Mohs Surgery for Skin Cancer of the Nose

The nose accounts for a large share of facial skin cancers. The skin is thin, tightly bound to underlying cartilage, and located in the center of the face where any change is visible. Three factors make nasal skin cancer surgery particularly demanding: cartilage may be involved or come close to the tumor, the cosmetic outcome matters more than at almost any other location on the body, and small reconstruction errors can compromise nasal airflow.

For these reasons, Mohs micrographic surgery is the preferred treatment for almost all skin cancers on the nose. It removes the cancer while preserving as much healthy tissue as possible, which is what makes a good cosmetic reconstruction achievable in the first place.

Surgeons divide the nose into nine aesthetic subunits: the dorsum, the two sidewalls, the tip, the two ala (the rounded sides next to the nostrils), the two soft triangles, and the columella. Each subunit has different skin thickness, mobility, and cosmetic visibility. A defect that crosses subunit borders is more visible after healing than one contained within a single subunit, and reconstruction technique is chosen with this in mind.

Cancers near or involving the alar rim are particularly challenging. The alar rim has no inherent structural support beyond skin and cartilage, and even small reconstruction errors can cause notching or retraction. Cancers on the nasal tip require equally careful planning to avoid distortion of the tip-defining points.

In Mohs micrographic surgery for nasal skin cancer, the visible tumor and a thin margin of surrounding tissue are removed under local anesthesia. The tissue is then processed and examined by Dr. Lopez under a microscope while you wait. If any cancer cells remain at the margin, only that specific area is removed in the next stage, leaving healthy tissue intact. The process is repeated until the margins are clear.

Most nasal Mohs cases are completed in one or two stages. Dr. Lopez averages 1.4 stages per Mohs case on head and neck sites. The single-day, margin-controlled approach is what allows nasal Mohs to achieve cure rates up to 99 percent for basal cell carcinoma and squamous cell carcinoma while removing far less normal skin than a standard excision would require.

After the cancer is fully removed, the defect is reconstructed. Most nasal defects can be closed with relatively straightforward techniques. The reconstruction approach depends on defect size, location, and depth, and Dr. Lopez chooses the simplest technique that will give a good cosmetic and functional result.

Common reconstruction techniques Dr. Lopez performs in house include:

For most defects:

• Primary closure or healing by secondary intention for smaller defects in locations where this gives a good cosmetic result
• Local flaps including dorsal nasal (rotation) flaps, rhombic flaps, V-Y advancement flaps, and nasolabial flaps

For a minority of larger or deeper defects:

• Full-thickness skin grafts, often harvested from the preauricular area or supraclavicular skin
• Cartilage grafts (typically harvested from the ear) when structural support of the nasal sidewall or alar rim is required
• Multi-stage reconstruction with a paramedian forehead flap or nasolabial interpolation flap

Dr. Lopez performs 99 percent of his own reconstructions, including the more complex multi-stage repairs when those are the right choice. Tumor removal and the first reconstructive stage are completed on the same day, in the same visit. There is no separate appointment with plastic surgery and no second surgical team.

Dr. Lopez has personally performed over 10,000 Mohs micrographic surgery procedures since completing his Mayo Clinic fellowship in 2018, with 1,757 cases performed in 2025. The head and neck are his most common treatment sites. In 2025, 1,288 of his Mohs cases (73 percent) were performed on the head, neck, or other anatomically sensitive sites, of which the nose accounts for a substantial share.

He has published peer-reviewed research on the management of cutaneous squamous cell carcinoma of the head and neck, including a case report on positive sentinel lymph node biopsy in a transplant recipient with squamous cell carcinoma of the nasal tip.

Dr. Lopez accepts referrals for nasal skin cancer cases from dermatologists, primary care physicians, plastic surgeons, oculoplastic surgeons, facial plastic surgeons, and radiation oncologists across Tampa Bay.

Most patients are scheduled for a same-day consultation, Mohs procedure, and reconstruction in a single visit. You arrive in the morning, the cancer is removed, tissue is examined while you wait, and reconstruction is completed once the margins are clear. You leave the office the same day with the cancer gone and the wound closed.

Most nasal Mohs procedures take part of a day and are completed in a single visit. A small number of cases requiring multi-stage reconstruction may involve one or two follow-up visits over the subsequent weeks for staged completion.