Mohs and Plastic Surgery for Atypical Fibroxanthoma on Scalp*

Mohs micrographic surgery was performed on a atypical fibroxanthoma or "AFX" on the forehead/scalp. Reconstruction was performed as a complex repair. The patient is very happy with the results. More

This is considered a "complex repair," a layered closure in a linear direction (straight-line scar). There are large, strong stitches deep below the surface in the "subgaleal fascia" that provide the strength of the closure. The top layer of sutures are not for strength, but help ensure fine approximation of the skin edges. The stitching and scar may seem longer than expected because a triangle was removed from each side of the hole creating an elliptical (football) shaped hole in order to prevent puckering on both ends. Lengthening and tapering the would helps to create a smooth fine scar. Failure to remove the triangles ("Burrow's triangles") almost guarantees an ugly scar with large puckers ("standing cone deformity" or "dog ear deformity") on each side. More