Skin Cancer Reconstruction

After facial skin cancer is removed through Mohs surgery, reconstruction is often needed to repair the resulting wound, especially when it involves cosmetically and functionally sensitive areas such as the nose, eyelids, lips and ears. These areas require meticulous attention to both appearance and function to maintain facial balance and ensure proper healing.

The reconstructive team is specially trained in facial surgery and experienced in managing defects ranging from simple to complex. Techniques include local tissue flaps, skin grafts or multi-staged procedures designed to minimize scarring and restore natural contours. For significant nasal defects, sometimes total nasal reconstruction, which involves a multi-layered and multi-staged approach, is necessary. Sometimes, cartilage from the ear or the rib is also needed to provide structure or support.

Reconstruction is typically performed shortly after cancer removal, typically within a few days, in close coordination with dermatologists and Mohs surgeons, and can be performed under local anesthesia in the office or in the operating room. Each reconstruction is tailored to the patient’s needs, with the goal of achieving a natural, lasting result that preserves both facial form and critical function. Healing from Mohs reconstructions is variable based on the type of procedure performed, but in general, patients can be back to normal activity within a week or two after surgery, although final healing takes place for the first year after surgery.

Common Reconstructive Techniques

Local Flaps

A local flap uses nearby skin and tissue to repair a defect after skin cancer removal.  Strategic incisions are made along normal facial boundary lines, and the tissue is repositioned to cover the wound while keeping its original blood supply. Local flaps are often used on the face because they provide a good match in color, texture and thickness, helping the repair blend naturally with the surrounding skin.

Skin Grafts

A skin graft involves taking a patch of skin from another part of the body, such as around the ear, above the collarbone, or even from the upper eyelid, and placing it over the wound to help it heal. This technique is useful when local skin isn’t available or flexible enough to close the area. Skin grafts are safe and effective, though they may appear slightly different from the surrounding tissue.

Staged Interpolated Flaps

An interpolated flap is a more complex type of flap that uses skin and tissue from a nearby area, such as the forehead or cheek, to repair larger or deeper defects. Unlike local flaps, interpolated flaps remain temporarily connected to their original blood supply with a visible skin bridge and are separated in a second surgery about three weeks later. This method is especially useful for rebuilding areas like the nose, where precise contour and support are critical for appearance and function.

Cartilage Grafting        

Oftentimes, when a Mohs excision involves the nostril, cartilage grafting is needed to provide structure and support, and maintain breathing. Ear cartilage, which is taken from the “bowl” part of the ear, is an excellent source for strong, flexible support with a shape that mimics the natural contour of the nose. Using this cartilage does not change the size, shape or appearance of your ear, and will not affect your hearing. Rarely, cartilage can also be taken from your nasal septum or rib.

What To Expect After Surgery

Most patients can return to normal activity within the first week after surgery, but final scar healing takes place over the course of one year.

In most cases, your incisions will be closed with dissolvable stitches that do not need to be removed. Occasionally, sutures that need to be removed are placed, and those are typically removed in the clinic five to seven days after surgery.

Bruising and swelling are possible and can be minimized by avoiding strenuous activity during the first week after surgery and icing the area as needed during the first few days. Bruising can also be treated by applying topical Arnica, an herbal supplement available over the counter or eating fresh pineapple.

Wound care after surgery is important. Avoid getting incisions wet for 48 hours after surgery. After that, soap and water can run over the incisions, but they should not be scrubbed. Applying Vaseline or Aquaphor at least three times per day for the first three weeks is extremely important for wound healing.

Three weeks after surgery, patients can transition to silicone-based scar cream or gel, gentle massage on the incisions and apply sunscreen at least SPF 30 or above.