Squamous Cell Cancer Upper Lip and Philtrum

@moorjan3: First let me welcome you to Mayo Clinic Connect. We have a lot of members here who have undergone Mohs procedures, myself included - although I personally have not had one in this delicate area. I can imagine how uncomfortable it is for you especially when you try to talk or eat, even smile or yawn as the deeper tissue is still healing.

Has your provider recommended any type of gentle massage to the area? This can generally be done once the incision area has healed so check with your clinician to see if you can begin massging the treated area in a firm circular motion, then up and down up to 3 times a day, 3-5 minutes with Vitamin E or silocone gel; these help to break down scar tissue. You can also try applying Vaseline (or some form of petroleum jelly) or Aquaphor (or equivalent form of medical grade oitment so the lip and philtrum are kept moist. You can also try cutting up food into small, manageable pieces so you don't have to work as hard moving your mouth. Try practicing gradual opening your mouth in exercises such as a small yawn, a small smile to gradually increase your comfort level.

The full healing of the inner sutures could take 3 months or so; give yourself some rest in the meantime. If symptoms persist beyond 4-6 months to give the nerves time to regenerate, check back with the physician who performed the procedure.

Can you let me know after a week or so if this helps with the tightness you're experiencing?

I have been doing the massage for 4 weeks and using silicone sheets at night. It is not helping with the high level of discomfort. I use Vaseline to massage and use the silicone sheets for about 13-15 hours at night while sleeping. I have also been doing the exercises with my mouth. My surgeon indicated internal sutures take 3-4 weeks to dissolve so I am not sure about your comment on healing at 3 months if you could elaborate on that. They are considering Kenalog steroid shot next week which would be week 8 given my high discomfort level. Thank you for your response.

my upper lip has had two different mohs for squamous. both looked horrible when done and I did most of what was suggested above. Its now 4-5 yrs and although it all healed up my lip line requires lip pencil to fill in a gap. Everything eventually healed flat but it takes time. I've completed 2 yrs on Libtayo and no longer have the multiple squamous outbreaks I had yearly. So happy not having MOHS. You mention discomfort and I didn't have much...maybe so many nerves are cut from all the other procedures. Mostly it was inconvenience...I lifted my lip to shove in food and used a straw as unfortunately my appetite didn't diminish.

@louisejewell Did you have asymmetry - mouth not centered under nose or pulling to the side where the stitch line is. I had a straight-line stitch from the bottom of my upper lip to my nostril so the left philtrum was impacted as well - line that runs between your nose and your lip. Everything pulls to the left where the stitch line is. It is very, very uncomfortable. Did your lip function fully return and if so how long did that take? The left side of my lip does not move up and down with the right currently. Thank you for your reply. Hearing other experiences is helpful. How long was the healing process where things mostly looked healed up.

@moorjan3: There are various types of sutures, for instance vicryl, monocryl or fast-absorbing - although the latter are generally not used in the lip area due to a weaker hold. The type of suture is based on provider preference generally based upon past experience. However, it is true that most of the actual holding power in the former two lose their strength after the first month although the actual thread can take longer to completely disappear - hence, the longer "recovery" time for complete absorption. For some people, it may be a shorter duration and for others longer - though one may not even be aware of this process. My background is in nursing so I tend to look at it from that perspective and it's not meant to be confusing, apologies if it added to your distress!

Kenalog could certainly be a good option as it sounds like you're doing everything you can to ease the discomfort. What this corticosteroid could do if you don't relieve the discomfort is essentially target the collegen to break down scar formation that may be contributing to the problems you're reporting.

Can you report back next week as to your progress?

@grammato3 yes I will report back and thank you. Any information is helpful and I appreciate the insight.

@grammato3
Regarding sutures. I had SCC removed (MOHS) from left hand. The surgeon wanted to use self absorbing sutures that did not need to be removed. I had some real issues with the suture line separating and long time healing.

I went into office for surgery check up and said what I was seeing and experiencing was normal. But then she saw a suspicious area about an inch from the sutures. She did a biopsy and came back SCC. So this time (MOHS) surgery she used the old type sutures that have to be removed. It healed so much faster but did need to have them removed. I did not get any separation along suture line like I did with self absorbing stiches.

I did though have a more profound scar and I think reason why did self absorbing ones first time. This timed she said wanted to eliminate the issues I had originally sutures. Yes I have a scar but I am 79 with some many skin spots, age spots, and everything in-between don't even notice.

@moorjan3 & others here:
I had the same Moh's done on my upper right lip area. ( What a painful area to have been worked on.) Doctor put an ice cube on area to "numb" area before giving the numbing shot. It's been over a year and the area still is tight, painful and pinches. It is inside my lip as well and sometimes I drool.
Now I have noticed another red spot on the left side of my mouth that sure looks like another cancerous area. I am not going back for a repeat Moh's procedure, I am too old for that, and my doctor does not use any procedures except surgery,

I am very sorry to hear that. Especially to hear how long you have been uncomfortable which is very concerning. Were you given any assistance to try to lessen the tightness and pain. That is a very long time to endure it. I hope everything is ok with the left side of the lip and you have a less painful experience if you have to pursue treatment. I am only 58 and working. I do need to find a solution to continue. It is very difficult and I am sympathetic with your discomfort as well. Thank you for sharing your story.

@mermaid7272 : I'm so sorry to hear you're still having discomfort. Have you spoken to your doctor about this?

As far as the spot you're seeing now, I'd strongly encourage you to have it checked out. You may not need any intervention at all, or perhaps something much less invasive than Mohs. Best to have it evaluated now than before it may become more burdensome. I'm wondering if the provider who last treated you is a doctor who specializes in a specific type of skin cancer treatment. For instance, one of the medical practitioners in the practice I go to only does Mohs surgery. If it's the case, would you be able to arrange for a consultation with a dermatologist in your area?