Mohs surgery is considered the gold standard treatment for certain types of skin cancer.
With its extremely high cure rate of up to 99%, it's easy to assume that complications from Mohs surgery are rare.
However, while major issues are uncommon, patients should still be aware of the potential risks and side effects of this procedure.
By understanding the possible complications of Mohs surgery, patients can take steps to minimize risks and be prepared if any problems do arise during or after the surgery.
Mohs surgery, named after Dr. Frederic E. Mohs who developed the technique in 1938, involves surgically removing skin cancer layer by layer.
After each layer is removed, the tissue is immediately examined under a microscope. This process continues until only cancer-free tissue remains.
This precise, systematic approach helps ensure all cancer cells are eliminated while preserving as much healthy tissue as possible.
Mohs has the highest cure rate of any skin cancer treatment and results in the smallest possible wound needed to remove the tumor. It is useful for cancer in delicate areas like the face.
While major complications are rare, some minor issues can occur. Common side effects and risks include:
Some minor bleeding is expected after the procedure. However, uncontrolled or excessive bleeding is possible if blood vessels are inadvertently damaged during the surgery. Applying pressure to the wound for 10-15 minutes after surgery can usually stop minor bleeding.
Infection rates for Mohs surgery are typically quite low (1-2%). However, any surgical site involves some infection risk. Signs include increasing pain, swelling, redness, warmth, and pus-like drainage from the wound. Infections usually respond well to oral or topical antibiotics.
For wounds to heal properly, the skin edges must be brought together neatly. This may not always be feasible based on the wound's location and size. Large, deep, or poorly aligned wounds can result in scarring or require reconstructive surgery with flaps or grafts.
Scarring of some degree occurs with all surgeries. Mohs often produces minimal scarring since it preserves the greatest amount of healthy tissue. However, poor wound healing can lead to larger, thicker, or more visible scars. Scars may fade over one to two years.
While unlikely, there are some more serious complications that patients undergoing Mohs should be aware of:
Removing skin cancer from the face can potentially damage sensory nerves. In very rare cases, the nerves controlling facial muscles can be cut, resulting in facial paralysis or difficulty closing the eye. Surgery near the eyelid or lip can also distort these features.
Temporary or permanent facial numbness can be one of your signs. The lips, cheeks, chin, and nose are high-risk areas. Numbness usually fades over weeks or months but can persist in some minor cases.
While minor bleeding is common, uncontrolled hemorrhaging requires immediate medical attention. It can lead to anemia or cardiovascular complications. Excessive bleeding may result from clotting problems or damage to larger blood vessels.
Dehiscence refers to the surgical wound opening up after being closed with stitches or staples. Factors like infection, poor healing, and excessive tension on the closure can cause dehiscence. These wounds require immediate emergency care to prevent further expansion.
This rare complication involves loss of blood supply to jaw bone, resulting in tissue death. It has been linked to some immunosuppressive medications patients may take after Mohs. While quite rare, it can lead to disfigurement and severely impact the quality of life.
The appearance of new cancer growth at the site of the original surgery is concerning.
Since Mohs surgery aims for the complete removal of cancer cells with narrow margins, any new growth could indicate the presence of residual cancer cells.
If symptoms such as itching, excessive bleeding, or numbing pain reemerge at the site of the original lesion, this could signal a recurrence of the cancer.
As Mohs surgery's objective is complete cancer removal, any returning symptoms warrant immediate medical evaluation.
Certain medical conditions and factors can increase a patient's risk of developing complications:
Dermatology experts recommend patients with any of these risk factors discuss options to optimize healing before Mohs surgery. Steps like blood sugar control and stopping blood thinners under medical supervision can be taken to minimize risks.
Patients should take certain steps prior to surgery to enhance healing and reduce risks:
Thorough preparation and open communication with your Mohs surgeon provide the best chance of avoiding complications like bleeding, scarring, infections, and poor wound healing.
Careful wound care and vigilance after surgery are crucial:
Strictly adhering to wound care instructions and reporting any concerns quickly leads to the best outcomes after Mohs surgery. Don't hesitate to call your surgeon with any questions or unexpected symptoms.
If complications do develop, here are some common treatment approaches:
Close monitoring and prompt treatment provide the best results when facing complications after Mohs surgery. Patients should follow up diligently with their care team.
While some minimal scarring is expected with Mohs surgery, excessive or unaesthetic scarring may warrant scar revision procedures. According to dermatology experts, scarring severe enough to consider revision typically includes:
Scarring requiring revision is evaluated on a case-by-case basis. Your Mohs surgeon can assess the need for revisions based on the scar’s physical characteristics and its functional and psychological effects.
If scar revision is deemed appropriate, some surgical techniques that may be used include:
The technique chosen depends on variables like scar size, depth, and location. Combinations of approaches may be used. Your surgeon will advise you on recommended options to optimize functional and cosmetic outcomes.
While certainly not guaranteed or even likely, patients considering Mohs surgery should have realistic expectations that complications can occasionally occur.
However, being informed of the risks and taking actions like quitting smoking, carefully following pre- and post-op directions, and promptly reporting concerns can greatly reduce the chances of complications arising.
Staying engaged with your treatment team and being vigilant in the recovery process allows for the best results from Mohs surgery.
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