From the Guidelines
To minimize scarring after Mohs surgery, it is crucial to follow a comprehensive wound care approach, focusing on keeping the wound clean, moist, and protected, as well as utilizing silicone-based products and sunscreen to support optimal healing and reduce the appearance of scars. When considering the management of scars post-Mohs surgery, the primary goal is to minimize their appearance and promote healing, thereby reducing morbidity and improving quality of life.
Key Recommendations:
- Keep the wound clean and moist by gently washing with mild soap and water daily, then applying petroleum jelly and a non-stick bandage until stitches are removed or the wound has healed.
- Utilize silicone-based products like silicone sheets or gels, which have been shown to be highly effective in reducing scar appearance when started after the wound has closed, typically used for 2-3 months.
- Apply sunscreen with SPF 30+ on the healed scar for at least a year to prevent hyperpigmentation, a common issue that can affect the cosmetic outcome of the scar.
- For raised or hypertrophic scars, consider the use of topical steroid creams like triamcinolone 0.1%, which can help reduce inflammation and excess collagen production.
- Massage the healed scar gently for 5-10 minutes daily to improve its appearance by breaking up collagen and promoting a more even texture.
These recommendations are based on the best available evidence, including guidelines for the management of cutaneous squamous cell carcinoma, which emphasize the importance of meticulous wound care and the use of adjunctive therapies to minimize scarring 1. By following these steps, patients can significantly reduce the appearance of scars after Mohs surgery, improving their overall quality of life and reducing the morbidity associated with noticeable scarring.
From the Research
Scar Reduction after Mohs Surgery
- Mohs surgery can result in scarring, and various options are available to improve the appearance of these scars 2
- The goal of scar revision is to replace pre-existing scars with ones that are less conspicuous, and it is essential for patients to have realistic goals before beginning any treatment 2
- Laser therapy has been shown to be effective in improving scar texture and reducing the appearance of scars after Mohs surgery 3, 4, 5
- Fractional ablative lasers create microchannels in the skin, inducing a normal healing response and allowing for the delivery of scar-modulating agents into the scar 3, 4
- Laser-assisted drug delivery (LADD) is a promising treatment modality for hypertrophic scars and keloids, and it has been shown to improve outcomes in these conditions 4
- The use of lasers post-Mohs surgery is a safe and well-tolerated option for scar revision, with high patient satisfaction and minimal adverse effects 5
Treatment Options
- Combination therapy with ablative fractional laser and topical corticosteroids has been shown to be effective in improving hypertrophic scars 3
- Laser resurfacing can be used to improve the texture and appearance of scars after Mohs surgery 5
- LADD can be used as an adjunct to non-surgical measures or as a treatment modality before more invasive measures such as surgical excision 4
Efficacy and Safety
- Studies have reported favorable efficacy and safety profiles for the use of lasers in scar revision after Mohs surgery 3, 4, 5
- The quality of evidence supporting the use of LADD is inconsistent and lacks power, and additional studies are required to optimize dosages, laser settings, and agent choices for the treatment of hypertrophic scars and keloids 4