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What Should I Do if I Have a Large Lump After Mohs Surgery?

I had Mohs done on small basal @ center forhead. I was left w/ a concave wide white scar, deep brow furrows, and a 10mm lump where final sutures were done 2yrs ago. One steroid injection helped flatten the lump some, but refused anymore. Taping flattens it but puffs up again after 1 hr.

Three derms & three surgeons won't help - they all said nothing will work on furrows & only offered more cuts to fix lump. The Internet says small injections will flatten lump w/ a spread out treatment.

Why can't I find someone to do this? Why no fillers for furrows? I even asked about fat filling, but I'd rather try a filler if the lump sinks in.

The lump looks like a big obvious zit! My hair is too fine to cover over.

Anyone have idea or referral? People suggest I should have it checked. Each Dr. gave different reason for why it's there. I have a small spot now on my cheek & I'm afraid to have procedure again.

Doctor Answers (9)

Removing a dog ear or lump near the skin cancer removal scar - Los Angeles

+1

There are many reasons to have the fullness, including a remote risk of a recurrence.  I would discuss the options for removal or repair with a qualified plastic surgeon. Raffy Karamanoukian, Los Angeles


Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

Cause and treatment of bump after Mohs surgery

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The cause of the bump could be a thickened scar, a cyst, a reaction to suture material and even recurrence of the skin cancer. Because of this last possibility, I would recommend that you see someone to evaluate the possibility of skin cancer recurrence. This is most easily done with a small incisional biopsy. Most skin cancers occur in the first two years after surgery, and while Mohs surgery does provide the highest cure rate for skin cancer, nothing is 100% perfect. So I would recommend seeing a doctor, preferably a fellowship-trained Mohs surgeon (i.e. member of the American College of Mohs Surgery), and confirm what is causing that lump. Once recurrence of the skin cancer is excluded the problem should be able to be improved. By the way if the lump is a recurrence, Mohs surgery is still going to give the highest cure rate for a recurrent tumor.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.5 out of 5 stars 6 reviews

Scar massage key to minimize post Mohs surgery scar

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Scar massage should be applied diligently 10x every 4-6 hours starting 3 weeks after Mohs surgery. If the affected post-op area remains hypertrophic, judicious low-concentration cortisone injection may be considered 3 months after surgery.

William Ting, MD
Bay Area Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

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Bump from surgery not from Mohs

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The bump and deformities that you mention are really from the surgical closure that you had, not from having the Mohs procedure itself.  The bump coul dbe several things, a hypertrophic (thick) scar or extra skin that is bunched up after closing the wound.  The hypertrophic scar respond well to multiple injections, the extra skin requires a surgical revision.  You describe an indentation as well which would require a surgical revision to correct.  Noone wants to have a second surgery, but unfortunately it is sometimes necessary to get the result that you want.  

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

Bump After Mohs Surgery

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There are a few reasons for a bump after mohs surgery. One of the most common is a suture that is being extruded and this is easily fixed.

Another is a pucker from a rotation flap- again, very simple to fix. Keloids or hypertrophic scarring can also give a bump and this can be treated with either injections or laser.

The most significant reason why people get a bump after Mohs is a recurrence of the skin cancer. While rare, it can occur and it may happen when a skin cancer is like a cluster of grapes rather than a single nodule. I would get a biopsy to see what is going on if there is any doubt.

Kenneth Beer, MD
Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Lump after Mohs surgery

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I would suggest that you discuss this lump with your Mohs surgeon. It is most likely that your lump is not indicative of a recurrence of your cancer but more indicative of scar tissue. As such the scar tissue can be treated so that it is worth discussing with your Mohs surgeon. At the same time, he or she can reassure you that this is normal and hopefully not reflective or any residual cancer.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Facial Plastic Surgery Consult

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Without seeing your problem, I can't comment on the best option for repair. I would suggest visiting a facial plastic surgeon since they focus on cosmetic and reconstructive surgery of the face only.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
4.0 out of 5 stars 12 reviews

Re-excision seems to be the simplest solution

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The most simple solution sounds like the one that has been recommended, which is re-excision of the area. This should be done to achieve 2 results:

1. To remove the lump in the area

2. To better evert the edges of the skin so that the final surgical line is no longer indented and blends in well with the skin in the area.

Please be sure that you seek out a Fellowship-trained Mohs surgeon or a plastic surgeon or a facial plastic surgeon to do this repair.

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

Please see nan ABPS surgeon

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Since I can't see exactly what you are talking about, I really can't give you a specific answer. However, if you would please go to the best American Board of Plastic Surgery certified surgeon in your area or in Phoenix, I am sure you will get a straight answer of what your treatment options are.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.