Skin cancer is the most commonly occurring cancer in the United States. Many individuals who develop skin cancer on the face undergo a procedure called Mohs micrographic surgery for treatment. In Mohs surgery, a dermatologist removes skin cancer. Often, the same dermatologist also reconstructs the area. However, when the area of damage is more complex (as is often the case on the face), a facial plastic surgeon can be called to repair the area.
Dr. Jess Prischmann, our experienced facial plastic surgeon, has reconstructed many patients following removal of skin cancer on the face and neck.
Who is a good candidate?
Any patient who has had skin cancer removed is a candidate for reconstruction. In our office, we often coordinate the reconstruction timeline PRIOR to skin cancer removal. This allows us to perform insurance verification and secure time in our schedule for reconstruction.
How is the surgery performed?
Reconstruction after MOHS is often performed the day after skin cancer removal. The consultation with Dr. Prischmann, however, is performed the same day as MOHS surgery. This allows her to see the area of damage and decide what techniques she will use for reconstruction.
Reconstruction is performed in an outpatient surgery center. In most cases, mild sedation will be used during the repair procedure; however, this is not always necessary. Local anesthesia can also be utilized, and this is something that is determined during the consultation.
Time in the operating room is typically 90 minutes.
I had surgery on my face for basal cell carcinoma in February of 2018. Immediately following the surgery I was referred to Dr. Prischmann for a consultation. It was a very emotional visit for me as Dr. Prischmann explained the paramedian forehead flap. My initial thought process was “I can’t do this.” It seemed impossible!
Dr. Prischmann met with my daughter and me and explained (with pictures) the process. Three visits to Centennial Lakes Surgery Center were required. The care there was excellent!
Dr. Prischmann said it would be difficult (and it was, very difficult), she said I would be happy with the result (and I am, very happy). Friends and family are amazed at my results. Dr. Prischmann is truly a miracle worker. I will be forever grateful! She was kind beyond measure, holding my hand before surgery and reassuring me every step of the way.
What is the recovery?
As with the surgery, this will depend largely on the area to be treated, the extent of the repair required, and the patient’s unique rate of healing. Dr. Prischmann will provide a general timetable of when to expect the recovery process to be completed, as well as instructions to follow to help ensure healing occurs as quickly and successfully as possible.
Frequently Asked Questions
Every day, Dr. Prischmann and her team care for patients following Mohs surgery. That is why we developed this guide to help answer some of your questions about skin cancer reconstruction. If you have any questions or concerns not listed here, please feel free to contact our office directly. Our Dr. Prischmann and her experienced team feel very honored and privileged to care for you!
What are the options for facial reconstruction? When do I need to see a facial plastic surgeon?
The type of reconstruction depends on many factors. The most important factors are typically the location and size of the damage. One of the fundamental principles in facial reconstruction is to reconstruct “like with like.” For example, if the damage involves your cheek, we first look for options to reconstruct this area with the adjacent cheek. If it involves multiple areas of the face, we look for ways to maintain the integrity of each independent region.
Often, your Mohs surgeon will schedule a consult with a facial plastic surgeon if the area to be reconstructed requires advanced techniques. You may also request a consult with a facial plastic surgeon.
Why am I scheduled to see Dr. Prischmann?
There are many reasons why we see patients following Mohs surgery. Sometimes the repair following removal of skin cancer requires advanced techniques. Other times, the patient or Mohs surgeon may request a consultation with our office. Either way, it is extremely common that Dr. Prischmann would be involved in the Mohs reconstruction process.
Why didn’t I know that I would be seeing a facial plastic surgeon before my Mohs surgery?
Sometimes your dermatologic surgeon does not know that there will be a need for a facial plastic surgeon until the entire tumor is removed. Tumors can often grow under the surface of the skin, making complete detection prior to Mohs surgery impossible for your dermatologist. The decision to send a patient to Dr. Prischmann’s office is made after care and consideration by your dermatologic surgeon.
What happens now?
There are two important steps following Mohs surgery: Consultation with Dr. Prischmann and repair of the open area.
Consultation: This is an appointment at Dr. Prischmann’s Edina office. Most of the time, this appointment will occur the same day as your Mohs surgery OR the day following your Mohs surgery. Dr. Prischmann will look at the area that needs to be repaired and thoroughly discuss your options. This appointment typically takes one hour.
Repair: This is a procedure performed at Centennial Lakes Surgery Center. We will make every effort to repair the damaged area as soon as possible, and the treatment will most likely take place a day or two following your Mohs surgery. Because the procedure will be performed at the surgery center, typically we will be able to give you some relaxing medication (sedation) to make the reconstruction process more comfortable.
Every patient is unique. This is why Dr. Prischmann prefers to carefully think about each reconstruction after the initial consultation appointment. Careful planning takes time. And careful planning leads to the most optimal outcome possible. Most of our patients will have the repair performed the day following the consultation.
Should I have Mohs surgery and plastic reconstructive surgery on the same day? Why?
Dr. Prischmann believes that it is best to have a consultation the same day as MOHS surgery and surgery the day AFTER skin cancer removal. This allows her to see the area of damage and thoughtfully evaluate reconstructive options prior to heading to the operating room. She schedules reconstruction the day AFTER Mohs surgery.
Does the risk of infection increase if the open area is not repaired immediately?
No. Leaving a wound open should not increase your risk of infection and can sometimes even be beneficial.
What should I bring to my appointment?
Here is a list of items you should bring: 1) insurance card 2) list of medications 3) health history.
Will my insurance company cover the procedure with Dr. Prischmann?
Dr. Prischmann participates in most insurance plans. It is always a good idea to double check with your insurance company to make sure Dr. Prischmann’s office is considered “in network” with your specific plan.
Is this surgery considered “cosmetic”? Isn’t Dr. Prischmann a facial plastic surgeon?
Your surgery is NOT cosmetic; it is considered reconstructive and is medically necessary.
What types of skin grafts are there? In what circumstances is a SPLIT thickness skin graft used? What about a full thickness skin graft?
There are two types of skin grafts: split thickness and full thickness. Split thickness skin grafts are sometimes used for scalp reconstruction. For the face, when we decide to use skin grafts, we almost always use full thickness skin grafts. Most commonly used for reconstructing the nose, full thickness grafts are harvested from areas where the skin is similar in color and texture (such as in front of the ear, from the neck, or from the nasolabial folds).
I still have questions. Who should I call?
Dr. Prischmann and her staff want you to have the best experience possible. Your reconstruction coordinator is Aabreana. You can reach her by phone at 952-567-7151 or via email at firstname.lastname@example.org.
We know this process can be physically and emotionally taxing. It is normal to feel sad, overwhelmed, and confused. We will do everything possible to help you during this difficult time. We truly are a team in every sense of the word, and we look forward to meeting you soon.
Kristin’s Story: One Patient’s Tale of Strength and Resilience After Facial Reconstruction
The treatment and recovery process for some individuals who undergo facial reconstruction after skin cancer can be both physically and emotionally challenging. The thing to remember is that you are not alone. One of our patients, Kristin, has graciously agreed to share her experience with skin cancer and facial reconstruction. She has a number of tips and suggestions that can help patients get through the process with hope, strength, and a focus on the ultimate goal.
If you have additional questions about skin cancer reconstructive surgery, or if you would like to schedule a consultation with Dr. Prischmann, please contact our office today.