Mohs surgery precisely removes certain skin cancers, like basal cell and squamous cell carcinomas, aiming to preserve healthy tissue and achieve high cure rates. Understanding the healing process is important for patients to set realistic expectations and support a smooth recovery. This article provides an overview of the healing timeline and what to anticipate.
General Healing Timeline
Healing after Mohs surgery progresses through several phases, from immediate wound closure to long-term scar maturation. Initially, the body stops bleeding and forms a clot. New tissue forms within three to five days (granulation phase), followed by wound contraction over two to four weeks as wound edges pull inward.
Most wounds show significant closure within the first few weeks, with noticeable healing by the end of the first month. Smaller wounds, particularly on the face, might appear mostly healed in four to six weeks, but complete healing extends much longer. The final maturation phase, involving collagen remodeling and scar fading, can take four weeks to two years. Roughly 90% of sites show substantial healing by two months, but the scar continues to soften and flatten over many months.
Factors Influencing Recovery
Several elements affect how long a Mohs surgery wound takes to heal. The size and depth of the excised tissue play a role, as larger wounds require more time for repair. The anatomical location also influences recovery; areas with less blood flow, such as the lower legs, ears, hands, or feet, heal more slowly than the face. Wounds over frequently moving joints, like the shoulder, can experience prolonged healing due to constant tension.
A patient’s overall health impacts recovery duration. Chronic conditions like diabetes can compromise circulation, delaying healing. Weakened immune systems or immunosuppressant medications increase infection risk, further extending recovery. Lifestyle choices, such as smoking, can significantly impair healing by constricting blood vessels and reducing oxygen flow. Patient age can also be a factor, with older individuals sometimes experiencing slower healing due to thinner skin.
What to Expect During Healing
Immediately following Mohs surgery, the treated area will be bandaged. Initial discomfort, swelling, and minor bleeding or oozing are common. Swelling and bruising often peak within one to three days before gradually subsiding.
During the first week, patients typically observe redness, continued swelling, and discomfort; a scab or crust may form. Do not pick at this scab to prevent infection and minimize scarring. If stitches were used, they are usually removed within seven to fourteen days.
In the weeks following stitch removal, the wound’s appearance gradually improves as the body continues its repair process. The surgical site will show residual redness and bruising, which slowly fade. For several months, and sometimes up to a year or more, the scar tissue will continue to remodel, becoming flatter and less noticeable. It is normal to experience some itching or tightness around the scar. Persistent redness indicates blood vessels delivering oxygen and nutrients to aid healing.
Promoting a Smooth Recovery
Patients can take several steps to support a smooth recovery and reduce complications. Adhering to the surgeon’s wound care instructions is important. This involves keeping the wound clean and dry, changing dressings daily, and gently cleaning the area with mild soap and water or a diluted hydrogen peroxide solution if recommended. Applying an ointment like Aquaphor or Vaseline to keep the wound moist supports optimal healing.
Limiting physical activity is important for recovery. Avoid strenuous exercise, heavy lifting, or movements that stretch the wound for at least five days to several weeks to prevent bleeding and tissue disruption. For discomfort, over-the-counter pain relievers like acetaminophen are effective.
Applying cold compresses for 10-15 minutes can help reduce swelling and pain. Elevating the surgical site, especially on the head, neck, or an extremity, can further minimize swelling. Protecting healing skin from sun exposure is important to prevent discoloration or hyperpigmentation; use sunscreen or protective clothing.
Recognizing Potential Concerns
While Mohs surgery typically has a smooth recovery, be aware of signs indicating complications or delayed healing. Infection signs include increasing redness, swelling, warmth, pain, pus, or a foul odor from the surgical site. Fever or chills might also suggest a widespread infection, requiring immediate medical attention.
Minor bleeding or oozing from the wound is normal, especially in the first few hours. However, excessive bleeding that doesn’t stop after 20-30 minutes of firm, continuous pressure warrants contacting the surgeon.
Other signs prompting a call include delayed or poor wound healing, or if the wound reopens (dehiscence). Persistent or worsening pain not relieved by medication also requires professional evaluation. Prompt communication with the surgeon addresses potential issues and ensures the best outcome.