Post Mohs Procedure, my Dermotologist Did NOT Do Skin Graft

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.
 

  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. 

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.

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.

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.

Second intention healing or allowing a wound to heal without suturing it is a preferred method of healing based upon size and location. A small defect can heal excellent particularly around the nasal ala areas and often does better than a flap in these areas.

Choice of repair after Mohs surgery is dependent upon a number of factors. Concave areas of the nose, ears, eyes, and temple frequenly heal well by secondary intention healing (allowing the wound to heal by itself). Talk to your doctor about why he/she chose to allow the wound to heal by secondary intention healing, and if the wound doesn't heal satisfactorily, ask your doctor about options to improve the final cosmetic result.

In each case after Mohs surgery there is a wound (now cancer-free) that must be dealt with.  Options include allowing the wound to heal on its own as was done in your case (also called second intention healing).  Other options are sewing it together directly (primary closure) or moving local skin in either as a flap or graft.

All of these can be good choices depending on the location, depth and size of defect, patient issues etc. - in many cases good surgeons might choose different options (ie not always a "right" answer)  If you have any specific questions, I'd ask your surgeon directly..

What your Mohs surgeon did was let the wound heal in by second intention.  It is not my first choice for defects of the nose, but depending on the size and location of the defect, it may leave an acceptable cosmetic outcome.    So yes, it is normal for small defects.  A picture of the defect would help. 

Personally, I prefer to use local flaps or grafts for my nasal defects, but there are many acceptable ways to approach reconstruction of  a Mohs defect.