Dr. Gerald Harris receives 2006 Wendell L. Hughes Award

Gerald J. Harris, MD, the recipient of the Wendell L. Hughes Award for 2006, delivered the lecture entitled "Oculofacial Reconstruction after Mohs Surgery" during a symposium on oculoplastic surgery at the American Academy of Ophthalmology Meeting.

Dr. Harris recounted the accomplishments of Dr. Hughes, the highlight of which is the technique of lower eyelid reconstruction, which he described in 1937, and which has remained the standard for reconstruction of defects of the low lid for almost 70 years. In recognition of that achievement, Dr. Harris based his lecture on the changes that have occurred in periocular reconstruction.

"Much of that change reflects the definitive Mohs surgery," he stated. Dr. Harris is professor of ophthalmology and chairman of orbital and ophthalmic plastic surgery at the Medical College of Wisconsin, Milwaukee.

Dr. Harris noted the dramatic upswing in nonmelanoma skin cancer in the United States, which develops in more than 1 million new patients annually; one in six individuals will be affected at some point. The majority of these cases, upwards of 80%, affect the head and neck.

"For nonmelanoma skin cancer, most micrographic surgery is increasingly perceived as yielding the highest cure rates while maximally conserving the normal tissue. Most societies report close to perfect results," Dr. Harris said.

Mohs technique is distinguished from other methods by a beveled incision and flattening of the specimen, allowing examination of each layer that is excised to facilitate conservation of tissue, he explained.

Dr. Harris described the various challenges met during these surgeries and how defects affecting the eyelids are handled in a variety of cases; the prime considerations are tumor location, the defect size, and the healing process after surgical reconstruction. The surgical techniques used can be combined with standard methods of marginal repair when needed.

"In reconstruction, an important consideration is that the defect size matters," he emphasized. "But the location is also important, because the lids and brows can be affected by any defect in the upper two thirds of the face, even if the defect does not touch the margin of the lid."

Mohs defects of the upper face can affect the eyelids, they vary widely, and are prone to latent retraction. Specific concerns determine the surgical principles in each sector.

"There is a broad range of reconstructive options, but the skin is a passive envelop that is subject to detachments and retraction vectors," he said. "Anchor flaps can prevent eyelid distortion and maximize the advantages of local tissue. Finally, these principles can be incorporated into the repair of larger defects, building on the innovations of our subspecialties."