The Missing Pipeline: Access to Plastic Surgery Reconstruction After Mohs Surgery for Head and Neck Skin Cancers

Mohs Micrographic Surgery (MMS) is the gold standard for minimizing damage to healthy tissue surrounding nonmelanoma skin cancer. However, extensive or complex lesions may require reconstructive plastic surgery to restore form, function, and aesthetic outcomes for patients. Social determinants of health (SDOH)-including socioeconomic status, geographic location, healthcare access, and insurance coverage-significantly shape patient outcomes. Disparities in access to MMS and subsequent reconstruction remain underexplored. This review highlights the need for Mohs and reconstructive plastic surgeons involved in post-MMS reconstruction to consider social determinants of health (SDOH) in their practice.

A structured literature review was conducted through PubMed and Web of Science, adhering to the PRISMA guidelines. Search terms used included "facial reconstruction," "Mohs surgery," "social determinants of health," "social determinants," and "disparities," limiting the review to head and neck post-MMS cases. Eighteen articles met inclusion.

Among the 18 studies that met the inclusion criteria, 11% (2/18) focused on skin cancer detection, 28% (5/18) focused on barriers to accessing MMS, 22% (4/18) explained patients' post-MMS outcomes, and 28% (5/18) focused on the desires for reconstructive surgery and outcomes, but only 11% (2/18) discussed reconstructive surgery post-MMS.

Although all included studies examined disparities in the Mohs surgery care continuum, only 2 of 18 specifically addressed disparities in access to post-MMS plastic surgery reconstruction. This highlights critical gaps in interdisciplinary collaboration between Mohs and reconstructive surgeons in initial skin cancer detection, MMS, and post-MMS reconstruction. These findings reflect real-world barriers, where patients face systemic challenges in obtaining timely and equitable reconstructive care. Future studies should examine how systemic, socioeconomic, and geographic barriers impact referrals and outcomes, and develop coordinated strategies between dermatology and plastic surgery to improve equitable access to reconstruction.