Closure

Primary (Side-to-Side) Closure

The simplest reconstruction: the wound edges are brought together and sutured directly. Ideal for smaller defects on areas with adequate tissue laxity (e.g., scalp, trunk, extremities). Often produces a fine linear scar that fades well over time.

Second Intention Healing

Allowing the wound to heal naturally from the base without surgical closure. Appropriate in select locations — particularly concave areas such as the medial canthus (inner eye corner), ear conchal bowl, and nasal ala — where scarring tends to be minimal and final results are often excellent.

Skin Grafts

A piece of skin harvested from a donor site elsewhere on the body (usually behind the ear, on the neck, or the inner arm) is placed over the wound. Grafts are used when there is insufficient local tissue for a flap, or when flap movement would distort surrounding structures.

Local Flaps

Local flaps use adjacent tissue — skin and underlying fat moved from immediately around the wound — to reconstruct the defect. They preserve the blood supply, produce the best color and texture match, and are the workhorse of facial reconstruction.

Interpolation Flaps

For larger or more complex defects, particularly on the nose, cheeks, and lips, interpolation flaps use tissue from a nearby but non-adjacent area. These are staged procedures — typically requiring two visits separated by several weeks.

The Art and Science of Scar Placement

Great reconstruction is not just about closing a wound — it is about closing it in a way that makes the scar as invisible as possible. Dr. Skinner uses a detailed understanding of facial anatomy to place incisions along natural boundaries, wrinkles, and shadows.

Over time — typically 12 to 18 months — well-placed scars fade significantly. What looks prominent at 6 weeks often becomes nearly imperceptible by 18 months.

Explore Reconstruction by Area

Nasal Reconstruction

Flaps, grafts, and cartilage grafting for nasal defects

Ear Reconstruction

Helical rim advancement, grafts, and cartilage techniques

Facial Reconstruction

Cheek, forehead, eyelid, and lip reconstruction

Flaps & Grafts Guide

Understanding all reconstruction options

Minimizing Scarring

What to expect and how to optimize results

Reconstructed at the Same Appointment

When your margins are clear, reconstruction begins immediately — so you leave the office the same day with your wound closed.

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