Skin Cancer – Moh’s Defect



Moh’s micrographic surgery is a surgical technique in which minute layers of skin tissue are meticulously removed and examined under a microscope. By removing thin layers of tissue in this incremental manner, the physician can be sure that all involved tissue is excised, and can simultaneously spare healthy tissue. Of all the surgical techniques available today, Moh’s surgery offers both the lowest recurrence rate of malignant lesions, and maximum preservation of healthy tissue. Moh’s surgery is performed by specialized Dermatologic Surgeons who perform the skin cancer removal, and then refer patients for reconstruction to a Plastic Surgeon. Alternatively, when Moh’s surgery is not required, the excision of the skin cancer as well as the reconstruction can be done in one stage by the Plastic Surgeon.

Moh’s surgery is more time consuming and expensive than traditional excision. However, its precision is especially valuable for recurrent or aggressive carcinomas, for treatment of cosmetically important areas such as the nose, eyelids and lips, and for high risk and invasive lesions (such as near a facial nerve). Moh’s surgery is frequently used to remove basal cell carcinomas, squamous cell carcinomas, and other lesions on the face, whereas melanomas require a complete wide local excision as a single block and frequently, reconstruction with local, regional or distant tissue. Melanoma excisions and the reconstructions are frequently performed by the Plastic Surgeons.

Dr. Anshu Gupta takes special interest in this area and provides expertise in surgical management of Melanoma as well as other skin cancers, offering a comprehensive spectrum of reconstructive options.

The reconstructive technique depends on the location, size, and depth of the tumor. Some of the more common techniques are depicted in the diagrams below.


Advancement Flap – prior to tumor resection


Advancement Flap – after tumor resection

advancement flap
Bilobed Flap

Resection and reconstruction of more extensive and invasive tumors involves more advanced techniques. These can be discussed in detail during your consultation. Some of the techniques are mentioned below however, many variations are available and after your consultation, Dr. Gupta will formulate a plan that is best suitable for you.

biloped flap
Rotational Flap

Negative Pressure Wound Dressing

  • Acellular Dermal Matrices (Skin substitute products)
  • Adjacent Tissue Rearrangement
  • Hyperbaric Oxygen Chamber
  • Growth Hormone Application
  • Scar Modification Therapies
  • Local Tissue Transfer (Regional Flaps)
  • Distant Free Tissue Transfer (Free Flaps)