Mohs micrographic surgery is a precise technique for removing skin cancer by excising thin layers of tissue and immediately examining them under a microscope until no cancer cells remain. This method maximizes the removal of cancerous cells while preserving the greatest amount of healthy surrounding tissue. Proper post-operative care is important for promoting efficient wound healing and minimizing the resulting scar, especially since Mohs surgery often involves cosmetically sensitive areas. Following a strict care regimen reduces the risk of complications and improves the final cosmetic outcome.
Initial Post-Operative Management
The first 24 to 48 hours following the procedure focus on stabilization and managing expected side effects. A pressure dressing is typically applied to the surgical site before you leave, which should remain undisturbed during this initial period unless otherwise instructed. If minor bleeding or oozing occurs, apply firm, continuous pressure with a clean, dry gauze directly over the dressing for 20 to 30 minutes without lifting it to check the wound.
Swelling, bruising, and mild pain around the surgical site are normal. Elevating the surgical area, especially the head or scalp, helps minimize swelling. For pain relief, take acetaminophen; avoid aspirin, ibuprofen, or naproxen for several days unless medically necessary, as they increase the risk of bleeding. Applying a cold compress wrapped in a cloth for 15 to 20 minutes every hour during the first day can also reduce discomfort and swelling.
The Daily Wound Care Protocol
The daily wound care routine typically begins 24 to 48 hours after the procedure, once the initial dressing is removed. The primary goal of this protocol is to maintain a clean, moist healing environment to prevent the formation of a hard, crusty scab, which can delay healing and worsen scarring. Begin by thoroughly washing your hands before touching the wound to prevent the introduction of bacteria.
The wound and surrounding skin should be gently cleansed once or twice daily using mild soap and water, or a dilute solution of half water and half hydrogen peroxide, as advised by your surgeon. The cleaning process should carefully remove any crusting, dried blood, or debris from the area without scrubbing aggressively. Gently pat the wound dry with a clean, soft cloth or gauze after cleaning.
After the area is dry, apply a layer of a plain petrolatum-based ointment, such as petroleum jelly, to the entire incision site. The ointment keeps the wound bed moist, facilitating the migration of new skin cells and supporting faster, cleaner healing. Finally, cover the site with a non-adherent dressing, such as a Telfa pad or a sterile bandage, secured with paper tape. Change this dressing once or twice daily following the cleaning and ointment application until the sutures are removed or the wound is fully closed.
Recognizing Signs of Complication
While the majority of Mohs wounds heal without issue, it is important to recognize specific signs that indicate a complication requiring immediate medical attention. Normal healing involves some mild redness and tenderness, but spreading redness, increased warmth, or pain that worsens after the first few days can signal an infection.
Other signs of infection include the presence of pus, which is thick, yellowish, or cloudy discharge, or a foul odor emanating from the surgical site. A fever of 100.4 degrees Fahrenheit or higher, accompanied by chills or a general feeling of being unwell, is a systemic sign of a serious infection. Any bleeding that does not stop after applying firm, continuous pressure for two consecutive 20-minute periods also warrants an immediate call to your surgeon or a visit to the emergency room.
Protecting the Healing Site and Scar Management
Protecting the wound from physical strain and environmental factors is important during the healing phase. Avoid strenuous physical activity, heavy lifting, or any exercise that causes excessive sweating or puts tension on the wound for at least one to two weeks, or until the stitches are removed. Tension or strain on the incision can disrupt the healing tissue and lead to a wider, more noticeable scar.
Do not submerge the wound in water; avoid baths, hot tubs, and swimming pools until the surgeon confirms the site is fully closed. Once the wound is completely closed, sun protection becomes the most important factor for long-term scar appearance. Ultraviolet radiation can cause scars to darken and become hyperpigmented, making them more visible.
Apply a broad-spectrum sunscreen with an SPF of 30 or higher to any exposed scar tissue. Once the wound is fully healed, typically around six weeks post-surgery, scar management techniques can improve the cosmetic outcome. Gentle scar massage with a lotion or oil helps soften and flatten the scar tissue by encouraging collagen remodeling. Topical silicone-based products, such as gels or sheets, are also recommended as they create a hydrating barrier that can reduce the thickness and redness of the maturing scar.