Repair And Healing

WOUND REPAIR AND NATURAL HEALING

What Is The Next Step After Mohs Micrographic Surgery Has Been Completed?

When we have determined that the skin cancer has been completely removed, a decision is made about what to do with the wound created by the surgery. Usually there are two choices: (1) to let the wound heal by itself ("granulation") or (2) to repair (close) the wound with stitches (either by bringing the wound edges together or with a skin flap or skin graft). The following chart compares these two methods.

	POINTS FOR	POINTS AGAINST
Natural healing (granulation)	No further surgery; less expensive	Takes 4-8 weeks to heal; noticeable scar may result.
Sutures (repair)	Fast healing (usually 1 week); maybe less noticeable scarring	Further surgery required; more expensive.

What Are The Methods of Wound Repair?

A wound may be closed by repair immediately after Mohs micrographic surgery by either (A) bringing the wound edges together and trimming excess skin (a "complex" repair), or (B) a skin graft, or (C) a skin flap (see illustration below). A skin graft is a piece of tissue the same size as your wound; it is tissue taken from elsewhere on the body (usually from behind the ear or over the collarbone). After the skin graft is taken it is sutured onto your wound. A skin flap is skin that is nearby the wound; this skin is shifted into the wound by a series of complex incisions.

Should Repair (Plastic) Surgery Be Performed? If So, When?

It is impossible to tell with certainty prior to surgery how deep or wide your wound will be. Although we have a general idea prior to Mohs surgery, we prefer to wait until all the tumor is removed before thinking about whether to repair the wound immediately or what kind of repair to select. This concept is like walking over two bridges. One has to cross the first bridge before getting to the second bridge.

Furthermore, it may be preferable to wait for a few days after Mohs micrographic surgery before a repair is done. Some repairs are more likely to be successful if they are delayed.

Why Allow The Wound To Heal By Itself?

Occasionally when surgical wounds after Mohs micrographic surgery are unacceptable to the patient and the patient's family, suturing the wound may be considered. However, we may advise some patients to allow the wound to heal by itself and then to wait at least one year before having repair (plastic) surgery.

We sometimes advise waiting for two reasons:

1. Frequently, a repair may be unnecessary and can be avoided because the cosmetic result without repair surgery may be equal to that accomplished by repair surgery - and it takes about a year to determine this. Although repair surgery may improve scars and other defects, you will not look exactly as you did before Mohs micrographic surgery. In some patients, repair surgery may result in an appreciable difference.

2. Even more important that cosmetic considerations - no method of treatment for skin cancer, including Mohs micrographic surgery, is successful in all patients. In those few patients who do have a recurrence, the tumors usually become evident within 12 to 24 months after the initial surgery. Resorting to repair surgery immediately may distort and cover up tissue that still contains malignancy. If tumor remains after repair surgery, it may be difficult to treat.