Utilization Patterns of Fellowship-Trained Mohs Surgeons in the Treatment of Melanoma in Situ and Melanoma

Abstract

In a largely referral based surgical practice, the nose is a frequently treated area. Given the fairly common incidence of rhinophyma, it is to be expected that many surgical procedures are often performed on rhinophymatous noses. In such instances, we have found that performing conservative thickness layers of tumors located within the rhinophymatous distal one-third of the nose efficiently clears the cancer. 2 The defect and surrounding rhinophyma can then be resurfaced with wire brush surgery (see Figure 1). 3 This consistently produces a more desirable outcome than repair with a large flap or graft because these tend to heal with uneven contours and trapdooring in highly sebaceous skin. Dermabrasion is especially helpful in sites such as the soft triangle or the alar groove of the nose 4 where full-thickness defects often lead to complex repair options, such as interpolation flaps. 5 When dermabrasion is used as a repair option, it must be performed to the entire distal third of the nose. 6 Not only is the defect recontoured but the surrounding rhinophyma is also treated. We have found patients are very pleased with the outcome of this type of procedure.