BACKGROUND. In the management of large facial neoplasms, the dermatologic s
urgeon must consider local factors affecting the success of closures.
OBJECTIVE. Large facial neoplasms can be removed serially with Mohs microgr
aphic surgery. Serial excision facilitates recruitment of adjacent normal s
kin for replacement of lesional skin, minimizing the risks of necrosis.
METHODS. A large morpheaform basal cell carcinoma was excised serially. The
initial defect was closed with an O to L advancement flap. The final excis
ion and repair 2 months later consisted of a combination of primary closure
with marsupialization and pursestring closure. A full-thickness skin graft
was used to close the final defect.
RESULTS. The patient had optimal cosmesis at 2-year follow-up.
CONCLUSION. Large facial neoplasms can be excised serially. This technique,
performed in the setting of Mohs micrographic surgery, takes advantage of
"mechanical and biologic creep," resulting in excellent cosmesis and functi
on.