WHAT HAPPENS AFTER THE TUMOR HAS BEEN REMOVED?
Almost all patients are photographed upon completion of Mohs surgery. These photographs become part of your medical record and may be used for teaching purposes.
After Mohs surgery, you will have a surgical wound. This wound will be dealt with in one of several ways. Dr Hanke will discuss with you which surgical options will produce the most cosmetically pleasing results, and he will be honest with you about the possibility of the cancer's recurrence.
The possibilities include: (1) healing by second intention; (2) closing the wound, or part of the wound, with stitches; (3) closing the wound with a skin flap or skin graft; or (4) arranging a consultation with one of several reconstructive surgeons. Upon completion of the surgery, Dr. Hanke will recommend which of these choices will be best for your individual case.
WHAT IS "HEALING BY SECOND INTENTION"?
Healing by second intention involves allowing the wound to heal by itself. This offers observation of the wound as it heals, after removal of a difficult tumor. There are certain areas of the body where a wound will heal just as well naturally as it would in a further surgical procedure. Sometimes a wound will be left to heal by second intention, with the knowledge that if the resulting scar is unacceptable, some form of reparative surgery can be performed at a later date.
If the wound is allowed to heal by itself, the dressing must be changed every day until healing is complete. All wounds normally drain, and dressings are changed to absorb the drainage. The nursing staff will teach you how to change the dressing, and will provide printed instructions.
If the wound is allowed to heal by second intention, it usually heals in four to eight weeks, depending on the size of the wound and on how quickly an individual tends to heal. When the healing has advanced, you will be permitted to stop the daily dressing changes. You may experience a sensation of tightness (or drawing) as the wound heals, but this is normal. After several months, the tightness will resolve.
Frequently, tumors involve nerves, and may take up to a year, or even two, before feeling returns to normal, or near normal. Occasionally the area stays numb permanently. The new skin that grows over the wound contains many more blood vessels than the skin that was removed. This results in a red scar, and the area may be sensitive to temperature changes (such as cold air). This sensitivity improves with time, and the redness gradually fades.
Patients frequently experience itching after their wounds have healed. This occurs because the new skin that covers the area does not have as many oil glands as previously existed. Plain petroleum jelly helps to relieve the itching.
WHAT HAPPENS IF THE WOUND IS CLOSED WITH STITCHES?
Wounds are often closed with stitches. This involves some adjustment of the wound, and sewing the skin's edges together. The procedure speeds healing and can offer a good cosmetic result. Often times, a scar can be hidden in a facial line or a wrinkle line.
The nursing personnel will teach you how to change the dressing daily and provide you with printed instructions. If an odd-smelling fluid oozes from the wound, call Dr. Hanke's office immediately.
The stitches will remain in place for five to seven days. While the stitches are in place, it is important to keep the area clean and refrain from activities that might pull on the sutures.æ
WILL I DEVELOP MORE SKIN CANCERS?
Studies have shown that once you develop a skin cancer, there is a possibility that you may develop more. The sun damage to your skin cannot be reversed. However, several precautions which involve good common sense, can be taken to prevent further skin cancers.
- Avoid sun exposure from 10:00 a.m. to 3:00 p.m. (May to September in Indiana)
- Apply a sunscreen with an SPF of 15 or greater, half an hour before going outdoors, and re-apply as directed on the product label.
- Wear protective clothing, including a broad-brimmed hat and ultraviolet blocking sunglasses.
- Stay away from tanning salons.
- Don't forget to use your sunscreen on overcast days. The sun's rays are as damaging to your skin on cloudy, hazy days as they are on sunny days.
- Use a sunscreen while at lower latitudes. The sun is stronger near the equator where the sun's rays strike the earth most directly.
