Dog Ears After Mohs: Fix Now or Wait till Later?
The puckering of skin that occurs after the closure of the wound after Mohs micrographic surgery (MMS) are commonly known as “dog-ears.” They are a result of the fact that most MMS wounds are circular, oval, or asymmetrical in shape, making a neater closure more challenging. Since these are not a desirable result, many workarounds and interventional techniques have been developed to correct these defects. One choice is to forego any intervention in the hopes they will settle out after swelling resolves and wound contraction takes place.
A recent study looked at regression of dog-ears after surgery and attempts to provide guidance on whether certain dog ears may require other interventions to correct certain dog-ears at the time of surgery. A total of 77 patients were enrolled accounting for 140 dog-ears. Patients were advised that these defects would occur and offered the option for surgical correction at any time. Wounds were located on either the head and neck, hand, extremity, or trunk. At 6 months following MMS, patients were examined to observe the site and assess for resolution of the dog-ear.
The results showed that the vast majority (81%) completely resolved after 6 months. As for their location on the body, 97% of the dog-ears on the hands resolved, no matter the original height of the defect, 94% on the trunk, 78% on the limbs, and 67% on the head or neck.
The authors conclude that since attempting to resolve dog-ears at the time of surgery can result in larger wounds and scars, when patients have MMS on hands, trunk or limbs, the dog-ears should be left to resolve on their own. However, dog-ears in cosmetically sensitive areas, such as the head and neck, should continue to be corrected at the time of surgery.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: October 9, 2017
Adapted from the original article.