Can you advise why it's still painful after 1 yr post op Mohs surgery?

Question

Hi! I had my 3rd Mohs surgery in same spot, left nostril to remove bcc a yr ago & a full thickness skin graft & bone cartilage added to support my nostril. I'm still feeling zaps of pain and continuous burning daily, even though there's nerve damage. It doesn't feel normal, as my 1st two Mohs I didnt have any burning or pain after only weeks. I'm worried there's still cancer in there. And how would I even know? I cant get a straight answer from Derms or my surgeons. I worry daily, what can I do?

Raffy Karamanoukian, MD, FACS · Answer

Moh’s surgery on the face often requires surgical repair and reconstruction to reapproximate the skin edges. Flaps or direct closure techniques are used. It is important that you optimize scar healing during this phase in order to reduce longterm scars. For red scars, we use Vbeam laser, followed by fractional laser for scar topography and contour. We recommend Plato’s Scar Serum twice daily for the immediate postoperative period. Fractional laser is safe for scar laser therapy. 
There are treatments for swelling and edema of the scars. If there is residual sutures or edema, we advise you to follow a scar treatment protocol that can minimize the time to recovery. Our office specializes in scar revisions for Moh’s surgery. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Irena Karanetz, MD · Answer

Hello,
Thank you for the question.
It is difficult to tell without seeing photos, but final wound healing can take up to 1-1.5 years to be completed after surgery.
Revision surgery can be performed in the future, but for now I would continue with conservative management and scar massage.
I would definitely discuss your questions and concerns with your Dermatologist and Plastic Surgeon.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

Joel L. Cohen, MD · Answer

if you had 3 surgeries in the same spot, I agree with you that pain can be concerning. Of course the pain could be related to scar tissue or could be related to the significant reconstruction with bone and cartilage. But it could be the possibility of continued tumor, and tumor getting into a nerve in the area and spreading along the nerve. Unfortunately, there is no perfect imaging modality right now to be able to deduce this type of tumor nerve invasion. But new techniques such as confocal microscopy are becoming more studied to be able to assist in these circumstances -- whereas otherwise clinical surveillance and when indicated "scouting biopsies" can be done to see if tumor is found.

Can you advise why it's still painful after 1 yr post op Mohs surgery?

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Can you advise why it's still painful after 1 yr post op Mohs surgery?

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Everything you need to know about Mohs Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.