title: Serial excision of a large facial skin cancer.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, andDepartment of Dermatology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Schanbacher
authors.forename: H W
authors.initials: HW
authors.lastname: Randle
mesh_terms: D000368:Aged; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000601:surgery*; D005153:Facial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015580:Mohs Surgery; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps