Oculoplastic reconstruction following Mohsʼ surgery

Abstract

Mohs' micrographic surgery has been advocated as the optimal management of non-melanoma skin cancer in the periocular region, allowing examination of 100% of the surgical margin. As a result of this total margin control, the technique offers an unsurpassed cure rate combined with maximal preservation of normal tissue. Mohs' excision of the tumor often leaves a defect that requires reconstruction. The authors' objective was to determine whether the size of the defect produced by Mohs' surgery and the type of reconstruction required differed from the results the authors would expect from standard surgery with a 3 mm margin. The authors reviewed the records of 60 patients who had undergone Mohs' surgery. They compared the size of the defect produced as well as the type of reconstruction required with the results they would have predicted for standard excisional surgery with a 3 mm margin. Results indicated that many of the patients had smaller reconstructions then they would have predicted. These patients also often had important structures preserved, and therefore had less extensive reconstructive surgery. In conclusion, the authors acknowledged that identification of extensive tumor extension in Mohs' surgery may produce an unexpectedly large defect for reconstruction. However, many patients require less extensive reconstructive surgery than would have been predicted.