Unpublished publication details reconstruction after removal of skin cancer on the face

Mohs micrographic surgery is considered the most accurate technique for removing the main forms of skin cancer, especially when located on the face. About 95% of patients who undergo the removal of a basal cell carcinoma (BCCs) – the most common skin cancer in Brazil and in the world, classified into 6 different subtypes, according to the way their cells are organized microscopically – located in the face, need reconstruction to reduce the impact of the wound.

Removal can be performed with Mohs surgery — which examines 100% of the margins during surgery right after their removal-, or with the conventional technique, which examines between 1% to 5% of margin samples days after surgery. .

For this reason, in conventional surgery, a “safety margin” of at least 4 millimeters (mm) around the tumor is removed. In Mohs surgery, on the other hand, it starts with 1 to 2 mm and, if necessary, more tissue is removed only at the site affected by the skin cancer.

When compared to conventional surgery, Mohs surgery has great advantages such as a higher cure rate, since 100% of the surgical margins are analyzed during the procedure, preservation of healthy skin and better aesthetic and functional results.

“In addition to providing the highest cure rate, the removal of only the tissue affected by the disease, preserving healthy skin and generating fewer scars, is the differential of Mohs Surgery. This often makes it the patient’s treatment of choice for removal of BCCs located in noble areas of the face such as nose, eyelids, lips and ears”, explains the dermatologist, specialist in Mohs Surgery, Felipe Cerci.

According to him, however, it is essential to master the techniques for reconstructing surgical wounds. With this in mind, Mohs surgeons Felipe Cerci (PR) and Bruno Fantini (SP) wrote the first book in Brazil on reconstruction in Mohs surgery, aimed at all doctors working in skin cancer surgery.

The book “Flaps and Grafts in Mohs Micrographic Surgery” was officially launched this Friday, August 26, during the 75th Congress of the Brazilian Society of Dermatology, which took place in São Paulo (SP).

The authors had the contribution of other experienced specialists from different countries, including Brazil, the United States, Switzerland, Spain, Portugal and Colombia.

“We had the collaboration of renowned US Mohs surgeons on this book. There, Mohs surgery is performed on a large scale, so they are very experienced, leading the world in this type of procedure, especially when considering reconstruction. It is a privilege to be able to count on this support from mentors, professors and colleagues in the USA”, emphasizes Cerci.


The main focus of the book is to address different techniques for the reconstruction of surgical wounds resulting from the removal of skin cancer.

“The face is an area very exposed to the sun, being frequently affected by carcinomas, so our work is focused on the reconstruction of the face, scalp and ears. This book is able to help all doctors who work in the surgical treatment of skin cancer, with an accessible language for the resident, but also with contents that add to the moderate and advanced level surgeon, addressing complex reconstructions”, says the surgeon. de Mohs, Bruno Fantini.

One of the highlights is the large volume of intraoperative photos, which allows the reader to visualize the main steps of facial reconstruction. In all, there are 1,484 photos and 40 illustrations. “The lack of step-by-step instructions during wound repair is common in books and makes learning difficult. We tried to offer a sequence of photos that facilitate the understanding of the reconstructions by the reader. Thus, we were able to achieve our main objective with the book, which is to share knowledge in order to benefit patients throughout the country”, explains Cerci.


The book is divided into two major groups of chapters. The first on the different methods of reconstruction: primary closure, healing by second intention, rotation, advancement, transposition, interpolation and island flaps, skin and cartilage grafts. The second part includes anatomical subunits: nose, ear, perioral, eyelid reconstruction, and so on.

In addition, the material provides an introduction to Mohs micrographic surgery and operative technique, which is the basis for all others. “Regardless of the complexity of a reconstruction, all must be carried out thoroughly to achieve the best possible results”, comments Cerci. In addition, at the end of the book there are another three chapters that discuss treatments to improve the scar (when necessary), complications and how to manage them, and surgery of the nail apparatus. “All the chapters have the same pattern, which makes the work very didactic. We seek to demonstrate the different types of reconstruction, since there is no exact recipe and cases must be personalized, according to each patient”, adds Bruno.

Creative process

The work was produced over a period of two years. Because both authors were involved in the training of resident physicians and training of dermatologists, their daily practice brought them closer to the main difficulties in planning, executing and managing complications during reconstructions. “The work shows, for example, details on how to give a surgical stitch, what happens if it is incorrect and how it should be adjusted. It also details, with carefully selected images, the techniques for removing cartilage from the ear for use in the repair of complex nasal wounds. All of this makes the book extremely useful for all doctors who work in the surgical treatment of skin cancer, regardless of their level of experience”, says Bruno.

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