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What Happens to Mohs Surgery Scar when Healed by Itself?

asked 2 years ago by Tazamcj in Michigan
Latest answer by Kenneth W. Neal, MD
Question viewed 6,824 times
Tags: age 75 and up, healing, scar

What can I expect after Moh's surgery if I let the scar heal on its own? I was told by a plastic surgeon that I could let it heal on its own, do a skin graft or nasal flap. I am curious as to how the body would heal on its own and what would the results look like? Because of large pores on my nose, I am afraid a skin graft would be very obvious. If it healed on its own, would it be more likely to match the adjacent skin? I am 84 years old and feel a nasal flap is too much surgery.

12 answers to What Happens to Mohs Surgery Scar when Healed by Itself?

Wound Healing after Mohs surgery

Letting the wound heal by itself or "secondary intention healing" is frequently the best option for some surgical wounds. Surgical wounds on concave (slightly depressed inward) areas tend to heal best, such as the bowl-shaped area near the ear canal, the area between the nose and eyelid, and the temple. The Mohs surgeon is probably in the best position to determine what needs repair and what can heal on its own.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon

www.dermatology-center.com

Mohs surgery wound allowed to heal by itself

It's amazing how well the skin can heal on its own (called healing by secondary intent). It may possibly be depressed after healing or heal over too much (become a raised bump). If it heals too much, that can easily be repaired. A depression is more difficult to repair but can be done possibly be dermal implant or filler. If you're not happy with how it looks you can always opt to have more surgery later.

M. Christine Lee, MD
Walnut Creek Dermatologic Surgeon

Secondary intention healing after Mohs Surgery

Secondary intention healing is an excellent choice for certain defects that result after a Mohs surgery. Generally speaking concave areas of the face, ideally, perialar areas (around the nostrils) that are concave, heal excellent by secondary intention.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

www.palmbeachdermasurgery.com

Usually not the best choice: Nasal skin is thicker

Although I agree with other posts which state that healing by secondary intention of a Moh's defect is sometimes appropriate, it is generally in the minority of situations. The reason for this is that nasal skin is thicker and more sebaceous than other area of the face. In addition, it is supported by relatively flexible underlying cartilaginous structures. Healing via secondary intention on the nose relies on wound contraction which can lead to distortion of varies nasal subunits, and a... more

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

Mohs on the Nose

Depending on the size and location of the surgical defect, second intention healing can give a better cosmetic result than having reconstructive surgery. However, it is not appropriate in all cases. If matching the adjacent skin is a concern, a flap or complex closure depending on the size and location of the nasal defect will give a better match to the adjacent nasal skin. The level of care required will be greater with the flap, but the aesthetic results after it has... more

Kenneth W. Neal, MD
Arlington Dermatologic Surgeon

Healing without reconstruction (second intention healing) may be a good choice after Mohs surgery

The wound (defect) created after Mohs surgery will need some sort of approach to yield the best result. This can involve primary stitching or more involved movement of neighboring skin (flap) or skin from another site (graft). In some cases the final result from allowing a wound to heal on its own is comparable (or even better) than a surgical reconstruction. This is primarily dependent on the size of the wound and the location on the face. An experienced Mohs surgeon or plastic surgeon... more

Daniel Berg, MD
Seattle Dermatologic Surgeon

Mohs surgery wounds can sometimes heal well on their own.

If the Mohs surgery location on your nose is in the concave part on the side just above your nostril, this is an excellent location for healing by itself (also known as healing by secondary intention, or granulation). Your Mohs surgeon or plastic surgeon should evaluate whether letting the wound heal this way might cause collapse of the nostril when you try to breathe in through your nose. If there is no risk of collapse, and you don't feel like more surgery, I think allowing it to... more

Jessica J. Krant, MD, MPH
Manhattan Dermatologic Surgeon

Mohs surgery scar healed by itself

You seemed to have answered your own question. If you feel you are too old for a nasal flap or worried about the skin grafts appearance, than by all means allow the wound to heal by secondary intention. Than you can decide if the appearance of the scar is acceptable to you. If you are not happy you can always have surgery. Regards from Miami

Darryl J. Blinski, MD
Miami Plastic Surgeon

Moh's healing by secondary intention

Moh's excisions were originally intended to heal by the wound shrinking and scarring over (secondary intention). Sometimes this works well and in some areas it draws the tissues together into a distortion of the facial features.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Wound healing and reconstructive surgery after Mohs Micrographic surgery

Healing by secondary intention may be appropriate for concave areas such as the temple, or the inside aspect of a ear (such as the scaphoid area of the ear). However, unless the defect is quite small, it may not offer the best cosmetic outcome on the nose as there will be some contraction leading to a likely depressed scar and some subtle or not so subtle distortion of the nasal contour, e.g. asymmetric flare of nostrils. Flap repair such as bilobed or rotational flap repair may be more... more

William Ting, MD
Bay Area Dermatologic Surgeon

What happens to Mohs surgery scar when healed by itself?

Some parts of the nose heal well without surgery of any kind (healing by secondary intention). Others heal poorly since the scarring process pulls and distorts the adjacent tissues. We often recommend the simplest procedure that would do the job and this is especially true in older patients in whom we are concerned of the risk of surgery or injections of epinephrine (adrenaline) commonly used to reduce bleeding and prolong the effect of anesthesia. A skin graft WILL look like a patch the... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Mohs surgery wound healing

Skin cancer surgical defects in certain locations on the nose can heal with a nice cosmetic result. These locations include smaller defects of the tip of the nose, the ala or "wing" of the nose and in some cases, the nasal sidewall. If a reconstruction is required, I usually will elect to go with a flap rather than a graft, to achieve better skin matching. Although it can take up to several weeks to heal in, a wound that is left to heal by "secondary intention" often looks better than you... more

Bryan K. Chen, MD
San Diego Dermatologist

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