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MOHS & post-cancer scars?
PAK83 posted:
How should a dermatologist monitor a post-cancer scar after removing skin cancer using MOHS?

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Skin Cancer Foundation
Michael W Steppie, MD responded:
The cure rate of the Mohs technique is 99% or better for most skin cancers. The Mohs techniques save patients' valuable skin. However, with any surgical procedures there is the potential for some degree of visible scarring. The follow up of a post-MOHS surgical scar will depend on several factors:

  • Size and location of the tumor
  • Individual skin characteristics and the reconstruction option available

Post-surgical scarring improves with time and can potentially take up to 1 year or more to fully mature. As your surgical site heals, new blood vessels can appear. These new blood vessels support the healing changes occurring underneath the skin. This can result in the reddish appearance of the scar. In addition, the normal healing process involves a period of skin contraction, which often peaks 4 to 6 weeks after the surgery. Again, most of these changes are temporary and will improve in appearance naturally over time, and scar revision techniques may be employed if necessary at any point in the future. Your dermatologist/MOHS surgeon is available for you throughout the healing process and will arrange post surgical check-ups to monitor your recovery, to remove any sutures and to answer any questions or concerns that may arise.

PAK83 replied to Michael W Steppie, MD's response:
Thank you Dr. Steppie.

I am more interested in how the doctor should monitor the scar well beyond the initial healing process.

Should doctors be measuring and monitoring the angle of the scar as part of annual cancer screenings? If the scar shifts 90-120 degrees over time, this could be sign of recurrence, right? (Over time, meaning potentially several years after surgery.)

Thank you for your help.
Skin Cancer Foundation
Michael W Steppie, MD replied to PAK83's response:
The angle of scars is not a definitive or prominent feature to consider in skin examinations looking for potential recurrences. However, any new tumor or recurrence on the surgical area might displace the scar somewhat.

Anyone who has had skin cancer has an increased chance of developing another, especially in the same skin area or nearby, generally because the skin has suffered permanent UV damage. Such recurrences typically occur within the first two years after surgery. Thus, follow-up examinations are vital. A superficial basal cell carcinoma might just require follow-up skin examinations, whereas an advanced melanoma requires more intense follow-ups, including blood tests, chest x-rays, lymph node exams, and other imaging tests to make sure no micrometastases (microscopic recurrences) are found.

It's important to schedule visits for follow-up skin exams with your dermatologist every 3-6 months, even if no suspicious signs are noticed. Self-monitoring, routine professional exams, sun avoidance, shade-seeking, and use of sun protection products are all essential parts of post-treatment care.
PAK83 replied to Michael W Steppie, MD's response:
Thank you Dr. Steppie.

In my situation, mohs was performed in 2000 for a basil cell. I continued my annual cancer screening exams. In 2008, I had minor facial paralysis due to the scar tightening up on my face. After a misdiagnosis of bells palsy, a biopsy and MRI indicated an invasive tumor in my cheek.

After reviewing photos over the years, it was obvious the scar shifted drastically or, using your term, was "displaced". As early as 2004-5, there was a huge change. Seeing myself every day, I did not notice. However, I believe my dermatologist should have noticed. Three years could have "saved" my face.

After removing the cancer, six weeks of radiation, and 10 reconstructive sugeries later, I'm trying to understand how this could have happened under a doctor's care.

A lawsuit is not an option; but, acceptance of the condition I am left in is imperative.....and my goal of these inquiries.

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