The Healing Process After Mohs Surgeryby Anne Windermere Patient Advocate
If you are reading this, there is a good chance that you are about to have Mohs surgery or you have just had your surgery recently. Many of you will have this procedure done to remove basal cell or squamous cell skin cancers. You may feel more at ease with having this procedure done knowing that Mohs surgery has such a high cure rate.
In fact, the American Society for Mohs Surgery states that: "Clinical studies have demonstrated that Mohs surgery provides five-year cure rates approaching 99% for new cancers and 95% for recurrent cancers." But what happens after your surgery? What is the healing process like?
Mohs surgery is quite commonly used to remove skin cancers in the facial region. For this reason, many patients will undoubtedly have concerns about how the wounds will heal and what things will look like when all is said and done. This article will hopefully address some of those questions and concerns.
How Long Will It Take to Heal From Mohs Surgery?
The answer to this question is, of course, it depends. Dr. Sam Naficy, a Seattle facial plastic surgeon, talks about the recovery time from work following Mohs Surgery: "Recovery (measured in terms of time off from work or social activities) can take between several days to several weeks based on the size, complexity, and location of the defect."
Doctor Kenneth G. Gross reports in "A Patient's Guide to Mohs Surgery" that: "Complete healing of the surgical scar takes place over 12 to 18 months. Especially during the first few months, the site may feel swollen or lumpy and there may be some redness."
The American College of Mohs Surgery states that: "Generally, a post-surgical scar improves with time and can take up to one year or more to fully mature." In reviewing the literature it seems that complete healing from Mohs surgery can take a year or more and much depends upon the size and depth of your wound.
What Factors Will Help the Healing Process and/or Prevent a Reccurrence of Skin Cancer?
Most doctors will recommend that you do not smoke or use nicotine which decreases oxygen supply to the wound and will hinder the healing process. The University of Wisconsin's Mohs Surgery Clinic also advises that you protect yourself from the sun as sun damage is what usually leads to the development of skin cancers in the first place. Use a sunscreen with a high SPF (over 15) even on cloudy days, wear a hat, and make sure to stay out of midday sun (10 am-2pm).
What Can I Expect the Wound to Look Like or Feel Like the First Several Months Following My Surgery?
The American College of Mohs Surgery reports that as your wound heals there may be a reddish appearance to the scar which is usually temporary. In addition the skin may contract and tighten and this usually occurs 4-6 weeks after surgery.
There may also be a bumpiness or hardening of the scar which is also usually temporary. Your wound may be red and raised for awhile but most scars will flatten and fade. It is estimated that this fading process will take anywhere from six months to a year.
What you will experience during the healing process may depend upon the area of the wound. For example, Dr. Ronald Shelton, a states that: "Swelling is more likely to occur around the eyes, as well as bruising. Lips tend to swell also. Ears may be more painful postoperatively than other sites." As always it is best to consult with your doctor about what you can expect during the months after surgery as everyone will be unique in how they heal.
What Complications Can Arise From Having Mohs Surgery?
As with any type of surgery there are always risks for complications to develop. Cleveland Clinic's information on Moh's Surgery includes a list of potential risks which they say are mostly rare. These risks can include: Poor wound healing, excessive bleeding from the wound, infection, loss of nerve function, and cosmetic deformities.
Doctor Natalie L. Semchyshyn wrote an extensive article about "Surgical Complications" which includes information about allergic reactions to sutures. Dr. William Ting, a Bay Area Dermatologic surgeon, adds that sometimes what may be considered a wound infection is really an allergic reaction to topical antibiotics. Dr. Ting states that: "More and more dermatologic surgeons are moving to just plain vaseline or Aquaphor for post-op wound care as there is significant prevalence of allergy to neomycin, bacitracin and/or polysporin."
The suggestion is made that if you experience excessive itching or pain days after your surgery to contact your Mohs surgeon so they can determine the cause and if your wound is healing properly.
Will There Be a Scar?
If your surgery is done on your face, this may be one of the first questions in your mind. The answer is yes, there almost always is a scar when you have Mohs surgery. One of the common regrets expressed on this site is that a plastic or reconstructive surgeon was not present to perform the closure of the wound. There are many people who may not need such a specialist but it is always wise to ask beforehand. Prior to your surgery always ask about your options regarding how the wound will be closed and also about how the scar can be minimized.
One of our most popular articles on skin cancer is an article written by Doctor Kevin Berman entitled: "Mohs Surgery: What will the Scars Look Like?" Here is an excerpt from that article:
"Silicone pads may help prevent hypertrophic (thick) scars although there is still no way to guarantee a perfect scar. Vitamin E containing creams and other creams designed to aid scarring may help but none have definitively been proven to aid the final outcome. If the scar is thicker than expected, you can talk with your surgeon about "dermabrasion" in which the skin is effectively "sanded down" to smoothen it and make the scar thinner. Scar revisions can also be performed in which the scar is excised or re-oriented to improve the final outcome."
As always, check with your doctor about what treatments are advisable for you.