Plastic Surgery

Mohs surgery team integrates skin cancer removal and reconstruction

UT Southwestern offers an integrated procedure that combines Mohs skin cancer removal surgery with precise soft tissue reconstruction, often in a single-day visit.

Mohs micrographic surgery is the most advanced skin cancer surgery available today. This intricate procedure removes skin cancer in layers rather than excising a large portion of skin. The surgical dermatologist examines each layer under a microscope to ensure all the cancer is removed, leaving healthy tissue untouched whenever possible.

With a cure rate of 99 percent for some previously untreated skin cancer and 94 percent for recurrent skin cancer, Mohs is highly effective and typically involves limited scarring.

However, even small patches of disturbed or missing skin on the face – the most common site for skin cancer – can dramatically affect a patient’s quality of life. Upwards of 90 percent of patients desire some improvement in their operative scars to look and feel themselves again. Too often, patients must find their own plastic surgeon and wait days or weeks to get the reconstructive care they need.

Through the comprehensive Skin Cancer Program at UT Southwestern, we offer an integrated, single-day procedure that combines the effectiveness of Mohs surgery with precise soft tissue reconstructive surgery, especially on the delicate areas of the nose, lips, ears, and scalp.

This unique outpatient procedure is done under local anesthesia, typically in just a few hours. These shorter, single-visit procedures reduce patients’ risks related to anesthesia or infection and can reduce the costs associated with separate visits.

We are one of the nation’s highest-volume Mohs micrographic facial reconstruction teams in the U.S., having performed thousands of operative cases on a variety of soft tissue facial defects. For example, we have performed more than 900 post-Mohs scalp procedures – approximately nine times what the average plastic surgeon might see. And we produced one of the foremost medical textbooks on the subject: Facial Reconstruction After Mohs Surgery.

In other words, our team provides a level of dedicated skin cancer reconstruction expertise you won’t find at any other medical center.

Ongoing research and proven results

We recently completed a study, published in the Journal of the American Society of Plastic Surgeons, on the safety of outpatient scalp reconstruction after Mohs surgery for basal cell carcinoma, squamous cell carcinoma, melanoma, and other skin cancer types.

Analyzing data from 913 scalp reconstruction procedures performed over 10 years, we showed that transplanting a patient’s own adjacent skin as a deep tissue graft or placing an Integra dermal regeneration template (artificial skin graft) is safe and effective under local anesthesia, even among elderly patients with more fragile skin. Previous research we’ve co-conducted has also shown that outpatient reconstruction surgery is safe for the nose, ear, and lip.

Dr. James Thornton wrote the textbook 'Facial Reconstruction After Mohs Surgery,' which summarizes 15 years and 12,000 cases in a surgical practice devoted to post-Mohs facial reconstruction.

Personalized skin cancer reconstruction

As we plan your procedure, our surgeons will ask about your daily routine and responsibilities so we can customize your care and get you back in action as quickly and safely as possible.

Patients with early-stage skin cancers (shallow patches smaller than a pencil eraser) can get exceptional results with no need for further revision. Patients with large, deep, or late-stage cancers (larger than 2cm wide and more than 2mm thick) may need additional reconstruction procedures, as well as radiation and/or chemotherapy.

With our expertise and collaborative approach, UT Southwestern is prepared for even the most complex skin cancer reconstruction cases. We will work with you to schedule most, if not all, of your appointments the same day, saving you the time and expense of multiple trips to campus.

We also welcome patients who are not satisfied with their outcomes from previous procedures at other centers, or whose cancer has returned. Since the original procedure likely used the healthiest, most easily accessible tissue for grafting, these cases require a level of expertise only a high-volume center such as ours can provide. We have successfully performed hundreds of these complex revisions on the most delicate facial tissues.

Recovery after reconstruction

Depending on your procedure, recovery can be as simple as returning to your daily activities, including showering and exercise. In more complex cases, we may need you to return to the clinic for dressing changes at the surgical site or additional procedures over the following weeks or months.

Every patient leaves the outpatient surgery center with my cell phone number. I encourage patients to call or text any time they have questions or need reassurance as they recover. It’s not uncommon for patients to send me photos of their skin, asking questions like, “Does this look like it’s healing properly?” or “Am I applying this bandage the right way?”

While current surgical techniques are highly effective, we are never satisfied with the status quo. UT Southwestern is on the leading edge of skin cancer clinical trials and research. Many of our ongoing research projects focus on refining long, complex procedures into shorter, less invasive surgeries to reduce complications such as infection or anesthesia-related complications.

When you are diagnosed with skin cancer, your main priorities become curing your disease and getting back to a normal, healthy appearance. Our integrated Mohs micrographic surgery can help you achieve both goals with an effective, efficient single-day procedure.

To request a consultation with a Mohs micrographic surgery expert, call 214-645-8300 or request an appointment online.