By Bradley T. J. Straka, MD
Board Certified in Dermatology and Mohs Micrographic Surgery
A skin cancer diagnosis brings an immediate priority: removing the cancer completely. For many patients, especially those with a spot on the face, another concern follows closely: How will I look after treatment?
At Highlander Dermatology & Aesthetic Center, my approach brings those concerns into the same treatment plan. I perform Mohs surgery for appropriate basal cell carcinomas, squamous cell carcinomas, and selected melanomas, with careful attention to reconstruction and scar improvement. For patients throughout Milwaukee, Brookfield, Lake Country, and Franklin, the goal is effective cancer treatment with the best functional and cosmetic outcome we can achieve.
How Mohs Surgery Preserves Healthy Skin
Mohs micrographic surgery combines precise cancer removal with microscopic examination of the surgical margins. I remove tissue in stages, map it, and examine the edges under the microscope. If cancer remains, additional tissue is removed from the involved area. This continues until the examined margins are clear.
That precision supports high cure rates while conserving healthy tissue. It is particularly valuable around the eyelids, nose, lips, and ears, where small differences in tissue preservation can affect appearance and function.
For basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), Mohs may be recommended because of the cancer’s location, size, growth pattern, or recurrence. Tissue preservation always follows the requirements for complete cancer removal. [1]
Mohs Surgery for Selected Melanomas
Melanoma requires a treatment plan based on its type, depth, location, and stage. Mohs is an option for selected cases, particularly melanoma in situ, including lentigo maligna, in areas where preserving healthy tissue matters.
In appropriate melanoma cases, I use rapid immunohistochemistry, a specialized staining process that helps identify melanocytes during microscopic margin assessment. This adds important detail when evaluating the borders of these tumors.
Mohs is not appropriate for every melanoma. Wide local excision remains a standard treatment, and some patients need lymph node evaluation or additional specialist care. The diagnosis determines the safest treatment. [2]
How Cosmetic Surgery Experience Informs Reconstruction
I am board certified in dermatology and Mohs micrographic surgery, and cosmetic surgery is also an important part of my practice. I perform cosmetic blepharoplasty, treatment of protruding eyelid fat or eye bags known as steatoblepharon, brow lifts, laser resurfacing, and scar revision.
That work informs how I approach reconstruction after skin cancer removal. Around the eye, for example, closure requires attention to eyelid position and the pull of surrounding tissue. On the cheek or forehead, I consider natural creases, skin movement, and contour when planning the repair.
I take a special interest in nasal reconstruction, with the goal of preserving the nose’s natural contours and achieving a scar that is as close to imperceptible as possible. That is the result I strive for with every repair.
Depending on the wound, reconstruction may involve a layered closure, a local skin flap, or a skin graft. Some wounds are better suited to healing without stitches. I choose the approach according to the defect and surrounding anatomy, with the aim of preserving function and making the healed result as natural as possible. [3]
The Same Cosmetic Attention for Standard Excisions
These principles extend to every skin cancer operation I perform. A patient having a standard excision deserves the same attention to closure and the eventual scar as someone undergoing a complex Mohs repair.
When standard excision is appropriate, I remove the cancer with the recommended margins and send the tissue for pathology evaluation. I plan the closure with attention to tension, tissue handling, and the position of the scar. Additional treatment depends on the pathology findings.
The method of cancer removal may differ, but my commitment to careful repair and thoughtful follow-up remains consistent.
Lasers and Scar Treatments After Skin Cancer Surgery
The cosmetic result continues to evolve after the sutures come out. Having a broad range of lasers and scar treatments available allows me to address specific concerns as healing progresses.
A red scar may benefit from a vascular laser. An uneven or texturally noticeable scar may be considered for fractional resurfacing, including CO2 or erbium laser treatment. Other options can include silicone scar products, injections for selected raised scars, or surgical scar revision.
The right choice depends on the scar’s characteristics, your skin type, its location, and the stage of healing. Treatment timing is individualized, and some scars improve sufficiently with wound care and time alone.
All skin cancer surgery can leave a scar. Lasers and other treatments can make scars less noticeable, but cannot guarantee invisible healing. My goal is to use the appropriate tools when they offer a meaningful opportunity for improvement. [4]
Planning for the Healed Result
Before surgery, we discuss the cancer diagnosis, the treatment recommendation, and the repair options that may be needed. The final reconstruction plan depends on the size and depth of the wound after cancer removal.
Afterward, clear wound care instructions and follow-up help us assess healing and decide whether additional scar treatment would be useful. Ongoing skin examinations remain important for detecting new skin cancers and monitoring treated areas.
I want patients to understand both the medical plan and what they can reasonably expect from recovery.
Skin Cancer Care for the Greater Milwaukee Area
Highlander Dermatology & Aesthetic Center serves patients from Brookfield, Milwaukee, Franklin, and the Lake Country communities. Whether you need Mohs surgery, standard skin cancer excision, a complex repair, or evaluation of a surgical scar, I bring cancer surgery and cosmetic experience to the same conversation.
If you have been diagnosed with BCC, SCC, or melanoma, contact our team at 262-290-4540 to discuss your next step. We will help you understand your options, with cancer clearance as the priority and careful attention to how you heal.
