What Should I Do if I Have a Large Lump After Mohs Surgery?

Question

I had Mohs done on small basal @ center forhead. I was left w/ a concave wide white scar, deep brow furrows, and a 10mm lump where final sutures were done 2yrs ago. One steroid injection helped flatten the lump some, but refused anymore. Taping flattens it but puffs up again after 1 hr.
Three derms & three surgeons won't help - they all said nothing will work on furrows & only offered more cuts to fix lump. The Internet says small injections will flatten lump w/ a spread out treatment.
Why can't I find someone to do this? Why no fillers for furrows? I even asked about fat filling, but I'd rather try a filler if the lump sinks in.
The lump looks like a big obvious zit! My hair is too fine to cover over.
Anyone have idea or referral? People suggest I should have it checked. Each Dr. gave different reason for why it's there. I have a small spot now on my cheek & I'm afraid to have procedure again.

Raffy Karamanoukian, MD, FACS · Answer

There are many reasons to have the fullness, including a remote risk of a recurrence. I would discuss the options for removal or repair with a qualified plastic surgeon. Raffy Karamanoukian, Los Angeles

William Ting, MD · Answer

Scar massage should be applied diligently 10x every 4-6 hours starting 3 weeks after Mohs surgery. If the affected post-op area remains hypertrophic, judicious low-concentration cortisone injection may be considered 3 months after surgery.

Andrew Kaufman, MD · Answer

The cause of the bump could be a thickened scar, a cyst, a reaction to suture material and even recurrence of the skin cancer. Because of this last possibility, I would recommend that you see someone to evaluate the possibility of skin cancer recurrence. This is most easily done with a small incisional biopsy. Most skin cancers occur in the first two years after surgery, and while Mohs surgery does provide the highest cure rate for skin cancer, nothing is 100% perfect. So I would recommend seeing a doctor, preferably a fellowship-trained Mohs surgeon (i.e. member of the American College of Mohs Surgery), and confirm what is causing that lump. Once recurrence of the skin cancer is excluded the problem should be able to be improved. By the way if the lump is a recurrence, Mohs surgery is still going to give the highest cure rate for a recurrent tumor.

Edgar Franklin Fincher, MD, PhD · Answer

The bump and deformities that you mention are really from the surgical closure that you had, not from having the Mohs procedure itself. The bump coul dbe several things, a hypertrophic (thick) scar or extra skin that is bunched up after closing the wound. The hypertrophic scar respond well to multiple injections, the extra skin requires a surgical revision. You describe an indentation as well which would require a surgical revision to correct. Noone wants to have a second surgery, but unfortunately it is sometimes necessary to get the result that you want.

Kenneth Beer, MD · Answer

There are a few reasons for a bump after mohs surgery. One of the most common is a suture that is being extruded and this is easily fixed.
Another is a pucker from a rotation flap- again, very simple to fix. Keloids or hypertrophic scarring can also give a bump and this can be treated with either injections or laser.
The most significant reason why people get a bump after Mohs is a recurrence of the skin cancer. While rare, it can occur and it may happen when a skin cancer is like a cluster of grapes rather than a single nodule. I would get a biopsy to see what is going on if there is any doubt.

What Should I Do if I Have a Large Lump After Mohs Surgery?

Answers (9)