Mohs surgery precisely treats common skin cancers. It involves removing cancer layer by layer, with each layer examined immediately under a microscope. This meticulous approach ensures all cancerous cells are excised while preserving healthy tissue, particularly for sensitive areas like the face. It aims for the highest cure rate with the smallest wound.
Understanding Mohs Surgical Healing
Healing after Mohs surgery progresses through phases. Initial wound closure occurs within weeks; complete scar maturation takes much longer. Immediately after, the surgical site is bandaged. Discomfort, swelling, and minor bleeding are common. Pain is typically mild to moderate, peaking within 24 to 48 hours and subsiding over the first week.
During the first week, a scab or crust forms as initial swelling and discomfort decrease. By the second week, pain and swelling significantly improve, though the wound may appear red or slightly raised. Over the next few weeks, the wound recovers, with new tissue forming and edges pulling inward. Surface healing for most wounds occurs within 4 to 10 weeks; smaller facial wounds often heal in 4 to 6 weeks.
Long-term healing, including scar remodeling and fading, can extend from several months to two years. During this period, the scar flattens and its color gradually fades, though some tightness or numbness might persist. Full scar maturation, with minimal redness and nearly flat raised areas, typically takes about one year.
Factors Affecting Healing Time
Several factors influence healing duration and quality after Mohs surgery. Wound size and depth play a role; larger, deeper excisions, or those requiring reconstructive techniques like skin grafts or flaps, take longer to heal. Wounds on areas with less blood flow (e.g., nose, ears, hands, feet) may heal slower.
Overall health impacts healing. Older individuals may heal slower due to age-related cellular function. Pre-existing conditions like diabetes can impair circulation and elevate blood sugar, hindering healing. Smoking can significantly delay wound healing by impairing blood flow. The specific closure technique (stitches or secondary intention) also affects the timeline.
Caring for the Surgical Site
Proper surgical site care is important for optimal healing and to minimize complications. The initial dressing should remain undisturbed for 24 to 48 hours, or as directed by the surgeon. After this period, cleanse the wound gently with mild soap and water once or twice daily. Apply petroleum jelly or a prescribed ointment, then cover with a fresh, non-stick dressing.
Activity restrictions prevent wound disruption. Avoid strenuous activities, heavy lifting, and bending from the waist for at least one to two weeks, especially if stitches are present.
Pain can be managed with over-the-counter medications like acetaminophen or ibuprofen. Applying ice packs for 10-15 minutes can help reduce swelling and discomfort.
Sun protection is important; sunlight can worsen scarring and inhibit healing. Apply a broad-spectrum sunscreen with SPF 30 or higher to the healed site, and wear protective clothing, for at least 6-12 months.
When to Seek Medical Advice
Recognizing complication signs is important for patient safety. Contact your medical provider for excessive or uncontrolled bleeding that doesn’t stop with continuous pressure. Signs of infection include increasing pain, swelling, redness, warmth around the wound, or pus/foul-smelling drainage.
Other concerning symptoms include severe or worsening pain not relieved by medication, fever, chills, or wound dehiscence. Any sudden changes in the wound’s appearance or unusual discomfort warrant prompt medical evaluation.
Long-Term Outcomes
After initial healing, focus shifts to the treated area’s long-term appearance and sensation. Scar maturation is an ongoing process that can take up to two years, during which the scar gradually flattens, softens, and fades. While scarring is an expected outcome of any surgery, Mohs technique aims to minimize it by preserving healthy tissue.
Temporary numbness, tightness, or itching around the surgical site may occur for several months, typically improving. In some cases, numbness can be permanent due to nerve involvement during the procedure. Regular dermatologist follow-ups are important to monitor healing, assess cosmetic outcome, and conduct surveillance for new or recurrent skin cancers.