Hi Dr. Kelly: I have a skin cancer on my cheek that is going to be removed with Mohs surgery next week. I am worried about scarring afterwards. How can I minimize the scar?
Answer: So sorry to hear about your skin cancer, but the vast majority are cured with surgery so at least there is some good news.
Mohs surgery is a procedure where the dermatologist removes the skin cancer and then immediately looks at the specimen with a microscope. This is done to make sure that the skin cancer is completely removed. If he sees any skin cancer at the border of the specimen, he will remove more skin and check the second specimen with the microscope. He needs to make sure the skin cancer is completely removed, with a clear margin all the way around. This is important because if it is not completely removed, a skin cancer could come back.
But once it is completely removed, you are cured.
Once the margins are clear, the wound needs to be repaired. This is most commonly done by the dermatologist, but occasionally the patient will go to a plastic surgeon on the same day to have the wound closed. Most repairs involve converting the wound to a football shape (ellipse), and then closing the wound as a straight line. Since your skin cancer is on the cheek, that is the most likely repair that will be needed.
Beyond meticulous technique, the most important variable to insure a good scar is to make sure the incision follows the relaxed tension lines of the face. These are the natural facial lines that show up as wrinkles as we get older. Unfortunately, for surgeons, these lines aren’t readily apparent in younger people.
The attached diagram shows the direction of these lines on the face. For the least noticeable scar, the wound repair needs to follow these lines. If it is done perpendicular to these lines, the scar will be much more noticeable.
Fortunately, most dermatologists follow this principle of relaxed tension lines for cosmetic wound repair. Nonetheless, if you want to be sure that you get the best possible result, I would encourage you to have the wound closed by a plastic surgeon.
Wound closure is all we do!
About Dr. Kelly
Dr. Kelly is a board-certified Plastic Surgeon and partner in both Miami Plastic Surgery and MPS MedSpa. He has been in practice over 25 years and has been recognized by his peers both nationally and internationally as one of the best plastic surgeons in the United States. In addition to being an expert on Cosmetic Surgery, his practice encompasses the entire spectrum of non-invasive treatments such as Botox, fillers, CoolSculpting, ultrasound, lasers and radiofrequency.
He also believes in giving back to our community, having served on the Village Council for eight years and volunteering as a coach for our youth sports programs. You can email him questions at email@example.com.