Mohs Reconstruction: When to Close, When to Refer, and the Evolving Role of Plastic Surgery
At the 2026 Masterclasses in Dermatology Annual Meeting, Dennis P. Orgill, MD, PhD, offered a pragmatic and collaborative perspective on reconstruction after Mohs surgery. His focus: understanding when dermatologic surgeons can manage closures independently and when partnering with plastic surgery optimizes patient outcomes.
Nonmelanoma skin cancer (NMSC) remains common and growing. In the United States annually, approximately 3.6 million basal cell carcinomas (BCC) and 1.8 million squamous cell carcinomas (SCC) are diagnosed, with nearly 90% occurring on the face, scalp, or neck. Mohs surgery has become a “cornerstone for treatment of many skin malignancies,” particularly in cosmetically sensitive head and neck regions.
Growth in Mohs procedures continues at an estimated 5% annually, with volumes increasing from roughly 140,000 cases in 1990 to projections exceeding 850,000 by 2030. As Mohs surgeons’ reconstructive skills have advanced, referral patterns have evolved. “Mohs reconstruction has gone down.”
Dr Orgill shared reconstruction observations that inform surgical decision-making. Older individuals, “particularly Caucasians,” tend to scar better and have looser skin, facilitating local flap options. Facial scars are often well accepted, but reconstruction choice requires thoughtful trade-offs.
For nasal defects, Dr Orgill covered options ranging from full-thickness skin grafts to rotation-advancement and bilobed flaps. The forehead flap remains “the gold standard of nasal soft tissue reconstruction” for larger or complex defects.
Dermal regeneration templates, including acellular matrices such as Integra, are increasingly used in selected cases. Pros include ease of application and favorable aesthetic outcomes; cons include delayed healing, discomfort, and longer overall recovery time.
Dr Orgill emphasized that multidisciplinary care can be particularly valuable in frail patients, aggressive tumors, or immunocompromised individuals, such as those with Marjolin ulcers.
“Multidisciplinary care can be helpful in complex cases,” Dr Orgill noted, underscoring that collaboration best serves patients.
For more meeting coverage, visit the Masterclasses in Dermatology newsroom.
Reference
Orgill DP. Mohs reconstruction: the role of the plastic surgeon. Presented at: Masterclasses in Dermatology; February 19–22, 2026; Sarasota, FL.
