What Can Be Done for Mohs Surgery Lumps?

Question

Nine months ago, I had Mohs surgery on my cheek (near my nose) for a very small Basal Cell Carcinoma (BCC). I developed two lumps from the surgery: one is a dog ear, and the other is a large lump that was caused from tissue being pushed by the surgeon. I was just told that this large lump will "never go away." Is there anything that a plastic surgeon can do to remove or lessen the appearance of this lump? I was never told that this could be a result of this surgery.

William Ting, MD · Answer

What you have is either a hypertrophic scar as a reaction to buried sutures or the so-called 'dog ear' or standing-cone deformity after reconstructive repair after Mohs micrographic surgery. The easiest solution would be to inject very dilute amount of cortisone to the affected area. Scar massage using your pinky finger should be done 10x every 8 hours and the affected area should flatten in the next several weeks. Simple surgical scar revision can be performed as a last resort.

Andrew Kaufman, MD · Answer

First of all, it really depends on what is the etiology of the "lumps." Frequently dog ears can resolve within months of surgery in some areas, such as the scalp, forehead, and trunk. Second, I would get a second opinion from another surgeon as the cause of these lumps and what can be done. Depending on the cause, the problem can likely be treated with injections at the surgery site or possibly another surgical procedure. I would recommend that you see a fellowship trained (through the American College of Mohs Surgery or ACMS) Mohs surgeon or a plastic surgeon/facial plastic surgeon who does a lot of reconstructive surgery in their practice.

Chris Thiagarajah, MD · Answer

The lumps after Mohs surgery have several treatment options

	1. massage to soften them - this will take some time - 6 months to a year 

	2. Steroid injection to soften them - this may or may not work well

	3. Scar revision - a procedure to minimize the lumps

	Remember that you had cancer on your nose and this was being done to rid your face of it. The most important thing is that the cancer is gone. Mohs is done to maximize the cosmetic outcome but it is not guarantee that you will "look like nothing was done". It may take additional procedures to get you cosmetically back to normal. It is important to realize that these are cosmetic concerns which your insurance company may not cover.

Steven Hacker, MD · Answer

Reconstruction after surgical removal of a cancer may at times result in an undesirable result. If you have an unsightly scar I would suggest you seek the opinion of a plastic surgeon to see if revising the scar would improve it's appearance. Be patient though , time is often the best solution and scars tend to minimize with time.

Shawn Allen, MD · Answer

First of all, be sure that you are dealing with a Fellowship-trained Mohs surgeon as the Fellowship emphasizes and requires expertise in cosmetic reconstruction. If they are Fellowship-trained, you can go to www.Mohscollege.org and look up your state and find your physician will be there.  
Aside from that, lumps after surgery such as dog ears are easily repaired with a small surgical excision. For deeper scar tissue lumps, an injection of Kenalog can often hasten the resolution of these lumps. Your first step is to report your concerns to your surgeon and they should be able to handle this problem (if they cannot, check the credentials of your Mohs surgeon at the website above). The next step would be to seek out a facial plastic surgeon or a general plastic surgeon, or another Fellowship trained Mohs surgeon.

John P. Di Saia, MD · Answer

Hello,
Get a consultation with a plastic surgeon who does skin cancer reconstruction and see what might be done. There may be limitations but there is no reason not to check it out.

Don Mehrabi, MD · Answer

Thank you for your question.  In regards to the dog ear pouching, most dog ears can be removed by doing a minor scar revision at that end. Most of these mini-surgeries are quick and have excellent results. Keep in mind that, when doing a dog ear revision, the scar will be slightly longer than before. For most people, that's a welcome trade-off.
With regards to the lump, it really depends on where it is, the size, and what the true reason for that lump may be. In most cases, a minor lump due to suture inflammation or scarring may be treated with steroid injections. Lumps or bumps due to large tissue movement may not be amiable to any reasonable treatment except corrective surgery.

Stella Desyatnikova, MD · Answer

Hard to tell without taking a look at you, but sounds like you developed a couple of lumps from the reconstructive portions of the procedure. "Mohs surgery" refers to the excision of tumor by a special method, and then we usually perform some kind of reconstruction to close the defect.
Occasionally, a revision surgery might be necessary to further improve the appearance of the operated site. It might be considered cosmetic, and might not be covered by your insurance. Talk to your surgeon about it, or go to an experienced facial plastic surgeon who does soft tissue facial reconstruction on a regular basis.

Bryan K. Chen, MD · Answer

At 9 months out from your surgery, any "settling" down of the dog-ear probably would have occurred by this time.  Dog-ears can be repaired, but this would require an additional surgical procedure.  The "lump" of scar that you describe probably would benefit from a series of cortisone injections. 
I would consult first with the Mohs surgeon who performed your surgery and/or closure.  If you are still dissatisfied, consider obtaining a second opinion with a board certified dermatologist or plastic surgeon.
Good luck.

Robert E. Zaworski, MD (retired) · Answer

After you are healed from your surgery, you may want to have scar revision to "tweek" the area for a better cosmetic result. This is very common after Mohs Surgery. The goal of your surgeon was to get all the cancer out at the time of surgery. Discuss this with a Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgery ( ASPS) for a better cosmetic result.

What Can Be Done for Mohs Surgery Lumps?

Answers (11)

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