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After a skin cancer is removed using Mohs surgery, the surgical wound needs to be repaired and the skin is closed to insure optimal healing. A number of different techniques can be used to reconstruct the skin, including a side-to-side linear closure, a skin flap, a skin graft, and others.
Regardless of the method used, the skin is often closed in a layered fashion. “This means two layers of stitches are used to close the skin,” explains Dr. Adam Mamelak, fellowship-trained Mohs micrographic surgeon at Sanova Dermatology in Austin, Texas. “A deep layer of stitches is used under the skin to guide the healing process, and a top layer of sutures is used to close the skin.” Nowadays, sutures may be made from a variety of materials. Some sutures are non-absorbable and need to be removed by the physician at a later date. Companies like Ethicon and Coviden make products such as PROLENE ®, ETHILON®, MONOSOFT®, SURGIPRO®, SURGILON ® and others. Other sutures made by those companies are designed to be absorbed by the body. Examples include sutures made with MONOCRYL®, VICRYL®, PDS®, and MAXON®.
Absorbable stitches are used for closing the deep layer of tissue after Mohs surgery. “However, because all sutures are technically ‘foreign substances’,” notes Dr. Mamelak, “the human body has a tendency to reject them.” Ideally, this means the body breaks them down and dissolves them over a period of 3 or 4 months. “Still, in some cases, the body decides not to break them down, but instead pushes them out through the top of the skin.” That’s why it is not uncommon for spitting sutures to occur after Mohs surgery.
With that said, there are ways to reduce the likelihood that spitting sutures will occur. To minimize the likelihood that spitting sutures will occur, Dr. Mamelak chooses suture materials that are known to be less reactive than others. He also monitors suture size and depth, makes sure any and all non-absorbable sutures are removed at the appropriate time. In addition, there are situations when Dr. Mamleak may opt to let a patient’s Mohs surgery wound heal without the aid of sutures at all. Clearly, that would eliminate the possibility of spitting to occur too.
If a spitting suture does occur, it can typically be addressed quickly and easily. “Sometimes patients will feel a sharp or pointed spot along their incision line, or even see a tiny white thread peeking through the skin,” says Dr. Mamelak. “Other times, these spitting sutures look like a pimple or red bump at the surgical site.”
In most instances, applying a warm or hot, moist compress to the raised area may help bring more of the suture to the surface. At that point, the surface material may be trimmed away or removed by your physician.
Contact Us
If you’ve been diagnosed with skin cancer and have questions about Mohs surgery, or if you have problems with spitting sutures and other issues after your skin cancer treatment, please contact Sanova Dermatology today at (512) 837-3376.