Ashley Wysong, MD, MS, FAAD (retired)

You are absolutely correct that removing the cancer and ensuring that it is completely out is the critical first step.  In addition to the Breslow thickness, it is important to know whether or not your melanoma has ulceration and whether or not it has an elevated mitotic index (>1), both of these features can potentially upstage your melanoma from a 1A to a 1B and may prompt consideration of additional work-up and treatments.

Assuming a Stage 1A melanoma without need for further evaluation, standard therapy after the biopsy and diagnosis is "wide local" surgical excision with 1 cm margins.  In order to assure clear margins, some physicians use "complete margin assessment" (or Mohs surgery) when pathologically processing the tissue to look at 100% of the surgical margin, however, the standard "bread loaf" technique of processing margins is standard of care.  One other important thing to know is that the lentigo maligna subtype of melanoma can sometimes require more than 1cm margins to completely clear the tumor.

Once the melanoma is confirmed to be out by pathology, the cosmetic reconstruction begins and you can have a detailed discussion with your dermatologic surgeon or plastic surgeon about the different options for reconstruction depending on the size, depth, and location of your wound.

Best wishes!

It is normal to have some redness, swelling, and drainage after Mohs surgery depending on the type of reconstruction you had to close your Mohs wound.  Itching can be a normal part of healing, but could also mean you are having a reaction to any topical ointments or creams you may be applying, to adhesive in your bandages, or even to the stitches that were placed.  Most importantly, increasing swelling, redness, pain, warmth, or discharge could be signs of infection.  It is important that you touch base with your doctor.

Don't hesitate to contact your Mohs surgeon to discuss your concerns.  I am available for my patients 24-7 and would definitely appreciate a call if they were experiencing concerns of any kind.  It's not uncommon for myself or other Mohs surgeons to meet patients after hours and on the weekends to take a look at the surgical wound. That's what we're here for!

Best of luck!