Scarring is always a concern with any skin surgery, especially if the procedure is on the face or another cosmetically sensitive area. “No matter how old, no matter what stage of life my patient is in, this is something that always comes up,” says Dr. Adam Mamelak, procedural dermatologist at Sanova Dermatology in Austin who uses Mohs micrographic surgery to treat skin cancer. Dr. Mamelak notes that the face is the most common area to develop skin cancer, along with other exposed areas such as the backs of the hands.
“The good news is that Mohs surgery is designed to minimize scarring scarring at the outset, by creating the smallest post-surgical wound possible,” explains Dr. Mamelak. This wound that remains after a skin cancer is removed is then taken care of in one of several ways. “Depending on the wound’s location and dimensions, a number of reconstructive options might be available, including stitches, skin flaps, skin grafts, ointments, silicone pads and pressure dressings to promote healing. In some instances, allowing the wound to heal naturally may also be an option.”
Dr. Mamelak stresses that for optimal results, it is important to follow the physician’s wound care instructions, including when it comes to the pressure dressing. The pressure dressing has a number of functions. First, it protects the wound from dirt and other external elements. It also applies pressure, absorbs wound drainage and keeps the area moist. In some instances, silicon dressings and oil emulsion impregnated gauze are also used. They help prevent the bandage from sticking to the wound and reduce maceration. “I typically tell patients to leave their pressure dressing in place for 48 hours, unless instructed otherwise,” says Dr. Mamelak.
Lubricating the wound with specific ointments and emollients is also done to promote healing and reduce scarring. “Wounds heal better when they’re kept moist and kept covered,” explains Dr. Mamelak. “It’s actually a myth that letting the air get to and allowing the wound to develop a scab or a crust is better for healing. Airing out your wound actually slows down the process.” The list of ointments and emollients used for such purposes includes Aquaphor, Bio Oil, vitamin E oil, silicon scar gel, Mederma, Biafine and others. They are designed to moisturize the skin, minimize scarring and reduce skin irritation during the healing process.
Once the wound heals, any residual scarring may be addressed. There are multiple methods that may be used to minimize the scarring. These include, but are not limited to intralesional injections, dermabrasion and laser resurfacing. They involve reducing the amount of surface scar tissue in the surgical area until little to no raised areas remains. In other instances, subcision may be used to elevate depressed scars and aid with the healing process.
“Patience is key,” says Dr. Mamelak. “Patients need to understand that it takes up to 6 months for the skin to heal completely after a surgery. Rushing into an additional procedure such as dermabrasion or laser too soon can potentially worsen the final result.”
Patients that undergo Mohs surgery are also advised to maintain their skin’s health by adopting several best practices. The list of best practices often includes wearing sunscreen, minimizing sun exposure, and avoiding the use of tanning beds. Adhering to such guidelines will minimize Mohs surgery scarring as well. “Scar can darken in the sun,” says Dr. Mamelak, “not to mention that excessive sun exposure could put you at risk for developing another skin cancer.”
Contact Us
For more information about minimizing scarring after Mohs surgery, please contact us at (512) 837-3376. We would be delighted to provide an individualized consultation and discuss which options would likely reduce your scar’s appearance.
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