Mohs surgery: Why do surgeons cut so much around the lesion?

@shells14: I have had several Mohs procedures so I undersand when the incisions seem surprisingly disproportionate to the actual presenting lesion. I see this is the first time you've posted in this forum on melanoma and skin cancer so I'd like to hear a bit more about your background with what led to your Mohs sugery while I take the opportunity to explain a bit more about what's involved when the procedure is performed.

Mohs is done to treat any one of the three types of skin cancers: basal cell (BCC), squamous cell (SCC) or melanoma, each with advancing types of severity. I have had all three and have undergone Mohs several times myself. When Mohs is performed, a thin layer of skin is excised that needs to extend at least 1-2 mm beyond the orginal detected cancer. This is because the cancerous cells can actually spread or remain beyond the visible margins and it is why the pathologist needs to view what has been removed under a microscope to determine if more layers need to be removed. Sometimes, even with a small lesion, it has been determined that the tumor type may require extra layers or extend further out from how the lesion appeared externally (for example, it may be deeper internally) to be certain the cancerous cells have been eradicated. Unfortunately, it's not unusual for skin cancers that present on areas around the face, such as the nose or eyelids may contain these types of hidden roots leading to a larger outcome than expected. While it may appear as if the medical provider has sacrified the cosmetic effect, the most important desired effect is ensuring the patient is cancer free. And most of the time, the sutures leave a very fine scar that can take up to a full year to more fully resolve without any need for cosmetic intervention. Personally, I had an extremely large incision going from mid-nose down to about the lip line along my cheek. It's been 5 years and no one can detect anything amiss.

It sounds as though you're early in the recovery stage so it's been hard understanding why this occurred and how you may heal; a process that can take at least 6 months, up to a year. There are products available shoud you feel you need them to assist with healing process which you can discuss with your medical provider, including those listed here: https://store.mayoclinic.com/post-surgery/scar-treatment/mohs-skin-cancer-surgery.html

It would help me to understand more about what brought you here. What kind of skin cancer was this and how recenly did you undergo the Mohs?

I had to look back at my post surgery pics to see how many stitches I had on my temple after Mohs and it was 10. I thought a lot was removed too, but after it healed it became imperceivable. Each case is different. I can imagine I’d be upset if it appeared much different than expected. I hope it will turn out ok.

Give it time. The basic purpose of MOHS is to remove the least amount of tissue that will ensure the high cure rate. In other words it usually spares over reaching the size needed to repair. Follow postop instructions for wound care and pose any concerns with your surgeon when you go for follow up. Mine was 3 layers deep and scar is only felt not visible.

@grammato3 Thank you for your response. It was detected on a full body check. It was basal cell carcinoma after a biopsy. It was very very tiny, so yes I was surprised how big of an incision was used. They did look for clear margins on after the incision and it was clear.

@celia16 Thanks appreciate your response.

@shells14: good for you for having a full body check and getting those clear margins! It still surprises me how many people think skin checks aren’t important but you’re one example of how valuable they truly are. And rest assured that six sutures are within the typical range for these types of procedures especially around the nose. You did the right thing in your steps to remain healthy and are a good example to others!
Can you back in with me after you’ve had more time to heal in early spring, so I can hear how you’re doing then? I bet you’ll see…and feel,,,a marked improvement.

The silicone sheets, scar cream with sunscreen topical Vit e are all helping and it’s just been 4 weeks
Also Dermablend d makeup

@donnabutcher Thank you for your response. I just ordered Mederma scar cream and didn't know about it. I am glad to have posted and thank you for the tips from everyone, it really helped.

I had MOHS 1 1/2 years ago. The SCC was on lateral side of base
of nose. Approximately 2-3 mm. Tiny! After the surgery (4 stages to complete) I had sutures from top nose near forehead all the way down below nose to base of nasal septum. Many sutures! I was just so stunned how long the incision ran down entire nose from forehead to almost upper lip. The scar was there so long and because soft tissue was removed, my nose is thinner but I now have a mid nose hump (not camel size). Like others have posted-the scar can take quite a while to heal. Be sure you clean gently and keep wearing sunscreen and discuss with Board Certified Dermatologist/surgeon any concerns.
I think the emotional side effects of just looking at face in mirror can be so surprising and not always what we expected from a surgery. I kept telling myself ‘this is not my nose’ each time I thought about how my face looked. “Nose Denial”??

The healing skin is very delicate and needs extra TLC. Give yourself some TLC also.

Take care.

I posted some time ago, and appreciate the positive feedback I received. I am nearing my Mohs procedure with apprehension. My lesion is directly below my left eye between lower lash and above the cheek bone. I realize healing in this area can be difficult and I am scheduled with an ocular surgeon for closing the second day after Mohs. My hope is to avoid that surgery and to heal naturally. At age 89 I am not so concerned with the cosmetic aspect--just want to be able to blink!! Sara Jane