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450 Sutter Street, Suite 1212, San Francisco, CA 94108 655 Redwood Highway Suite 250, Mill Valley, CA 94941

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Mohs Surgery Reconstruction

Mohs micrographic surgery (also known as Mohs chemosurgery) is a surgical technique in which very thin layers of skin tissue are meticulously removed, stained, and examined under a microscope.

It is named after dermatologist Frederick E. Mohs, who developed the technique in the first half of the 20th century. By removing layers of tissue in such an incremental manner, the physician can be sure that all tumor tissue is excised, and can simultaneously spare normal tissue. Of all the surgical techniques available today, Mohs surgery offers both the lowest recurrence rate for malignant lesions and the maximum potential for preservation of healthy tissue. Mohs surgery is performed by specialized Dermatologic Surgeons who limit their practice to treating skin cancer patients and performing skin cancer removal. Frequently, the Mohs surgeon will then refer patients for reconstruction to a Facial Plastic Surgeon such as Dr. Ransom. This helps to ensure the best possible outcome, both in terms of cancer care and cosmetic appearance – especially in highly visible and functional areas, such as the face.

Mohs surgery is more time consuming and expensive than traditional removal (sometimes called “wide local excision”). However, its precision is especially valuable for recurrent or aggressive carcinomas, for treatment of cosmetically important areas such as the nose, eyelids, lips, or chin, and for high risk and invasive lesions (such as those near branches of the facial nerve or other nerves). Mohs surgery is now frequently used to remove basal cell carcinomas (BCC), squamous cell carcinomas (SCC), some melanomas, and selected other lesions on the face.

After a malignant lesion is removed with Mohs surgery, a depression or hole in the skin remains (the surgical defect). Such scars may be rather disfiguring, but reconstructive surgery may be performed immediately after Mohs surgery to repair the damaged site. Dr. Ransom specializes in carefully reconstructing the facial tissues in such patients, restoring the natural appearance of the facial contours and the delicate skin of the head and neck, and preserving the crucial functions of the facial structures (such as the nose, eyelids, or lips).

Some of these repairs require multiple stages and thus expertise in local and regional flap reconstruction. Dr. Ransom has extensive training in complex and multi-stage Mohs reconstruction. These procedures can be performed with local anesthetic in nearly all cases, making the process easier for the patient and helping to promote a faster recovery. Please visit the photo gallery for some examples.

Who is a candidate?
Patients with a skin cancer of the Basal Cell (BCC) or Squamous Cell (SCC) variety in a sensitive location such as the face are candidates for Mohs surgery. Mohs reconstruction (repair of a defect from Mohs surgery) may be performed by your dermatologic surgeon in many cases. However, referral to a facial plastic surgeon such as Dr. Ransom is often made in cases where the defect is large, in a complex 3-dimensional area (e.g., the nose or lips), or requires multiple stages with flaps and grafts. Dr. Ransom receives Mohs reconstruction referrals from multiple dermatologists in San Francisco and Marin County.

Dr. Ransom see patients from all over Bay Area for Mohs surgery reconstruction, including Mill Valley/Marin County, Napa/Sonoma, San Raphael/Petaluma and the world.

Frequently Asked Questions

Q: If I want Dr. Ransom to perform my Mohs reconstruction, how can I set this up?
A: First, you can discuss your preference for plastic surgery closure with your Mohs surgeon. Then you can call our office to coordinate the timing of the cancer removal and the repair. Next, either you or your dermatologist can fax our office the information about your skin cancer history. We will then work with you and your referring physician to create a comprehensive plan.

Q: Does insurance cover the cost of Mohs reconstruction?
A: Yes, all insurance plans, including Medicare, cover the costs associated with Mohs reconstruction. Depending on the specifics of your plan, you may still have out of pocket costs associated with your deductible, copays, etc. Dr. Ransom accepts all major PPO plans and is contracted with Medicare for these procedures.

Q: What type of anesthesia is used for Mohs surgery repairs?
A: In the overwhelming majority of cases, local anesthesia is used and the surgery is performed in the office. For very large defects of the face, nose, or scalp, some patients may require sedation in addition to local anesthesia. This can be arranged at our surgery center in the building or at a hospital in San Francisco or Marin County.

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

5.0

Based on 19 reviews

Christina G.
I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!
Tk I.
I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!
Joey B.
I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.
Edward T.
Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.
Lisa C.
Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.
Cheryl H.
Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.
Jill P.
I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.
Arielle C.
Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.