Some types of skin cancer can be like an iceberg: what is visible on the skin surface sometimes is only a small portion of the growth.
Beneath the skin, the cancerous cells may cover a much larger region than is visible to the naked eye. In these cases, a specialized technique called Mohs surgery may be recommended. In this procedure, the cancerous lesion is removed and microscopically examined by a dermatologist. The goal is to make sure all cancerous cells have been removed, while preserving the normal skin as well as possible. Once clear margins are reached, the resulting wound may need reconstructive surgery to restore a more normal appearance.
A wound which is too large to simply sew back together can sometimes be reconstructed with a local flap. During Mohs reconstruction, board certified plastic sugeon Dr. Lynn Derby use a local flap to reposition healthy, adjacent tissue over the wound. The suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the appearance of the resulting scar.
Another option for some wounds is a skin graft, where healthy skin is removed from one area of the body and relocated to the wound site. Very large or complicated defects sometimes require cartilage or bone grafts or combinations of flaps and grafts. For some patients, reconstruction may require more than one procedure to achieve the best results.