Mohs Surgery & Skin Cancer Reconstruction
Introduction to Mohs Surgery & Skin Cancer Reconstruction
One of the most effective methods for the treatment of skin cancer is through the use of Mohs micrographic surgery. This is performed by a Dermatologic Surgeon, a specially trained Dermatologist. The Dermatologic surgeon may also perform the reconstructive surgery after they remove the skin cancer.
In some cases, the skin cancer occurs in an area where specialized surgical expertise is desired, such as a skin cancer on the nose, lips, or other critical anatomic structure. Dr. Pepper is a uniquely trained, double board-certified Facial Plastic Surgeon with extensive experience in reconstructive surgery after skin cancer removal.
Dr. Pepper’s Philosophy of Skin Cancer Reconstruction
As a double board-certified surgeon, Dr. Pepper’s goal is to preserve both form and function in a manner that is harmonious with the rest of the face. He is uniquely qualified for the reconstruction of skin cancer. In addition to having years of experience and having performed hundreds of these cases, Dr. Pepper originally trained in facial reconstruction with one of the legends in this field, Dr. Shan Baker. Dr. Baker, who is now retired, authored the definitive textbooks on both nasal reconstruction and facial reconstruction after skin cancer excision. It is for this uncommon experience and expertise that Dr. Pepper is sought out for complex facial reconstructive cases after skin cancer treatment. His philosophy of reconstruction divides the face into different anatomic zones, and each part of the face has unique strategies for effective reconstruction. Lastly, Dr. Pepper’s skill and experience with aesthetic or cosmetic surgery of the face is a key foundation of his reconstructive surgery. The uncompromising goals of aesthetic facial surgery are synergistic with facial reconstructive surgery.
Dr. Pepper’s expertise in nasal reconstruction is based equally on his extensive experience in both rhinoplasty and complex nasal reconstruction. He has performed an exceptionally high number of nasal reconstructions and is sought out for his expertise in this area. Similar to the rest of the face, the nose can be divided into various subunits based on skin quality, thickness, and the natural interplay of light and shadows on its surface topography. His reconstructive experience spans the entire range of nasal defects. He has multiple strategies for reconstructing all nasal defects, from several millimeter defects of the nasal tip to defects that encompass the entire nose.
Each subunit of the nose has unique surgical reconstructive techniques for restoring form and function. Because of this variety in a relatively small anatomic space, it takes hundreds of these cases in order to gain the necessary expertise to perform these surgeries reliably. His research (1, 2) in nasal reconstruction was ground-breaking in offering accurate guidance to patients regarding what to expect and at one point after surgery.
Cheek & Lip Reconstruction
Dr. Pepper’s vast experience with aesthetic surgery of the face – including facelift surgery, blepharoplasty, and brow lifts – is the foundation of his skill in cheek and lip reconstruction. As a testament to this expertise, he authored the most highly cited article in the last ten years on cheek and lip reconstruction (3).
Similar to nasal reconstruction, cheek and lip reconstruction is effectively divided up into anatomic zones that drive the reconstructive choices of the surgeon.
However, unlike the nose, as the face ages the naturally occurring lines of the cheek and lip also change. This subtly alters the techniques employed and also offers more opportunity for camouflage of scar lines on the face.
Skin cancers of the cheek may, on occasion, be deep enough to threaten the facial nerve. This is the motor nerve that moves the muscles in the face, and injury to this nerve causes facial paralysis. This is a feared complication of both skin cancer excision and surgical reconstruction that requires dissection in areas close to the nerve. As a nationally recognized expert in facial nerve surgery and the Director of the Stanford Facial Nerve Center, Dr. Pepper is sought out for skin cancers that either threaten or involve the facial nerve.
Lastly, the effective treatment of skin cancer defects requires a key ingredient beyond surgical skill: logistics. At Stanford Facial Plastic Surgery, Dr. Pepper and his staff have the utmost experience with coordinating our surgical reconstruction with your Dermatologist or Dermatologic Surgeon. Patients are offered coordinated treatment dates, such that their reconstruction occurs on the day immediately following their skin cancer excision. We pride ourselves on this excellence in multidisciplinary care because skin cancer treatment is one of our highest priorities. If you would like a consult for skin cancer reconstruction, please call us at (650) 736-3223 (FACE).
Asaria, Jamil, Jon Paul Pepper, and Shan R. Baker. 2010. “Key Issues in Nasal Reconstruction.” Current Opinion in Otolaryngology & Head and Neck Surgery 18 (4): 278–82. https://doi.org/10.1097/MOO.0b013e32833af8f8.
Pepper, Jon-Paul, Jamil Asaria, Jennifer C. Kim, Shan R. Baker, and Jeffrey S. Moyer. 2012. “Patient Assessment of Psychosocial Dysfunction Following Nasal Reconstruction.” Plastic and Reconstructive Surgery 129 (2): 430–37. https://doi.org/10.1097/PRS.0b013e31823aeb0a.
Pepper, Jon-Paul, and Shan R. Baker. 2013. “Local Flaps: Cheek and Lip Reconstruction.” JAMA Facial Plastic Surgery 15 (5): 374–82. https://doi.org/10.1001/jamafacial.2013.1608.
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