When managing complex skin cancers of the face, especially those around the mouth and jawline, collaboration across surgical specialties becomes essential. One procedure that has transformed the precision and outcomes of skin cancer removal is Mohs Surgery a microscopically controlled technique primarily used for the treatment of basal cell and squamous cell carcinomas. While its origins lie in dermatologic surgery, Mohs is increasingly intersecting with oral and maxillofacial oncology due to the anatomical proximity of facial skin cancers to oral structures.
This collaboration between dermatologic surgeons, oral oncologists, and reconstructive specialists represents a growing model of integrated care that ensures both oncologic safety and functional restoration for patients.
Understanding the Foundation of Mohs Surgery
Mohs micrographic surgery is a highly specialized, stepwise technique for excising skin cancers with complete margin control. The method involves removing tissue in stages, examining each layer under a microscope to detect residual cancer cells, and continuing until all margins are clear.
This approach is particularly advantageous in regions where tissue preservation is crucial — such as the eyelids, nose, and perioral region. For lesions located near the lips, commissures, or nasolabial folds, Mohs allows for maximal tumor clearance while minimizing cosmetic and functional damage.
The Overlap Between Mohs Surgery and Oral Oncology
Although oral oncology traditionally addresses malignancies arising inside the mouth — including squamous cell carcinoma of the oral cavity, tongue, or gingiva — the boundaries between oral and cutaneous cancers are not always distinct. Skin cancers that originate on the lips or perioral skin can extend into mucosal surfaces, requiring both dermatologic and oral surgical expertise.
This intersection demands a multidisciplinary strategy that goes beyond tumor removal. It includes understanding tumor biology, surgical anatomy, reconstructive needs, and postoperative rehabilitation. Collaboration ensures that patients receive a seamless continuum of care, from diagnosis through reconstruction and recovery.
Clinical Scenarios That Require Collaborative Management
Several clinical cases highlight the importance of integrating Mohs surgery with oral oncology:
- Cutaneous Squamous Cell Carcinoma of the Lower Lip
The lower lip is one of the most common facial sites for squamous cell carcinoma due to chronic sun exposure. Mohs surgery ensures complete excision while preserving as much lip tissue as possible. However, if the tumor infiltrates the vermilion or oral mucosa, an oral oncologist’s input becomes critical for achieving adequate deep margins and reconstructing oral competence. - Perioral Basal Cell Carcinoma with Mucosal Extension
While basal cell carcinomas rarely metastasize, their local invasion can be extensive. When a basal lesion invades beyond the cutaneous boundary, oral and maxillofacial surgeons assist in assessing intraoral involvement, protecting salivary ducts, and managing nerve structures. - Recurrent Facial Skin Cancer Following Prior Excision
For patients with recurrent cancers or radiation history, soft tissue planes are altered. A joint Mohs–oral oncology approach helps define new resection strategies while maintaining vital functions such as mastication and speech.
Preoperative Planning and Diagnostic Imaging
Preoperative evaluation is the foundation of successful multidisciplinary surgery. Collaboration begins at the diagnostic stage, where dermatologists and oral oncologists coordinate to define the true extent of the tumor.
Advanced imaging — such as MRI or cone-beam CT — can delineate deep invasion into the buccal mucosa, mandible, or perioral musculature. This helps determine whether Mohs Surgery alone is adequate or whether a combined resection involving intraoral access is required.
In addition, pathologists trained in both dermatologic and oral histopathology play a vital role in interpreting frozen sections and ensuring no microscopic tumor nests are overlooked in the transition zones between skin and mucosa.
Surgical Coordination and Technique Integration
During surgery, seamless communication between teams is essential. Typically, the Mohs surgeon handles the stepwise excision and margin analysis. Once the tumor-free plane is achieved, the oral oncologist or maxillofacial surgeon contributes by addressing deeper tissue removal, bone involvement, or reconstructive flap design.
For example:
● When the vermilion border is resected, the oral surgeon ensures proper lip reapproximation to maintain articulation and oral continence.
● For extensive cheek or commissure defects, a local flap or mucosal advancement may be necessary, often coordinated between both specialists.
● In cases involving the mandible or gingiva, osseous reconstruction or implant-supported rehabilitation may follow.
This division of expertise ensures that both oncologic precision and aesthetic-functional restoration are optimized.
Postoperative Rehabilitation and Follow-Up
Healing after Mohs surgery near the oral region can affect speech, eating, and facial expression. Oral rehabilitation therefore becomes an integral part of multidisciplinary care.
Postoperative management includes:
● Physical therapy to restore muscle mobility around the lips and jaw.
● Dental or prosthodontic support for patients with partial resections or tissue loss.
● Speech therapy to address articulation or swallowing issues.
Beyond physical recovery, patients may also experience anxiety or emotional distress following cancer treatment. Seeking online counselling for anxiety can help individuals manage postoperative stress and adjust to changes in appearance or daily functioning, supporting overall mental well-being during recovery.
Follow-up surveillance is shared between dermatology and oral oncology teams to detect recurrence early and manage new lesions that may arise from field cancerization or chronic actinic damage.
Advantages of a Multidisciplinary Mohs–Oral Oncology Model
Integrating Mohs surgery with oral oncology offers several tangible benefits:
- Comprehensive Margin Control: Microscopic verification from Mohs complements the wide-field oncologic approach, minimizing recurrence.
- Enhanced Functional Outcomes: Oral surgeons contribute to restoring complex structures essential for speech, mastication, and appearance.
- Patient-Centered Care: Collaborative planning reduces surgical stages, anesthesia exposure, and overall recovery time.
- Improved Aesthetic Results: Reconstructive input ensures scars are minimized and oral symmetry is maintained.
Together, these outcomes underscore why collaborative care models are becoming the standard for head and neck cutaneous malignancies.
Looking Ahead: The Future of Integrated Facial Oncology
As skin cancer rates continue to rise globally, particularly among older adults, the overlap between dermatologic and oral oncology will only grow. Future innovations — such as intraoperative imaging, 3D-printed facial scaffolds, and immunohistochemical mapping — will further refine how Mohs Surgery interfaces with oral and maxillofacial procedures.
Interdisciplinary centers where dermatologists, oral surgeons, oncologists, and pathologists work side by side are already demonstrating better oncologic outcomes and patient satisfaction. The goal is not merely to remove cancer, but to restore quality of life — maintaining a patient’s ability to eat, speak, and smile confidently.
Conclusion
The evolving collaboration between Mohs surgeons and oral oncologists represents the best of modern surgical medicine — precision, preservation, and partnership. For cancers that straddle the boundary between skin and mouth, neither specialty can act in isolation. Together, they create a treatment pathway that combines microscopic accuracy with reconstructive artistry.
Incorporating Mohs Surgery into multidisciplinary care ensures that patients facing complex facial and perioral cancers receive the most comprehensive and compassionate treatment available — one that protects both life and function.
