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

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

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.

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.

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.  

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.

I would suggest that you discuss this lump with your Mohs surgeon. It is most likely that your lump is not indicative of a recurrence of your cancer but more indicative of scar tissue. As such the scar tissue can be treated so that it is worth discussing with your Mohs surgeon. At the same time, he or she can reassure you that this is normal and hopefully not reflective or any residual cancer.

Without seeing your problem, I can't comment on the best option for repair. I would suggest visiting a facial plastic surgeon since they focus on cosmetic and reconstructive surgery of the face only.

The most simple solution sounds like the one that has been recommended, which is re-excision of the area. This should be done to achieve 2 results:
1. To remove the lump in the area
2. To better evert the edges of the skin so that the final surgical line is no longer indented and blends in well with the skin in the area.
Please be sure that you seek out a Fellowship-trained Mohs surgeon or a plastic surgeon or a facial plastic surgeon to do this repair.

Since I can't see exactly what you are talking about, I really can't give you a specific answer. However, if you would please go to the best American Board of Plastic Surgery certified surgeon in your area or in Phoenix, I am sure you will get a straight answer of what your treatment options are.