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Surgical Flaps in Mohs Micrographic Surgery

Goddard, Lindsey; Ivey, Lauren; Seeburger, Jack

Journal of the Dermatology Nurses' Association: March/April 2019 - Volume 11 - Issue 2 - p 75–78
doi: 10.1097/JDN.0000000000000455

ABSTRACT Skin cancer can be broadly categorized into melanoma and nonmelanoma skin cancer (NMSC). Squamous cell carcinoma and basal cell carcinoma are the most common subtypes of NMSC. When a patient presents with a skin finding suspect for NMSC, a confirming skin biopsy is performed. On the basis of the biopsy results, patient factors, and clinical characteristics of the cancer, an appropriate form of treatment is selected. Mohs micrographic surgery (or Mohs) is a tissue-sparing surgical approach, utilizing frozen section margin control. Once removal of the NMSC has been assured by Mohs surgery, the resultant skin defect is evaluated for repair. The choice of repair should maintain or restore function and aesthetic form while minimizing skin tension. Using a skin flap may be the best choice of repair to achieve these goals. Here, we describe both rotation and advancement flaps. Rotation flaps are constructed using an arciform incision adjacent to the original wound. Advancement flaps describe the movement of skin and tissue directly forward to close the wound, employing no rotational movement. There are three main subtypes of advancement flaps: unidirectional, bidirectional, and island pedicle or V-to-Y flaps.

Lindsey Goddard, MD, Department of Dermatology, Loma Linda University, Loma Linda, CA.

Lauren Ivey, MS, School of Medicine, Loma Linda University, Loma Linda, CA.

Jack Seeburger, MD, Department of Dermatology, Veteren Affairs Hospital, Loma Linda, CA.

The authors declare no conflict of interest.

Correspondence concerning this article should be addressed to Lindsey Goddard, MD, Department of Dermatology, Loma Linda University, 11370 Anderson Street, Suite 2600, Loma Linda, CA 92354. E-mail:

Copyright © 2019 by the Dermatology Nurses' Association.