Skin cancer may develop almost anywhere on the body, but the nose is one of the most common places it appears. Because the nose gets a lot of sun exposure, it’s especially vulnerable to sun damage that may lead to skin cancer over time.
It’s normal to feel nervous if your doctor has recommended Mohs surgery to remove a spot on your nose. Many people worry about how the procedure will go or how their nose will look afterward.
Mohs surgery is unique because the surgeon removes the cancer while leaving as much noncancerous, healthy skin as possible, examining each section under a microscope during the procedure. Skin cancers are often like icebergs, with much of the cancer below the skin’s surface and not visible from external examination. That means it’s not possible to determine exactly how much tissue needs to be removed until microscopic analysis is performed. But this thorough approach helps ensure all the cancer cells are removed while saving as much healthy skin as possible.
Mohs surgery has a cure rate of up to 99% for new skin cancers, making it the most effective treatment for most skin cancers.
This article discusses the basics of this type of surgery, including:
- The Mohs procedure on the nose
- Mohs surgery nose scars
- Recovery
- Nose reconstruction surgery after cancer
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at (877) 460-4673.
The Mohs Procedure on the Nose
Before your Mohs procedure starts, your doctor numbs the area so you won’t feel any pain, but you’ll stay awake the whole time.
“Patients have better outcomes with increased safety when they are awake for the procedure” says Gaurav Singh, M.D., M.P.H., F.A.A.D., F.A.C.M.S., a dermatologist and Mohs micrographic surgeon at City of Hope® Cancer Center Chicago. “Our goal is to keep patients maximally comfortable throughout the surgery. We talk to our patients, enjoy learning about them and even play music they enjoy so they often report enjoying their procedure!”
During the procedure, your surgeon will remove the visible skin cancer along with a very thin layer of surrounding skin, then looks at that layer under a microscope. If any cancer cells are still there, he or she will remove another thin layer and check again. This process repeats until all the cancer is gone. Each round usually takes about an hour, including wait time for the real-time microscopic analysis.
Once your doctor is sure the cancer is completely removed, he will close the area. Your surgeon will discuss optimal reconstruction options with you, and stitches are typically performed to limit noticeable scarring.
Mohs Surgery Nose Scars
It’s normal to have some kind of scar after Mohs surgery, even on the nose.
Any time skin is cut, the body heals by forming a scar. However, Mohs surgery is designed to remove as little healthy skin as possible, which may help keep the scar smaller and less visible.
Your doctor will also carefully plan how to close the area — including with a flap or graft if necessary — to help it heal smoothly and blend in with the natural shape of your nose. Over time, most scars fade and become much less noticeable. “Any surgery can and does have scarring,” says Dr. Singh, who has performed more than 10,000 Mohs surgeries. “During Mohs surgery, I cut around and below what's visible, and ensure we give the best possible cure rate and cosmetic outcome.”
Careful wound care and keeping the area protected from the sun may help your scar heal and fade over time.
Recovery
When it comes to recovery, it’s important to take care of your wound after surgery for optimal healing and appearance.
“Any surgery can take up to a year for the scar to reach its final form,” Dr. Singh says. “Recovery on the nose is generally the same as other parts of the body, and wound care is typically done for a few weeks after the surgery for the optimal outcome.”
Options for closing Mohs surgery wounds typically include those listed below.
Healing on its own: Small wounds may be left open to heal naturally. This usually takes a few weeks and often leaves a scar.
Stitches: Many wounds are closed with stitches, which are removed or dissolve after healing.
Skin graft: For larger wounds, your surgeon may use a small piece of skin from another part of your body to cover the area.
Skin flap: Sometimes, skin surrounding the wound is moved to cover it. Because it’s nearby, the color and texture usually match very well.
Most patients may return to normal activities soon after surgery, but it’s important to follow post-surgery instructions to support healing and minimize scarring.
Nose Reconstruction Surgery After Cancer
While not every patient needs plastic or reconstructive surgery after Mohs surgery, it’s a common practice, especially with cancer on the nose. In many cases, the repair may be performed the same day, right after the cancer is removed. Sometimes, it’s scheduled a few days later to allow the area to begin healing first. The goal of reconstruction is to restore both the look and function of your skin as much as possible.
“Patients almost always get reconstruction afterwards,” says Dr. Singh, who performs Mohs surgery in the Chicago area. “It’s usually done the same day by the Mohs surgeon, but in some cases, reconstruction is coordinated with a plastic surgeon. Our goal is to work with patients’ goals and make a shared decision on the best next steps for their individual cancer.”
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at (877) 460-4673