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Defects from post-Mohs Surgery on the vermillion borders of the lip by a combination plastic surgeon and Mohs surgeon team: a cross-sectional study


Journal of Dermatology & Cosmetology
Omeed Michael Memar, Academic Dermatology & Skin Cancer Institute, USA
Benjamin Caughlin, Department of Surgery/Division of Otolaryngology, University of Illinois Health Hospital System, USA

Abstract

Background: Skin cancer can affect the lips and Mohs micrographic surgery is the ideal mode of removal. However, how are post-Mohs defects affecting the vermillion border approached by a clinic with both a plastic surgeon and Mohs surgeon team?
Method: A cross-sectional study was designed of 8 consecutive Mohs cases with a post-Mohs defect affecting the vermillion border in a practice with a Mohs surgeon and plastic surgeon. These were the only vermillion defects out of 358 consecutive Mohs procedures. The participants ranged in age from 30-82years of age. Their post-Mohs defects were between 1-3.5cm in greatest diameter, but 2.5cm was the mean diameter. The surgical procedures were performed by a two-surgeon team for post-Mohs defects. For each case, information was gathered, including patient age, type of tumor, tumor location, greatest diameter of the tumor, Mohs stages for clear margins, and the greatest diameter of the final wound size. Also, the techniques used in the defect repair were documented. The one patient who needed more than one repair technique was assessed.
Results: Basal cell carcinoma (BCC) was the only tumor that affected thee vermillion border. The defects were closed primarily by advancement flaps. The philtrum defect that involved the vermillion was closed primarily with an advancement flap. The greatest number of defects affected the left upper lip, and the areas were closed equally by an advancement flap, an island pedicled flap, a full thickness skin graft (FTSG), and a myocutaneous flap. The right lower lip was not affected in our patient pool. Men outnumbered women in BCC of the vermillion border. The combined closure of the lip involved the left upper lip and consisted of an island pedicled flap and a FTSG.
Conclusion: Men and overwhelmingly affected with BCC of the vermillion border and advancement flap is the most common closure technique.

Keywords

lips, vermillion border, mohs, facial plastic surgery, basal cell carcinoma, plastic surgeon, skin cancer, lip cancers, diagnoses, BCC, squamous cell carcinoma, sebaceous carcinoma, basosquamous carcinoma, melanoma in situ, dermal fillers, philtrum, myocutaneous flap

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