Mohs scar treatment

[George021]

Hi,

My 44 year old mother had a Mohs surgery done to remove a small basal cell carcinoma on the nasal-labial area of her face in mid Sept 2009. The first layer came back negative. The doctor recommended a "0-Z" reconstructive procedure because the results would be a lot better, even though only about a 1cm diameter piece of skin was removed. 6 stitches were used to sew up the wound; the top 1 or 2 points were tight and led to a scab forming (about 1-2 days later), which was moistened with hydrogen peroxide, and then removed.

I have attached a picture of how the scar looks today.

1) Was the "reconstructive" procedure the correct choice or should we have just let it heal without additional cutting?
2) Was removing the scab with hydrogen peroxide the wrong decision?
3) What caused the poor results?

After the stitches were removed, the doctor recommended massaging the scar with Vaseline for a few minutes a day. It has been almost 2 months; the scar area is still very red (hard to notice in the picture), the top half of the scar is a lot wider than the bottom, and the scar is still very crooked, in an S or Z shape.

4) Should we continue with the Vaseline massaging?
5) I know that the scar will never completely disappear, but are there any other solutions to further minimize the appearance of the scar that we could be exploring? (such as scar laser treatment)
6) When would be best to start new treatment to cover the scar?
7) What are the risks involved with the new treatments?

Sorry for so many questions, but my mother is very sad and unhappy with the results and I would really like to be able to help her.

Thank you very much in advance.

[George021]

Thank you very much for your reply.

[Howard Rosenberg, MD]

It is my opinion that a simple linear excision of the lesion, parallel with the nasolabial fold would have been best.  Breaking up the scar with a z-plasty in this location seems like overkill and also places a portion of the scar perpendicular to the nasolabial fold, which I believe is unsightly and inappropriate.  Any additional local care to the area will probably not improve its appearance. Additional time may help.

Since it is so soon after her original procedure, I would wait for full scar maturation over the next six months or so.  If the escar does not fade to her satisfaction by that time, I would consult with a plastic surgeon about surgical revision of the area.