The topic of scarring, especially on the face or other highly visible places, is a common concern with skin procedures, no matter what stage of life a patient is in. As a board-certified dermatologist with specialty training in Mohs surgery, Dr. Adam Mamelak has found that skin cancer most often affects areas like the face and back of the hands, because they are frequently exposed to the sun. “The good news,” says Dr. Mamelak, “is that Mohs surgery is designed to minimize scarring at the outset, by creating the smallest post-surgical wound possible.”
When a patient is diagnosed with skin cancer and undergoes Mohs surgery to remove the tumor and its roots, the remaining wound can be reconstructed in different ways, such as with stitches, skin flaps, and skin grafts. In some cases, Dr. Mamelak may suggest letting the wound heal naturally. Factors such as the wound’s size and where it’s located will help determine which reconstructive technique is most appropriate. Post-operative wound care with pressure dressings, silicone sheets, and ointments can also help with healing.
Dr. Mamelak advises patients to follow their surgeon’s instructions for wound care after surgery to ensure the best possible outcome. Common best practices for promoting wound healing and minimizing scarring include the following:
1. Keep the Wound Covered with a Bandage
For the first 48 hours after Mohs surgery, or until your doctor has instructed, you should wear a pressure dressing over the surgical site. This type of dressing helps protect the wound from dirt while also applying pressure and absorbing any excess blood or fluid. Other types of bandages that may be used include silicone pads and oil emulsion-impregnated gauze. These ensure the bandage doesn’t stick to the wound, helping reduce additional damage.
2. Make Sure the Wound Stays Moist
Airing out a wound is a myth for wound care that can actually slow down the healing process. Keeping the surgical site moist by covering it with a bandage and using certain ointments and emollients can help promote healing and minimize scarring. When a scab or crust forms, the wound has a higher risk of scarring and can take longer to heal. Popular ointments for keeping the wound moist and soft include Aquaphor®, Bio Oil®, Mederma®, BIAFINE®, vitamin E oil, and silicone scar gel. They can also help reduce skin irritation as the incision line heals.
3. Limit Sun Exposure & Wear Sunscreen
“Scars can darken in the sun, not to mention that excessive sun exposure could put you at risk for developing another skin cancer,” explains Dr. Mamelak. This is why he urges patients to avoid tanning beds, wear sunscreen, and minimize sun exposure altogether. These are important steps that can minimize possible scarring after Mohs surgery.
4. Explore Scar Revision Treatments When Healed
Multiple treatment options are available for reducing your final scar appearance. Common scar revision procedures include intralesional injections, laser skin resurfacing, and dermabrasion. These methods are intended to decrease the amount of scar tissue visible at the surgical site until the scar is as flat as possible. Some patients may benefit from another revisional procedure known as subcision, which is used for depressed scars to elevate them and stimulate healing.
5. Be Patient & Don’t Rush the Healing Process
Dr. Mamelak emphasizes that patience is an essential part of scar healing. It can take up to 6 months for this process to be completed. Patients shouldn’t undergo a scar revision procedure until they have completely recovered from their Mohs surgery, because treatments like dermabrasion and laser resurfacing could potentially make the scar worse. After the wound has healed, the residual scarring can typically be improved.
For more details on how you can minimize scarring during and after your recovery from Mohs surgery, please schedule a consultation with Dr. Mamelak to learn about the best options for your needs.