How to Repair Mohs Surgery Wound?

asked 2 years ago by Mike Tamborrino in 06902
Latest answer by Larry S. Nichter, MD, MS
Question viewed 5,049 times
Tags: forehead, cancer, scar

I had Mohs surgery on 8/14 to remove a basal cell cancer from my forehead. The wound is now open and covered and I'm weighing my options for repair. It's about the size of a silver dollar. It does seem to be closing/shrinking from all sides, albeit ever so slowly.

What are the advantages/disadvantages of waiting for it to continue to close before doing a skin graft or skin flap? Thanks!

11 answers to How to Repair Mohs Surgery Wound?

Repair after Mohs surgery

Most repairs are performed on the day of the Mohs surgery. I tend to perform all necessary repairs on the ssame day. Some doctors like to allow the wound to heal for a period of time before applying a skin graft. This allows the base of the wound to fill in somewhat so there is less of a depression on the grafted skin. In my mind there isn't really any benefit to allowing a wound to heal before performing a flap repair. By the way many areas will heal well if allowed to heal by... more

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon

www.dermatology-center.com

Plastic Micrographic Surgery

Mike, As your doctor likely discussed with you following surgery during the discussion about the treatment options available for the wound, many wounds will heal if left alone. Most wounds left to heal on their own heal will do so with worse scarring than if they are surgically closed immediately - however the forehead is one of the few areas that does tend to do ok and in some cases does brilliantly. The longer a wound remains open, typically, the worse the scarring. We know that wounds... more

Justin Piasecki, MD
Gig Harbor Plastic Surgeon

Mohs surgery repair

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... more

Ritu Saini, MD
New York Dermatologic Surgeon

Repairing Mohs Surgical Wounds

Although the wound will eventually heal itself, the scar will be worse and why would anyone want to walk around with a "hole in their head" requiring daily wound care when it can be closed immediately?? Closure of a Mohs defect depends on the location, size and shape of the wound.. If it is small it closed primarily. If too large for that (e.g the size for example the size of a silver dollar as in your case then a flap, that is attached nearby is rotated in to fill... more

Larry S. Nichter, MD, MS
Orange County Plastic Surgeon

Reconstructive surgery after Mohs micrographic surgery

Ideally, reconstructive surgery repair should take place immediately after eradiation of tumor with Mohs micrographic surgery. If you choose to have a plastic surgeon to do the repair, reconstruction should take place that afternoon or the very next morning to minimize risk of infection. Certain wounds along concavity such as inside of the ears may be amenable to self-granulation without further repair assuming one is consistent with emollient application after Mohs surgery.

William Ting, MD
Bay Area Dermatologic Surgeon

Repair after Mohs

The first option in many cases is to close the wound by your Mohs surgeon that day. If the defect is large and the skin tight, sometimes you can allow for healing slowly over 4-6 weeks to close the area. This then can be later closed if needed as the wound will be at least 20% smaller if not more. This requires patience on your part. Sometimes it heals so good on its own that revision is not even needed but this may be more true in other areas rather than the mid... more

Shawn Allen, MD
Boulder Dermatologist

Is time critical for closure for forehead mohs defect

I would recommend getting the defect closed sooner as opposed to later. Here is the thing...yes you can take a chance and let it granulate (heal) in and see what it looks like. Most of the time it will be fine but sometimes it doesn't turn out well. At that point, If you don't like it you can have a surgeon do a scar revision which would be cosmetic. However, if a surgeon closes it after it will reduce the risk of a cosmetically unacceptable result and reduce the more

Chris Thiagarajah, MD
Washington DC Oculoplastic Surgeon

Mohs surgery and reconstruction

The location and size of the defect on the forehead really dictates the best approach to closure. I have seen all approaches including flaps, grafts, primary closure , and secondary intention result in excellent cosmetic results. I typically prefer closing the defect the same day as the Mohs surgery.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

www.palmbeachdermasurgery.com

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... more

Kavita Mariwalla, MD
New Haven Dermatologic Surgeon

Forehead scars are better after reconstruction

Most wounds of the body (including Moh's) will heal by themselves--referred to as healing by "secondary intention". The problems with this is that it may take a long time to close completely and usually, but not always, the scar is worse than if a well-executed surgical closure was performed. The forehead usually yields very good scars with reconstruction. The surgeon has to plan the operation so that the eyebrows are not asymmetric and the end of the reconstruction and that... more

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon

Mohs reconstruction

It is best to reconstruct the area of the defect soon after Mohs procedure to prevent infection and provide the best aesthetic outcome. This is done best using local flaps, although at times skin grafts can be used. Occasionally, if the defect is very deep, it can be left to granulate partially, before reconstruction.