Serial Excision of a Large Facial Skin Cancer

Background. In the management of large facial neoplasms, the dermatologic surgeon must consider local factors affecting the success of closures. Objective. Large facial neoplasms can be removed serially with Mohs micrographic surgery. Serial excision facilitates recruitment of adjacent normal skin 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 excision 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 function.