Lumpy Scars After Mohs Surgery

Your Comprehensive Guide to Understanding and Managing Post-Operative Scarring

Imagine gazing at your reflection in the mirror, only to find an unfamiliar face staring back. You're not the same person who walked into the surgeon's office, eager to fight off skin cancer through Mohs surgery. While you won your battle against the disease, you were left with an unexpected opponent: lumpy, noticeable scars.

As uninvited guests, these scars may be evoking a myriad of emotions — from frustration to fear, despair to discomfort. But what if we told you there's a comprehensive guide to understanding and managing post-operative scarring after Mohs surgery?

Whether you're still coming to grips with the aftermath of your surgery or searching for ways to feel like yourself again, read on. Together, let's turn these unexpected souvenirs of your battle into badges of survival and resilience.

Mohs Surgery and Skin Grafts

Mohs surgery, renowned for its precision and efficacy, is a go-to technique when confronting skin cancer, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Conducted by a trained and board-certified Mohs surgeon, this advanced procedure involves an incredibly meticulous process.

During the surgery, thin layers of skin are systematically removed and promptly scrutinized under a microscope. This layer-by-layer approach continues until only cancer-free tissue remains, ensuring the highest potential cure rate while simultaneously preserving as much healthy tissue as possible, thereby minimizing scarring.

Beyond its precision, Mohs surgery stands as a gold standard for treating many types of skin cancer due to its ability to minimize the chances of the cancer reappearing. While it effectively removes cancerous cells, the primary goal is to save as much healthy skin as possible.

In certain instances, the nature of the surgical procedure may necessitate the use of skin grafts. In these cses, aa piece of skin from an adjacent, healthy area is strategically used to cover the surgical wound, aiding in the healing process and further minimizing the cosmetic impact of the procedure.

Mohs Surgery Scar Types

Following the removal of skin cancer through Mohs surgery, the body's natural healing process can result in the formation of several different types of scars. It's essential to recognize these potential outcomes and understand that the appearance of a bump after surgery may be more common than you think.

1. Hypertrophic or Keloid Scars

These are characterized by an overgrowth of collagen at the site of the wound, leading to raised, thickened, and often whitened scars. They develop at the skin level and may stand out. Hypertrophic scars occur due to an overactive healing response, while keloid scars, notably, can extend beyond the boundaries of the original surgical wound and may continue to thicken over time.

2. Normal Fine-Line Scars

These scars are common post-surgery. They typically heal to leave a raised line that progressively fades and flattens over time. While they are not usually painful, they might be itchy for several months.

3. Atrophic or Depressed Scars

Also known as pitted or sunken scars, these are characterized by depressed areas on the skin that occur due to loss of tissue during the healing process.

4. Contracture Scars

These scars cause tightening in the surrounding tissue, potentially affecting functionality and movement. They pull down the adjacent skin and can significantly change the appearance of the affected area.

5. Discolored or Pigmented Spots

Post-operative spots can be a result of sun exposure, aging, or the surgery itself. They are typically harmless but might be cosmetically undesirable for some patients.

Cure Rate of Mohs Surgery

Among skin cancer treatment options, Mohs surgery boasts a high cure rate reaching up to 99%, minimizing the possibility of skin cancer recurrence. Yet, patients should remain vigilant for signs of future skin cancers, especially if they have a skin type prone to sun damage.

Symptoms of Skin Cancer

The symptoms of skin cancer can vary depending on the type of skin cancer. Here are some common symptoms associated with different types of skin cancer:

Common Symptoms	Basal Cell Carcinoma	Squamous Cell Carcinoma	Melanoma
A pearly or waxy bump	✔
A flat, flesh-colored, or brown scar-like lesion	✔
A bleeding or scabbing sore that heals and returns	✔
A large brownish spot with darker speckles		✔
A mole that changes in color, size, or feel, or that bleeds		✔
A small lesion		✔
Asymmetrical shape of a mole or spot			✔
Irregular or jagged border of a mole or spot			✔
Uneven color of a mole or spot			✔
Diameter of a mole or spot larger than the size of a pea			✔
Changes in the mole or spot over time			✔

In addition to these specific symptoms, there are more general indications of skin cancer that may not be tied to a particular type. These can include:

• New growths on the skin
• Changes in the size, shape, or color of existing skin growths or moles
• Pearly or waxy bumps on the face, ears, or neck
• Flat, pink/red- or brown-colored patches or bumps
• Areas on the skin that resemble scars
• Sores that are crusty, have a depression in the middle or bleed often
• Wounds or sores that won't heal or that heal but come back again
• Rough, scaly lesions that may itch, bleed, and become crusty

Always consult with a healthcare professional if you notice any of these symptoms or any other unusual changes to your skin.

Wound Care after Skin Cancer Surgery

Proper wound care is vital in the days, weeks, and months after surgery. Initially, some bit of blood oozing is normal, and an ice pack can help reduce swelling. The wound should be kept clean using a dry cloth to dab any excess blood gently. The use of an anti-bacterial ointment and butterfly bandages can aid in healing.

Other wound care tips that you can do:

1. Maintain cleanliness: Ensure your wound stays clean and dry by gently washing it 1 to 2 times a day with a mild, fragrance-free soap and warm water. Always clean your hands thoroughly before and after caring for the wound to minimize the risk of introducing or spreading germs.
2. Use suitable ointments: To prevent a crust from forming or being inadvertently removed, apply a thin layer of petroleum jelly or a prescribed antibiotic ointment on the wound. This also helps to keep the area moisturized, promoting faster healing.
3. Bandage appropriately: Use nonstick gauze or an adhesive bandage cut to the size of your wound to cover it. This helps protect the wound from external irritants and reduces the risk of infection.
4. Handle with care: Be especially gentle when washing the wound. If it's located on your scalp or another sensitive area, be mindful not to scrub or disturb the healing tissues.
5. Follow-up care is crucial: The importance of follow-up care cannot be overstated. Be sure to schedule and attend all post-operative appointments. If you encounter any issues or have concerns about your healing process, do not hesitate to contact your doctor or nurse.

Post-Surgery Considerations

In the weeks after surgery, it's crucial to mind your activities and pay attention to your body's responses to promote optimal healing. Here's what to bear in mind:

• Limit physical strain: Avoid heavy lifting or bending from the waist for as long as your sutures are in place. Such activities can put undue pressure on the wound and disrupt the healing process.
• Expect swelling and bruising: Particularly when surgery has been performed near the eyes, swelling and bruising are common post-surgery reactions, generally appearing within five to seven days. The use of an ice pack in the initial 24-48 hours can help reduce these symptoms. It's also normal for the area surrounding your wound to feel numb for weeks, or possibly longer.
• Manage discomfort: While significant discomfort is uncommon after Mohs surgery, any mild discomfort you may experience can usually be managed effectively with over-the-counter pain relievers like acetaminophen.
• Monitor for bleeding: Though bleeding is rare following Mohs surgery, slight blood or seepage on your dressing is normal. If you notice active bleeding (such as a bandage soaked with blood), remove the bandage and apply firm pressure over the area with dry gauze or dry cloth for 20 minutes. If bleeding persists, contact your doctor or the on-call dermatologist after office hours.
• Understand your healing process: Remember, any extra skin or scar tissue that forms post-surgery is part of your body's healing process and an integral part of the collagen architecture. The appearance of these should gradually improve over time, though the timeline may vary for each individual. 

Scar Healing and Treatment Options

There are many scar treatment options available for healing. Over-the-counter silicone sheet brands or silicone gels can be used to apply firm pressure to the scar, aiding in the appearance of scars. In addition, steroid injections, often used in conjunction with silicone strips, can be beneficial in reducing scar size and itching.

The Role of Silicone Gels and Sheets in Scar Healing

Silicone products are a classic option for scar care due to their efficacy in reducing the prominence of hypertrophic scars. They work by creating a moist environment conducive to scar healing, reducing collagen production, and helping the scar blend with normal skin.

Area	Silicone Gel	Silicone Sheets
Composition	Easy-to-apply gel	Soft, flexible, self-adhesive dressings made of 100% silicone
Application	Can be used on any skin type, including sensitive skin and in children. Versatile, can be applied on irregular scar surfaces, moving parts, and scars of any size	Applied directly over scars. Can be worn alone or underneath pressure garments, splints, or casts
Function	Works by reducing transepidermal water loss and raising the skin surface temperature, which may stimulate collagenase activity. Balances the expression of growth factors to aid in scar healing	Create a protective barrier over the scar, preventing the production of excess scar tissue and aiding scar maturation. They assist with scar hydration, helping the body maintain moisture during the healing process and regulate collagen production, minimizing scarring. Improve the color, height, and texture of a scar, and relieve itching and discomfort

Final Thoughts

Facing Mohs surgery is a daunting task, let alone navigating the aftermath that often involves dealing with unexpected lumpy scars. However, understanding these outcomes and exploring your options in managing post-operative scarring can provide hope in restoring your confidence and reclaiming your identity.

Whether you're currently grappling with the impact of Mohs surgery or considering your next steps toward recovery, this guide serves as a comprehensive resource to help you make informed decisions. Remember, your scars are not just reminders of a tough battle, but they also symbolize your bravery and resilience in the face of adversity.

Battling with lumpy scars after Mohs surgery? Our dedicated team at Dermatology & Skin Health is committed to supporting you on this journey. We specialize in delivering top-tier medical and cosmetic treatments including Mohs reconstructive surgery, designed to reduce the appearance of your scars and enhance your skin's health.

We understand how challenging living with facial scarring can be, and that's why we're committed to devising personalized care plans that fit your specific needs. Reach out to us to schedule an appointment today, and let us help you restore confidence in your skin!