Top 8 potential complications after Mohs surgery
No medical procedure is without risk. Even the extreme precision and accuracy used in Mohs surgery, the gold standard method for removing cancerous tumors from the skin, can lead to an occasional unwanted result.
“Many are surprised,” says Dr. Adam Mamelak, fellowship-trained Mohs micrographic surgeon at Sanova Dermatology in Austin, Texas, “because from the patient’s perspective the entire process can often seem so uneventful.” Dr. Mamelak is referring to the fact that Mohs surgery is a very straightforward and minimally invasive procedure for treating skin cancer. The surgery is quick, and performed on an outpatient basis, typically under local numbing medication. That means there’s no operating room and no one putting you to sleep!
Still, there are a few things that can potentially happen:
- There is always some oozing or bleeding when you cut the skin. “We often use local anesthetic containing a small amount of adrenaline or epinephrine, which helps constrict blood vessels and minimize any potential hemorrhage,” explains Dr. Mamelak. Some oozing after surgery is normal, however it is possible (although uncommon) to get bruising and even a hematoma (collection on blood under the skin) after surgery.
- Pain is another potential complication after Mohs surgery. In 2010, Dr. Mamelak published a research paper in the Journal of the American Academy of Dermatology specifically examining pain levels after Mohs surgery. He found that pain was often related to the extent of surgery and the type of reconstruction used to repair the skin after the skin cancer was removed. “Just about everyone asks me if they will have pain after their procedure, and the majority of patients are really surprised how little discomfort they actually experience,” say Dr. Mamelak. Most patients return to their normal activities 2 hours after the procedure. Still, Dr. Mamelak always advised patients on how to ensure they are comfortable after their surgery.
- There is no way to cut the skin without causing a scar – and scarring is another potential adverse outcome after Mohs. Scars can be can the appearance of the skin and sometimes be itchy or even tender. Dr. Mamelak uses advanced reconstructive surgery techniques to ensure any scarring after Mohs surgery is minimized. “I also tell patients that optimal healing requires patience.” Dr. Mamelak notes that it can take up to 6 months for a surgical wound to completely heal, before the end result can truly be judged.
- Necrosis refers to the skin in the surgical wound dying during the healing process. Dehissence means the edges of the stitched surgical wound gets pulled or comes apart. There are a few reasons why this can happen, including an infection or bleeding/hematoma under the skin
- Infection is extremely rare after Mohs surgery and most studies shown that this happens less than 1-2% of the time. In certain circumstances, Dr. Mamelak may prescribe an oral antibiotic after the procedure to help prevent this complication.
- When the tumor is removed, a cut is made through the skin. When you cut through the skin, often the superficial nerves int he skin can also be severed. This nerve damage can create a change in sensation or numb area in the skin around the surgical area. If the tumor is very deep,the nerves that control muscle movement can also be effected and the movement of some muscles can be impaired.
- A number of patients develop an allergic skin rash after surgery. This allergic reaction is typically due to the adhesive in the surgical tape used to bandage the area. It is rare although not impossible to have an allergic reaction to the local anesthetic used for Mohs surgery.
- The final potential complication is recurrence. Although the cure rates with Mohs surgery are exceedingly high – over 99% for some primary tumors – they are not 100%. When skin cancers recur, this often appears and a bump or sire immediately adjacent to the surgical site. It is for this reason Dr. Mamelak says it is crucial for patients to follow up for regular skin checks with their dermatologist.
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