All surgeries come with some degree of risk, and even with the utmost precision, Mohs surgery is no different. Although Mohs is considered the gold standard for removing skin cancer, complications can still occur. Board-certified dermatologist and fellowship-trained Mohs micrographic surgeon Dr. Adam Mamelak says that many people are surprised when they experience a complication “because from the patient’s perspective the entire process can often seem so uneventful.” Mohs surgery is typically a quick, minimally invasive procedure. Patients usually only need a local anesthetic to numb the treatment area, and they can return home after their procedure.
Despite its relatively straightforward process, there is still the possibility that complications can occur after Mohs surgery. Some risks of the procedure include the following:
- Bleeding: Anytime an incision is made, bleeding will occur. Dr. Mamelak prefers to use a local anesthetic that contains epinephrine, as this helps constrict blood vessels and reduce blood loss. After surgery you may still experience bruising and potentially a hematoma (blood collecting under the skin).
- Pain: Dr. Mamelak advises patients on how they can minimize discomfort after Mohs surgery. While some pain is normal, most patients are surprised at how little discomfort they have, allowing them to resume their normal schedule after just two hours. In a research paper published in the Journal of the American Academy of Dermatology, Dr. Mamelak evaluated the link between pain levels after Mohs surgery, the complexity of the procedure, and the reconstructive technique used after the skin cancer removal.
- Scarring: As with any surgery, scarring can’t be avoided with Mohs surgery. Scars may alter the look of the skin as well as cause itching and soreness. To minimize post-operative scarring from Mohs surgery, Dr. Mamelak uses precise reconstructive techniques to minimize trauma to the area. Keep in mind that healing from surgery takes time, and a surgical wound may take up to six months before the final result can be seen.
- Necrosis: When the tissue dies at the wound site as it’s trying to heal, this is known as necrosis. This can result from different factors, such as infection or hematoma. Necrosis may develop with dehiscence, which is characterized by the edges of the stitched wound separating.
- Infection: Although very rare, infection is a potential complication after Mohs surgery. Studies have shown that this occurs less than 1-2% of the time, though. In some cases Dr. Mamelak may prescribe an antibiotic to help prevent the possibility of infection.
- Nerve Damage: When the tumor is surgically removed, this can also sever superficial nerves. If this damage occurs, the area may feel differently or become numb. Should this happen in a patient who has a tumor deep under their skin, this may impair the nerves that control certain muscles.
- Allergic Reaction: Some patients may break out into a skin rash after Mohs surgery. This reaction usually results from an allergy to the adhesive in the surgical tape that is covering the wound. However, in rare cases patients may have an allergic reaction to the local anesthetic.
- Recurrence: Mohs surgery has an incredibly high cure rate, with over 99% of some primary tumors being cured. When skin cancer does recur, this often presents as a bump next to the original area that was operated on. Although this is rare, Dr. Mamelak urges patients to regularly get skin examinations by their dermatologist to catch skin cancer at its earliest stages if it does recur.
If you have any questions about Mohs surgery or would like to learn more about the risks of the procedure, please contact our office to schedule an appointment with Dr. Mamelak.