Mohs surgery repair

Dear Mike,

The answer to your question depends entirely where on the forehead your wound is. I would not recommend a skin graft -- it is very difficult to get an exact color match and will look very obvious. If the wound heals by itself, it will take some time (3-6 weeks) and it will feel like nothing is happening for the first 2 weeks and then all of a sudden it will start to heal from underneath and around the sides. If a wound heals on its own, it will shrink down to 1/3 the size of the wound.

It is sometimes easier to undergo a scar revision after it has healed by second intention because the resultant scar will be smaller.  Otherwise, repair directly after Mohs is advised but it really depends on the area of the forehead as to whether you should have a flap or a linear repair done. If you go to an experienced Mohs surgeon (fellowship-trained and Mohs college certified) or a plastic surgeon you will be able to get the right advice based on your current wound.

Best of luck,

Dr. Mariwalla

There are several options with respect to reconstruction following Mohs surgery.

One can have the wound repaired immediately following Mohs surgery, they can allow it to heal in completely without having any reconstruction, or the wound can be allowed to heal to some extent so that it is made smaller before having reconstruction done. The main advantage to allowing it to heal in some on its own first are that it will likely necessitate a small flap/graft. 

Secondly, there are many times in which the cosmetic result from allowing a wound to heal in by itself completely can be superior to that achieved from a flap/graft (ie. this is often seen on the nose, depending on how deep the wound is). The down side is that there are times in which the cosmetic result is not as acceptable because the scar appears as a faint white patch that can be less appealing than a series of lines that can be strategically placed to mininize their appearance. Another main disadvantage is that it often takes a long time for the wound to heal in by itself, even partially and will likely require a larger bandage for a longer period of time.

Depending on the size of the wound, your Mohs surgeon may want you to be on antibiotics during a portion of the healing process. It is important to take your lifestyle needs into account (can you accept a larger bandage for a longer period of time, decreased physical activity for a longer period of time) when making this decision. Basically, allowing the wound to heal in first some stretches the whole process by some time, however, it could have a great impact in decreasing the overall size and improving the appearance of the final size.