Management of Large Mohs Defects

Abstract

This study was performed to determine the appropriateness and relative merits of closing Mohs defects of the head and neck at the time of surgery or after surgery, in contrast with allowing defects to heal spontaneously. For 185 patients who had large Mohs wounds of the head and neck (scalp, nose, cheek, forehead, lip, chin, ear, or neck) that healed spontaneously and who underwent postoperative reconstruction as required, we recorded wound location, size, and depth. We then evaluated the cosmesis and functional result periodically and >6 months after operation by chart review, interview, or both. We found that large wounds of the scalp, neck, and ear (except through-and-through defects) often heal spontaneously with acceptable cosmesis. Large defects of the nose usually require prompt reconstruction. Large defects of the central cheek, lip, and chin usually heal spontaneously with poor cosmesis. However, we often reserve surgery for an unacceptable cosmetic result, because repairing a small scar is often less complex than reconstructing a large Mohs defect. We conclude that spontaneous healing of selected Mohs wounds of the head and neck can result in satisfactory cosmesis and function, thus obviating or minimizing the need for complex surgical repair. Surgeons can select management of Mohs wounds effectively and efficiently by accurately predicting the final cosmetic and functional result of spontaneous healing, thus reserving surgery for unfavorable cosmetic or functional results.