Post Mohs Procedure, my Dermotologist Did NOT Do Skin Graft

Question

He cautorized only to allow for healing from within. Is this normal and best practice for a small basal cell carcinoma on the nose?

Ron Shelton, MD · Answer

There are many factors that go in to a decision about reconstruction after Mohs surgery or excision of a skin cancer on the nose.  The convex areas such as the nasl tip or the convex surface of the nostril in those patients whose nostrils are very rounded, do not typically heal well with just dressing changes.  The concave areas of the crease around the nostril heal somewhat better, or the area between the nasal bridge and the eye in its concavity.  If a patient's skin is very thick and has oily porous skin, the second intent healing may leave too shiny and thin a scar to match.  Skin grafts are not a perfect match, either, however.  In fact, over a year, the graft becomes thinner and yellow or even brown on rare occasions whereas others become white.  Some wounds that are left to heal on their own contract and leave a disfigured appearance of a close-by cosmetic area if it is pulled from the conraction.  For these reasons, a flap is often done, in which the neighboring skin maintains its blood flow and texture and color but creates a larger scar than second intent healing or a graft. Reconstruction possibilities are numerous and require a physician to think of your anatomy, skin characteristics, neighboring regions with their "free margins" that can get pulled because they have nothing anchoring them, etc. Science and art is involved in this decision making process, mixed with experience.

Lawrence Kass, MD · Answer

Obviously, the answers you are getting vary.  My best guess is that if this was small, the results will be better with the way your doctor treated you than if a skin graft had been employed.  Be patient.  It will likely look fine.

Stephen Prendiville, MD · Answer

There are areas where healing by secondary intention can leave an acceptable cosmetic result.  However, in most situations, the nose is not one of them.  Nasal skin is very thick and overlies a cartilaginous framework, leading to contour irregularities and contracture if secondary intention is chosen as the method of healing.

Robert Strimling, MD · Answer

Yes, this may be OK.  This is called healing by granulation and often times for a small superficial cancer defect on the nose this is the best healing option.  Healing by granulation will take some time, from weeks to months.  Follow-up with your dermatologic surgeon as directed and discuss any healing concerns with him or her.

Brian E. Dubow, MD · Answer

We commonly allow "defects" from Mohs surgery to "granulate" or heal naturally.  The decision to do this vs. perform a repair (skin flap, graft etc.) depends upon the size, shape and location of the wound.  If the natural healing process does not give you an acceptable cosmetic result, you can always have the scar revised later on which will result in the same result had the repair been performed at the time of surgery.

Post Mohs Procedure, my Dermotologist Did NOT Do Skin Graft

Answers (9)

Answer: Healing by granulation after Mohs Surgery

Answer: Healing by granulation after Mohs Surgery

Answer: Yes this is OK, and was done to help you heal naturally

Answer: Yes this is OK, and was done to help you heal naturally

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Everything you need to know about Mohs Surgery

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Post Mohs Procedure, my Dermotologist Did NOT Do Skin Graft

Answers (9)

Answer: Healing by granulation after Mohs Surgery

Answer: Healing by granulation after Mohs Surgery

Answer: Yes this is OK, and was done to help you heal naturally

Answer: Yes this is OK, and was done to help you heal naturally

Browse related questions

Recommended reading

Everything you need to know about Mohs Surgery

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