Mohs Surgery on the Nose

Mohs surgery is performed in an outpatient setting using local anesthesia. The patient remains awake, but the area is numb. After each layer is removed, the tissue is frozen, cut, stained, and examined.

Dr. Morganroth acts as both the surgeon and the pathologist. He maps the specimen so any remaining cancer can be traced to its exact location.

The number of stages cannot always be predicted from the size of the cancer. A small lesion may have deeper extensions, while another tumor may clear after one stage. Once no cancer remains, Dr. Morganroth evaluates the wound and recommends a repair.

The best reconstruction depends on the wound’s size, depth, and location; the amount of remaining skin; and whether cartilage or the inner nasal lining was removed. Dr. Morganroth also considers your overall health, healing ability, medications, smoking, and personal priorities. The goal of reconstruction is to preserve nasal shape, support the nostril, protect breathing, and place scars where they are less noticeable.

Healing without stitches

Small or shallow wounds may heal naturally, called healing by second intention. The wound gradually fills with new tissue and skin grows across the surface. This may work well in concave areas, such as the crease beside the nose. Healing takes longer than a stitched repair and requires wound care, but it avoids another incision.

Direct closure

A small wound may be closed by bringing the edges together with stitches. Direct closure is most suitable when enough loose skin is available, and closure will not pull the nose out of position. Because nasal skin has limited movement, this option is not possible for every defect.

Skin graft

A skin graft uses skin taken from another area, often near the ear, forehead, or neck, to cover the wound. Grafts can be useful for shallow defects when nearby skin cannot be moved. The color, thickness, or contour may initially differ, although the appearance usually improves with healing.

Local skin flap

Larger or deeper wounds may require an interpolation flap, such as a nasolabial flap from the cheek or a paramedian forehead flap. The tissue remains attached to its original blood supply for several weeks before the connecting bridge is divided. Forehead flaps are often used for substantial defects because they provide reliable coverage and a useful skin match.

Staged flap reconstruction

Larger or deeper wounds may require an interpolation flap, such as a nasolabial flap from the cheek or a paramedian forehead flap. The tissue remains attached to its original blood supply for several weeks before the connecting bridge is divided. Forehead flaps are often used for substantial defects because they provide reliable coverage and a useful skin match.

Cartilage and full-thickness repair

When surgery removes structural support, cartilage may be taken from the ear or nasal septum and placed beneath the repair. Cartilage grafting helps prevent nostril collapse, retraction, or breathing problems. Full-thickness defects may require reconstruction of the inner lining, structural framework, and outer skin.

Swelling, bruising, tenderness, drainage, and temporary numbness are common after nasal reconstruction. Patients receive instructions for cleaning the wound, applying ointment, changing dressings, limiting activity, and protecting the repair. Complex flaps may require additional procedures.

Scars generally soften and fade over several months. Some patients benefit from scar massage, silicone products, injections, laser treatment, dermabrasion, or a minor revision after healing stabilizes. The final result depends on the cancer, defect, repair method, and individual healing. Regular skin examinations and sun protection remain important because a history of skin cancer increases the likelihood of another skin cancer.