Each month we will be selecting one member question to be answered by our consulting dermatologist, Dr. Lawrence Green, who is the Assistant Clinical Professor of Dermatology at George Washington University School of Medicine. To find out more about Dr. Green please visit his website: Aesthetics, Skin Care, and Dermasurgery. One of the most popular topics brought up by members of SkinCancerConnection is about Mohs surgery.
Mohs micrographic surgery is a specialized skin surgery used to remove skin cancers using the most minimal excision necessary, leaving healthy surrounding skin intact. This type of surgery is most commonly performed to treat basal and squamous cell carcinomas located on the face. The success rate for this type of surgery is extremely high. The American College of Mohs Surgery reports that: "Mohs surgery has the highest success rate of all treatments for skin cancer - up to 99%." Most patients feel reassured that this type of surgery will get rid of their skin cancer but have concerns about the healing process.
This month’s question comes from Number1Grammy who asks:
Q: How long until my scar is presentable after Mohs? I had 15 stitches and a two inch cut on my left cheek to remove infiltrating basal cell…very small, but three swipes. Does anyone have pictures of recovery time frame? Thanks
Dr. Green: Mohs surgery refers to the process of removing skin cancers (most commonly basal cell carcinomas) from sensitive or tight areas of the face, such as on or near the nose and ears. It is a tissue sparing procedure, where the dermatologic surgeon also acts as a pathologist and checks to see that all the skin cancer is removed, with minimal extra normal skin around it, before she/he stitches you back together. Because Mohs surgery entails the quick pathologic checking of skin cancer while you wait, Mohs surgery does not refer to how the skin cancer is fixed or repaired or the scar left once the procedure has been performed. The resultant scar depends on if and how the Mohs dermatologic surgeon decides to repair the skin after the cancer is gone, and is not done in any special way specific to Mohs surgery.
In fact, Mohs surgery was named after Dr Frederic Mohs, a dermatologist who invented quick section type pathology so the patient can get instant results after skin cancer removal and know the cancer is completely gone. Dr Mohs classicaly never stitched people up after he removed skin cancer, and just let them heal naturally over time (This did usually leave a bigger scar than if they had been stitched up).
Today, all dermatologists are experts at skin cancer repair and leave the best scars (or lack thereof) possible, but the Mohs dermatologist is specialized to remove just the amount of skin needed with little extra. This is an advantage on certain tight areas of skin such as the ears and nose where there is little extra skin to spare. That is why the vast majority of Mohs surgery is for skin cancer in these parts of the face.
The general healing process after Mohs would depend on how the dermatologist repaired the area where the skin cancer once was, but has nothing to do with the Mohs surgery itself. So, the healing would depend on how things have been stitched up or left to heal in on its own.
Thank you Dr. Green for sharing your expertise on this topic
In addition I wanted to share some links to images of the healing process following Mohs surgery. Remember that every patient will heal differently, as Dr. Green reports, depending upon factors such as the depth and location of the excision, any complications, etc.
"¢ Treatment for Basal Cell Carcinoma (Shows image of how a patient’s scar looks six weeks after Mohs surgery.)
"¢ Skin Cancer Weekly Progress: This is a personal gallery of patient Christine Barrack who has courageously shared her weekly photos of healing after Mohs surgery on her nose.
"¢ On a site called Scars1.com there is a photo gallery of what the healing process following Mohs (on the nose) can look like.
"¢ Skin Cancer Forum: Patient photos and story about getting a basal cell carcinoma removed from nose using Mohs Surgery.
We also have many articles on Mohs surgery and what the recovery process can be like including the following:
If you are a patient who has undergone Mohs surgery and would like to share your story and/or images of your healing please let us know. We would like to hear from you.