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Q: Despite my sleeping with my head elevated, I awakened this morning with a lot of swelling under my left eye. I had Mohs surgery yesterday on my forehead near my hairline on the left side. Is this normal?

A: Yes, this is very common after surgery. Scalp surgery often causes forehead swelling, and forehead surgery creates swelling that by gravity brings the fluids down to the thinnest skin area on the face which is the lower eyelid. You may also become “black and blue” in the lower eyelid even though no surgery was done there! Surgery on the cheek or near the bridge or side of the nose also tends to cause swelling near the lower eyelid. Try not to bend over at the waist for a week after surgery and sleep with your head elevated on a few pillows and don’t sleep on that side of the body on which you had facial surgery. Don’t strain in the bathroom and don’t lift heavy objects. I often recommend for my patients to take Arnica montana, an herb, to lessen the tendency to swell if the surgery is expected to cause significant fluid accumulation or if my patient is anxious about the swelling potential. Ice packs can help but they must be recommended case-by-case so as not to jeopardize some flaps and grafts that are done as the reconstruction after the Mohs surgery.

How easy is it to misdiagnose a bug bite for a basal cell carcinoma?

It usually is easy to diagnose a recent onset bite from a longer standing basal cell carcinoma but sometimes the basal cell can be somewhat small and slightly red as is a bug bite. Usually though, there is some translucent color in the basal cell carcinoma. If the border is very ill-defined a biopsy may then show skin cancer and depending on the location of the body, Mohs micrographic surgery may be indicated for removal.

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