By Carlos Wolf, M.D.

Dear Dr. Wolf,

My dermatologist diagnosed me with basal cell cancer near my nose. I was told I needed Mohs surgery and that a plastic surgeon should close my defect. Is it ever okay to simply let the incision close by itself?

The simple answer is, yes, it can close by itself. However, it will heal faster and close better if it is properly closed, and a plastic surgeon can give you the best result.

During Mohs surgery, a dermatologist removes the cancer cells microscopically. This procedure enables the patient to have immediate reconstruction without fear of leaving any tumor cells. Many years ago before reconstructive techniques were available, many patients were advised to let the primary excision heal over a period of time. This technique would often give a satisfactory cosmetic result, but it would take weeks and maybe months to completely heal. Today, dermatologists, facial plastic surgeons and plastic surgeons work together to offer the patient a better experience.

In many cases, the defect that is left behind after Mohs surgery is much bigger than the patient or the doctor predicted. The defect is dictated by the extent of the microscopic tumor margins. Oftentimes, the reconstruction performed by the plastic surgeon entails simply mobilizing skin flaps and closing them. The defect may be so large that free flaps or larger facial flaps are needed to close the incision. When a very experienced facial plastic surgeon or plastic surgeon teams up with a dermatologist skilled in Mohs surgery, most defects can be closed with great results.

The bottom line, the most important step prior to having a Mohs surgery, especially when the lesion is located on your face, is to plan for immediate reconstruction. 

Dr. Carlos Wolf is a board-certified plastic surgeon. He is a partner in Miami Plastic Surgery and Clinical Assistant Professor in the Department of Surgery at FIU Herbert Wertheim School of Medicine. 

For more information, email, call 305-595-2969, visit or follow Dr. Wolf on Instagram.

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