Hi, 50 year old male, i just had Mohs surgery performed yesterday on a basal cell carcinoma. The wound is about the size of a nickel and is on the top of my head. Dr scheduled closure 10 days after surgery. He said that the reason was because he wanted to see if anymore BCC was there in 10 days, but since my first stage pathology was negative, i thought all of the BCC was gone. Why would he schedule my wound closure 10 days later? It hurts like hell and i just want it over. Any thoughts?
Wound Closure 10 Days After Mohs Surgery?
Doctor Answers (5)
the value of Mohs surgery is that when the margins are clear and the surgery is completed then you can be closed in the office. There are times when you may need to heal before closure but these are few specific cases.
Step #1 Find out if your dermatologist is a fellowship-trained Mohs surgeon. If not , I would recommend you seek a second opinion by a fellowship-trained Mohs surgeon. Got to mohscollege.org to see who in the area is certified. They will be able to examine your case , your notes and see what is going on. If your surgeon is fellowship-trained then you need to get a better understanding of what they are thinking and what they see that concerns them that their margins were not clear. In any event some clarification is needed since you seem to be confused and possibly rightfully so.
Delayed closure after Mohs
There are a couple of possible reasons to delay repair: 1. The surgeon sent the final specimen to a pathologist for permanent sections to confirm the negative margin, 2. The surgeons wants to repair the Mohs defect with a delayed skin graft. Waiting for 10-14 days before graft placement improves the wound bed to enhance the chance for graft take and allows for some filling in of the wound bed to improve the final contour.
Delayed Wound Closure After Mohs Surgery
I would agree with Dr. Hruza. Best option is to ask your doctor exactly why he is delaying repair of the defect. If the defect is particularly deep or there is exposed bone, he may want to wait for sufficient granulation tissue to develop before placing a graft. The possibility that he is waiting for a final pathology report before repairing is less of a possibility as generally the surgical margins are determined on the same date (exceptions perhaps being some unusual types of skin cancer). Good luck.
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Scalp defect after MOHS
I am not sure why you are waiting 10 days. The only reason I can see is the final pathology report. The wound can be closed and if the margins are positive again then you will need more surgey to remove the remaining part of the tumor.
Best to Close Mohs Surgical Wounds Same Day if Possible
The beauty of Mohs surgery is that there is confidence that all of the skin cancer was removed at the time of surgery without waiting. My own personal experience is that I coordinate with the Mohs surgeon to send the patient to my plastic surgery office immediately following the Mohs surgery for me to do the reconstruction.
You might want to ask the specific reasons why this answer was given.