Does Mohs Surgery Require Stitches?

Most Mohs surgery procedures do involve stitches, but a meaningful fraction of wounds heal without any sutures at all. In a large prospective evaluation of over 1,350 Mohs cases, about three quarters of wounds were sutured or grafted closed, while roughly one in five were left to heal on their own without any stitching whatsoever. The closure method your surgeon chooses depends on where the wound is, how large and deep the final defect turns out to be, and which approach will deliver the best cosmetic and functional result for your particular situation.

The Main Ways a Mohs Wound Gets Closed

After each tissue layer is removed and examined under the microscope, the surgeon assesses what remains: the wound’s size, depth, shape, and anatomical location. From there, the options generally fall into a few categories:

Linear closure: stitching the wound edges directly together, the simplest and most common approach for smaller wounds.
Local flaps: rearranging nearby skin to cover the defect, secured with sutures.
Skin grafts: transplanting skin from elsewhere on the body to fill the wound.
Secondary intention: leaving the wound open and letting the body close it naturally, with no stitches at all.
Adhesives or strips: using medical-grade glue or adhesive tape instead of surface stitches.

In that prospective study of 1,358 Mohs cases, 1,014 wounds were repaired in the dermatologic surgery unit, 262 healed by secondary intention, and 92 were sent to other surgeons for more complex reconstruction.¹ Your surgeon typically makes this decision in real time, once the final layer has been cleared and the full scope of the wound is visible.

When Stitches Are the Standard Approach

Linear closure, which means pulling the wound edges together and suturing them shut, is the most straightforward repair and the go-to choice whenever the defect is small enough and the surrounding skin is loose enough to allow it. For facial reconstruction after Mohs surgery, linear closure is the predominant technique across the cheek, forehead, and area around the mouth when conditions permit.² For temple defects, linear repairs aligned with the skin’s natural tension lines tend to give good cosmetic results over the long term.³

When a wound is too large or too awkwardly shaped for direct stitching, surgeons often turn to local flaps. A flap involves lifting a section of nearby skin, rotating or advancing it to cover the gap, and suturing it into place. Common types include V-Y advancement flaps, nasolabial flaps (using skin from the crease beside the nose), and forehead flaps. In a study of 70 patients who received local flap repairs for facial skin cancer defects, V-Y advancement flaps were the most frequently used, followed by nasolabial flaps. Complications were uncommon: only 2 of 34 V-Y flaps had minor suture separation at one edge, and all 24 nasolabial flaps healed without any complications at all.⁴

For larger nasal defects, a collaborative approach between a Mohs surgeon and a plastic surgeon may be needed. Full-thickness skin grafts, rotation flaps, or combinations of the two are commonly used for post-Mohs nasal defects greater than about 1.5 centimeters, all of which require sutures to secure.⁵

When the Wound Heals Without Stitches

Secondary intention healing means leaving the wound open and letting your body close it on its own. New tissue gradually fills in from the bottom and edges of the wound, and the surface re-forms without any surgical assistance. No stitches, no grafts, no flaps. You keep the wound clean and covered with ointment and bandages, and the body does the rest.

This approach works well in specific spots. The inner corner of the eye, the ear’s antihelix, the temple, and the crease beside the nose are areas where secondary intention healing tends to produce good cosmetic results because the natural contour of those concavities hides the resulting scar. It can also work for relatively small and shallow defects on eyelids, ears, lips, and the backs of hands.⁶ For lip defects specifically, one study found satisfactory functional and cosmetic outcomes for wounds on the vermilion lips as large as about 2.8 square centimeters, even when the wound extended into surrounding skin and the muscle layer underneath.⁷

The appeal goes beyond simplicity. Leaving a wound open makes it easier for your dermatologist to monitor the site for cancer recurrence, since there is no flap or graft obscuring the original tumor bed. Complication rates with secondary intention healing are low, likely under 3% and possibly lower than with sutured repairs. Surgical site infections are uncommon, occurring in roughly 1% to 4% of cases, and patients tend to report less postoperative pain.⁸

Despite these advantages, secondary intention currently accounts for less than a quarter of all Mohs wound closures.⁸ Recent reviews have argued it is underutilized, and survey data from Mohs surgeons suggest the list of appropriate wound sites is expanding to include convex areas like the scalp and anterior lower leg, as well as deeper and larger wounds than were traditionally considered suitable.⁹

Sutureless Surface Closure With Adhesives

Even when a wound does need to be physically held together, you might not end up with traditional stitches on the surface. Cyanoacrylate tissue adhesives, which are essentially medical-grade versions of super glue, can replace external sutures. In a randomized trial comparing adhesive to sutures for skin cancer wound closure, there was no significant difference in how the healed wounds looked. Surgeons found the adhesive faster and easier to apply, and patients spent less time on wound care and reported higher satisfaction with the adhesive-closed side.¹⁰

When patients had one wound closed with adhesive and the other with fast-absorbing gut sutures and were asked which they preferred, most had no strong preference. But among those who did express one, cyanoacrylate was significantly favored.¹¹ Adhesive strips are another option that can hold wound edges together without needle and thread.¹²

An important distinction: “sutureless” in this context usually means sutureless on the skin surface. In most cases, buried absorbable sutures have already been placed underneath to do the structural heavy lifting of holding the deeper tissue layers together. The adhesive or strip replaces only the outer layer of stitches, which are the ones you’d otherwise need to come back and have removed. So the experience for you as a patient is genuinely suture-free in terms of what you see and what you have to care for at home, even though dissolvable stitches are working below the surface.

What Determines Your Closure Method

Your surgeon doesn’t know which closure method will be used until the surgery is complete and the final margins are clear. A tumor that looked small on the surface may have extended further than expected, leaving a bigger wound than anticipated. The decision hinges on several factors evaluated at that moment.

Location is the most powerful influence. Concave areas of the face, where the skin naturally curves inward, tend to heal well by secondary intention because the resulting scar settles into a depression and becomes less noticeable. Convex areas like the tip of the nose or the forehead are trickier. Scars on raised surfaces are more conspicuous, so surgeons more frequently opt for flaps or grafts in those spots. The inner eye corner, the ear, and the alar crease beside the nose are classic locations where wounds can often go without stitches entirely.⁶

Wound size and depth are the other major variables. A small, shallow defect on the temple might heal beautifully on its own, while a deep wound in the same area needs a sutured repair. Very large nasal defects often require the combined expertise of a Mohs surgeon and a reconstructive surgeon working together.⁵

Your overall health enters the equation too. Patients on blood thinners may benefit from secondary intention healing because it avoids the tissue manipulation of flaps, which can increase bleeding. If you have a history of poor wound healing or immune suppression, your surgeon may favor a more controlled closure. Patient preference also matters. Some people want the wound closed and done with in one visit; others prefer a simpler approach that skips additional procedures. Your surgeon should walk you through the trade-offs for your specific case before proceeding.

What Suture Removal Involves

If you do get external stitches, they typically need to come out about 5 to 14 days after surgery. Facial sutures generally come out sooner, often within a week, because the face’s abundant blood supply accelerates healing. Sutures on the trunk or extremities usually stay longer. The removal itself is quick and generally not very painful: the provider clips each stitch and slides it out.

For some patients, the follow-up visit is the most inconvenient part of the whole process, especially if they traveled to see a specialized Mohs surgeon. A recent study explored whether patients could safely handle suture removal at home. About 90% were willing to try, and after watching educational resources, their confidence increased and their anxiety dropped. Among those who attempted it, 97% succeeded without problems.¹³ Home removal isn’t offered everywhere and isn’t appropriate for every wound, but it’s an option an increasing number of clinics provide with proper instruction.

Buried absorbable sutures, placed beneath the skin surface to hold deeper tissues together, don’t need removal. They dissolve on their own over weeks to months. Occasionally one works its way to the surface before fully dissolving, a minor issue called suture extrusion. In a study of 446 Mohs defect repairs, suture extrusion was among the factors associated with increased postoperative complications.¹⁴ If you notice a small thread poking through the skin days or weeks after surgery, it’s usually not dangerous, but let your surgeon’s office know.

Complications Across Closure Types

Mohs surgery has a strong overall safety record regardless of how the wound is closed. In the large prospective study mentioned earlier, only one patient among over a thousand sutured repairs experienced partial wound separation.¹ That is a remarkably low dehiscence rate, though it reflects a well-controlled surgical setting.

The type of repair does influence which complications are more likely. Cheek and perioral reconstructions carry higher complication rates compared to other facial zones.² Certain flap designs, including glabellar, bilobed, and rhombic flaps, have been linked to higher complication rates in surgical series.¹⁴ For nasal reconstruction using grafts and flaps, the most common postoperative issues were raised or depressed scarring rather than anything medically dangerous.⁵

Secondary intention healing, despite leaving an open wound, does not appear to carry a meaningfully higher infection risk. Infection rates in these cases have been reported at roughly 1% to 4%.⁸ The trade-off is a longer healing timeline. A sutured wound may look essentially closed within a couple of weeks, while a wound healing by secondary intention can take several weeks to a few months to fully close, depending on its size and location.

Why Patient-Reported Outcomes Are Still a Blind Spot

One underappreciated gap in the Mohs reconstruction literature is the lack of data on how patients actually feel about their results. A critical review of facial reconstruction studies after Mohs surgery found that 81% did not include any patient-reported outcomes or standardized measurements of patient satisfaction.² Surgeons assessing their own work may rate a cosmetic result quite differently than the patient living with it. If a scar is technically well-executed but sits where you see it every morning in the mirror, the patient experience and the clinical assessment can diverge sharply.

This matters when you are deciding between closure options. Much of the existing guidance about which approach gives the “best” cosmetic outcome is based on surgeon ratings or unstandardized photographic comparisons. As more research incorporates what patients themselves think, the balance between stitched repairs, flaps, grafts, and secondary intention healing could shift. For now, the best approach is a candid conversation with your surgeon about what to expect cosmetically, functionally, and in terms of healing time, because the published data doesn’t always capture the full picture of what recovery looks like from the patient’s side of the experience.

1
JAMA Dermatology. A Prospective Evaluation of the Incidence of Complications Associated With Mohs Micrographic Surgery
2
Journal of Craniofacial Surgery. Facial Reconstruction After Mohs Surgery: A Critical Review of Defects Involving the Cheek, Forehead, and Perioral Region
3
PubMed. Surgical repair of temple defects after Mohs micrographic surgery
4
PubMed Central. Overview of Local Flaps of the Face for Reconstruction of Cutaneous Malignancies: Single Institutional Experience of Seventy Cases
5
PubMed Central. Nasal Reconstruction of Post-Mohs Defects >1.5 cm in a Single Cosmetic Subunit Under Local Anesthesia by a Combination of Plastic Surgeon and Mohs Surgeon Team
6
Actas Dermo-Sifiliográficas. Secondary Intention Healing After Mohs Micrographic Surgery: An Updated Review of Classic and Novel Applications, Benefits and Complications
7
Dermatologic Surgery. Cosmetic and Functional Outcomes of Second Intention Healing for Mohs Defects of the Lips
8
Actas Dermo-Sifiliográficas. Secondary Intention Healing After Mohs Micrographic Surgery: An Updated Review of Classic and Novel Applications, Benefits and Complications
9
Dermatologic Surgery. Broader Practice Indications for Mohs Surgical Defect Healing by Secondary Intention: A Survey Study
10
Dermatologic Surgery. A Prospective, Randomized, Single-Blind Study Comparing Cyanoacrylate Adhesives to Sutures for Wound Closure in Skin Cancer Patients
11
PubMed Central. Fast Absorbing Gut Suture versus Cyanoacrylate Tissue Adhesive in the Epidermal Closure of Linear Repairs Following Mohs Micrographic Surgery
12
PubMed Central. The surgical outcome of sutureless skin closures using Octyl-2-cyanoacrylate (Dermabond™) versus Steri-Strip™
13
Dermatologic Surgery. Patients are Willing and Successful With Home Suture Removal After Mohs Surgical Procedures
14
Facial Plastic Surgery. Successes, revisions, and postoperative complications in 446 Mohs defect repairs