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Postoperative Defect Size as a Criterion for Reconstruction Planning in Mohs

Kodumudi V, Rosenthal A, Conde G, et al.
Dermatologic Surgery (2025)

JC: October 2025

This study examined how postoperative defect size should guide reconstruction planning decisions after Mohs surgery. The analysis provided evidence-based criteria for selecting among closure methods (primary, flap, graft, second intention) based on final defect dimensions and anatomic location.

Take-Home Messages

•Postoperative defect size is a key determinant of reconstruction method selection and should be systematically assessed after Mohs surgery.
•Evidence-based defect size thresholds can help standardize reconstruction decision-making and improve surgical outcomes.

Topic

Reconstruction

Flaps, grafts, wound closure techniques after Mohs

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Abstract

Brigham and Women's Hospital (BWH) criteria classify cutaneous squamous cell carcinoma (cSCC) with a preoperative (clinical) size ≥2 cm as high risk. However, the role of postoperative defect (histologic) size after Mohs micrographic surgery (MMS) in cSCC staging remains unclear. To compare outcomes of cSCCs treated with MMS that have a clinical size <2 cm but a histologic size ≥2 cm with those clinically ≥2 cm. Data were collected at a tertiary academic center. Patien...