Understanding Mohs for Lower Leg Skin Cancers

Thinking about Mohs surgery on your lower legs? Get all your questions answered here.

Unsure if Mohs surgery is right for you? At Dermatology & Skin Health, we specialize in Mohs surgery for recurrent, aggressive, or complex skin cancers on the lower legs.

Read on as we explain what Mohs surgery is, the main indications like recurrent growths and preserving function, the meticulous surgical process, recovery period, expected pain levels, risks vs benefits, costs, and tips for selecting the right Mohs surgeon.

What Are the Indications for Mohs Surgery on Lower Leg?

The main indications for Mohs surgery on the lower leg are removing recurrent skin cancers, treating aggressive tumors, preserving tissue in functionally critical areas, eliminating rare cancers, and reducing surgical infection risks based on our experience.

• Removing Recurrent Skin Cancers

One of the top indications is removing recurrent basal cell or squamous cell carcinomas on the lower legs that have returned after previous treatments like cryotherapy or surgical excision. 

Mohs surgery has the highest cure rates for eliminating these stubborn, treatment-resistant tumors on the shins, calves, ankles, feet, and other areas of the lower legs.

• Treating Aggressive Skin Cancers

Mohs surgery is also ideal for getting rid of more aggressive or rapidly growing skin cancers on the lower legs. The precise layer-by-layer removal can effectively eliminate basal cell and squamous cell carcinomas that may have indistinct edges or be spreading under the skin surface on lower leg areas.

• Preserving Function in Critical Areas

We often recommend Mohs surgery for lower leg skin cancers located in functionally important areas where maximizing tissue preservation is vital. 

These include the ankles, feet, shins, calves, and other pretibial surfaces of the lower leg where saving as much normal tissue as possible is needed for maintaining mobility and stability.

• Removing Rare Skin Cancers

While less common, certain rarer skin malignancies found on the lower legs may also warrant Mohs surgery. For instance, Merkel cell carcinoma and other unusual cancers can be effectively treated and eliminated through the accuracy of the Mohs technique.

• Reducing Infection Risk

Finally, Mohs surgery minimizes the risk of surgical site infections that can occur after procedures on the lower extremities like the legs. By targeting only diseased tissue, Mohs optimizes recovery and lowers infection risk.

A large prospective study of over 4,400 patients found a basal cell carcinoma recurrence rate of only 1.3% per year after Mohs surgery.

Don't wait - contact DSH today to explore your Mohs surgery options for lower leg skin cancer.

How Is Mohs Surgery on Lower Shin Performed? 

Mohs surgery on the lower shin involves numbing the area, removing the tumor plus a thin layer of tissue, mapping and analyzing it microscopically, taking additional thin layers if needed until clear margins are achieved, and then closing the wound. 

At Dermatology & Skin Health, our Mohs surgeons take a precise, staged approach to removing skin cancers on the lower shin while preserving healthy tissue.

1. First, the visible tumor is outlined and thoroughly numbed with local anesthesia. More anesthesia is often needed on the lower legs due to less circulation and superficial nerves.
2. The surgeon then removes the tumor along with a thin surrounding layer of tissue. This is meticulously mapped, color-coded, and sent to our lab for analysis under a microscope.
3. If any cancer cells remain at the edge of the removed tissue, the surgeon references the map to take another thin layer of skin only from the involved areas. This staged process continues until the margins are completely cancer-free.
4. Once microscopic analysis confirms clear margins, the wound is closed using sutures, skin flaps, grafts, or second intention healing based on factors like size and location.

Patients are given detailed wound care instructions and follow-up appointments to monitor lower leg healing. We emphasize vigilance for risks like infections.

What Is the Recovery Time for Mohs Surgery on Lower Leg?

The typical recovery time for Mohs surgery on the lower leg is 4-6 weeks, but it may take up to 8 weeks depending on the repair method, with smaller incisions healing faster while larger wounds closed by second intention or skin grafts taking longer.

Typical Recovery Timeline

• Full healing typically takes 4-6 weeks, though it may extend up to 8 weeks based on our experience and especially factors like wound size, repair method, and location on the lower leg.
• Small incisions closed with sutures often heal within 1-2 weeks if proper wound care is followed.
• Larger wounds are allowed to heal by second intention or skin grafts take longer, around 3-4 weeks or more.

Higher Risk of Complications

• Infections - reported in up to 30% of lower extremity cases.
• Delayed wound healing - due to poorer circulation and edema.
• Poor cosmetic outcomes - more scarring or disfigurement.

Importance of Activity Modification

• We advise patients to avoid vigorous activity, compression garments, submerging wounds, or direct trauma to allow proper healing.
• Activity restrictions for 4-6 weeks and diligent wound care reduce risks of complications.
• Compliance with instructions is key for optimal recovery after lower leg surgery.

What Level of Pain After Mohs Surgery on Leg Is Normal?

At Dermatology & Skin Health, we have found patients typically experience mild to moderate surgical pain that resolves within a few days after lower leg Mohs surgery.

Based on our clinical experience, pain levels peak in the first 1-2 days and then gradually improve over 3-4 days as the surgical site heals. Pain is often managed effectively with oral medication.

Factors that influence pain include the wound size, location on the leg, type of repair, and individual differences in pain perception. Larger excisions, flap repairs, and surgical sites on more sensitive lower leg areas tend to cause more discomfort.

We work closely with patients to optimize multimodal pain control after lower leg Mohs surgery. This includes prescription medications, ice, compression, elevation, and over-the-counter pain relievers as needed. Staying ahead of the pain works well in most cases.

Severe or worsening pain after the first few days may indicate potential complications, so patients should alert our office for evaluation.

Risks and Benefits of Mohs Surgery on Lower Leg

The benefits of Mohs on the lower leg are a high cure rate, maximized tissue preservation, and thorough cell analysis while risks include a slightly higher infection rate of 7% and potential for impaired healing. Though performed properly, Mohs has very low risks and the highest skin cancer cure rates on the lower legs.

Benefits of Mohs Surgery on Lower Leg

1. High cure rate - Mohs removes up to 99% of skin cancers on the lower legs while conserving the maximum healthy tissue.
2. Tissue preservation - By staged removal and analysis, Mohs spares as much normal skin as possible, minimizing scarring or disfigurement on the lower legs.
3. Thorough cell analysis - Microscopic review during surgery ensures full removal of cancerous cells, resulting in very low recurrence rates.

Potential Risks of Mohs on Lower Leg

1. Infection - Lower legs have a slightly higher infection risk of around 7%, requiring antibiotics.
2. Impaired healing - Additional interventions may be needed for proper wound healing on the lower legs.
3. Other risks - Bleeding, graft failure, scarring issues, or nerve damage may rarely occur.

Overall, Mohs surgery minimizes risks and provides the highest cure rates for skin cancers on the lower legs when performed meticulously by an experienced specialist.

Cost of Mohs Surgery on Lower Leg

We recommend patients consider the following factors when selecting a Mohs surgeon for skin cancer treatment on the lower legs:

Specialized Training and Credentials

• Look for completion of a 1-2 year Mohs surgery fellowship after dermatology residency. This intensive training is vital.
• Confirm board certification in Mohs micrographic surgery from the American College of Mohs Surgery (ACMS). This demonstrates proficiency.
• More years of experience performing Mohs surgery, especially on the lower extremities, is better for successful outcomes.

Reviews from Previous Patients

• Read testimonials and reviews to understand others’ experiences with potential surgeons. Look for consistently positive feedback.

Expertise in Lower Leg Reconstruction

• Choose a surgeon thoroughly experienced with lower leg repairs like flaps and grafts. This region can be more complex.
• Ensure they have advanced skills for optimal scarring and healing on the calves, shins, ankles, etc.
• An experienced, highly trained Mohs surgeon is crucial for the successful treatment of skin cancers on the lower legs.

Learn how DSH's specialized surgeons use Mohs for better lower leg skin cancer outcomes - contact us now!

FAQs
I had Mohs surgery on my lower leg today and it's burning, is this normal?

Burning after Mohs surgery on the lower leg is common due to potential nerve damage, though see your doctor if the burning is severe or accompanied by symptoms like excessive bleeding.

What causes leg edema after Mohs surgery on the leg?

Leg edema after Mohs surgery can be caused by poor circulation, arterial plaque buildup, diabetes, or other conditions slowing the healing process.

Can Mohs surgery on the lower leg be done without stitches?

Yes, Mohs surgery on the lower leg can sometimes be done without stitches if the wound is small or in an area where scarring is acceptable.

Is plastic surgery after Mohs surgery on the lower leg common?

Yes, plastic surgery is often recommended after Mohs surgery on the lower leg to restore appearance and function when there is extensive tissue removal.

Can you explain Mohs surgery on the calf?

Mohs surgery on the calf involves surgically removing layers of tissue containing skin cancer until margins are clear, preserving healthy tissue.

If you had Mohs surgery on your leg, should you stay off your feet?

Yes, after Mohs surgery on the leg, you should stay off your feet as much as possible, limit physical activity, and keep the leg elevated to prevent swelling and promote healing.

Why is the wound on my lower leg not healing after Mohs surgery?

Wounds on the lower leg may heal slowly after Mohs surgery due to poor circulation, chronic medical conditions, infection, or other factors impairing the healing process.