Mohs Surgery on Nose - Stitches or Left to Heal by Itself?

First off, kudos to you for using a Mohs surgeon to treat a skin cancer on a cosemtically sensitive area.  As stated before, make sure that you are using a fellowship-trained Mohs surgeon.

Personally, I do not like to leave defects on the nasal tip to heal by secondary intention.  I feel that this leaves an unacceptable scar.  There are other locations were secondary intention healing is acceptable (concha of ear, small medial canthal defects), but I do not consider the nasal tip one of these.

Depending on the size of your final defect, there are several repair options.  If your defect is midline on the nasal tip, your surgeon may be able to close it primarily (in a straight line).  If that is not feasible, then you are looking at a skin flap (moving around adajcent skin) or a skin graft.   I am not a big fan of grafts on the nasal tip unless it is really small and shallow. 

First of all, are you seeing a board certified and fellowship-trained Mohs surgeon. You can tell by going to Mohscollege.org and look up your doctor. Next, you should know that this surgical decision can only be determined after the Mohs layers show no residual cancer cells and the depth of the area is known.  Sometimes these "small" cancers can be tiny or be just the tip of the iceberg.  Lastly, your fellowship-trained Mohs surgeon is required for certification to have extensive experience with reconstruction. So they will be able to tell you if a skin graft , a local flap, a linear closure , or healing without stitches is best.  In general, the nose tip is rounded and is not prone to ideal healing without stitches whereas the creases of the nose would do much better without stitches.  Rest assured, that if stitching is needed this will cut down your healing time by up to 3 weeks as compared to leaving it open to heal on its own. Lastly, be aware that every wound can and will heal without any stitches, but if ideal cosmetic outcome is of concern then discuss this with your Mohs surgeon.