Mohs surgery is a specialized, precise technique for removing skin cancer, layer by layer, while preserving the maximum amount of healthy tissue. This method offers the highest cure rates for common skin cancers while minimizing the surgical defect. Because this procedure results in a wound, meticulous aftercare is necessary for a successful recovery and optimal cosmetic result. Adhering to a clear wound care regimen is the most important action a patient can take to prevent complications like infection and delayed healing.
Daily Wound Cleaning and Dressing Changes
The first step in wound care begins by keeping the initial dressing applied by the surgeon dry and intact for 24 to 48 hours, depending on the surgeon’s specific instruction. Once the initial dressing is removed, typically after a shower to help loosen the adhesive, daily care focuses on maintaining a moist environment to encourage faster healing. A moist wound bed is the standard of care in dermatologic surgery because it accelerates the process of re-epithelialization, where new skin cells migrate across the wound surface to close the defect.
Before touching the surgical site, hands must be thoroughly washed. The wound should be gently cleansed using a mild soap and water or a half-strength solution of hydrogen peroxide and water, applied with a cotton-tipped applicator or gauze. The cleaning motion should be gentle to remove any crusted material or old blood without scrubbing. Preventing a hard scab from forming is important, as scabs can impede the migration of new skin cells and slow healing.
After cleaning, the area should be gently patted dry with a clean towel. A generous amount of plain petroleum jelly or a similar product like Aquaphor should be applied directly to the wound, creating a layer similar to cake icing. This moisture barrier prevents the wound from drying out and is superior to many topical antibiotic ointments, which can cause allergic skin reactions or contribute to antibiotic resistance. The site is then covered with a non-adherent dressing, such as Telfa, secured with paper tape to prevent sticking. This process should be repeated once or twice daily until the wound has completely closed or sutures are removed, typically in one to two weeks.
Managing Common Post-Surgical Symptoms
It is normal to experience swelling and bruising around the surgical site, particularly during the first 48 to 72 hours. Swelling (edema) and bruising (hematoma) are temporary side effects of tissue manipulation during surgery. These symptoms often peak on the second or third post-operative day before gradually subsiding.
To help reduce swelling, keep the surgical site elevated above the level of the heart as much as possible, especially when resting. For facial surgery, this means sleeping with the head propped up on two or three pillows. Applying a cold compress (such as a bag of frozen peas wrapped in a thin cloth) for 15 to 20 minutes at a time, with a two-hour break between applications, can alleviate discomfort and minimize swelling during the initial 48 hours.
For managing pain, most patients find that over-the-counter acetaminophen is sufficient to control discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, should be avoided for at least five days unless approved by the surgeon. These medications carry a risk of increasing bleeding at the surgical site, which could compromise healing.
Activity Limitations and Protection
To ensure the wound edges remain securely approximated and prevent complications, specific activity limitations must be observed during recovery. Physical activity that significantly raises the heart rate or blood pressure, or causes straining, should be avoided for at least one to two weeks. This includes strenuous exercise, heavy lifting, and vigorous sports, which can place tension on the incision and potentially lead to wound splitting (dehiscence).
For wounds on the head or neck, excessive bending over should be limited, as this action can increase blood flow and pressure, potentially causing bleeding or increased swelling. Gentle walking is usually permissible, but any activity that causes the wound to pull or stretch should be immediately discontinued. If the surgical site is on an extremity, keeping the limb elevated is necessary to assist with fluid drainage.
When showering, it is generally safe to get the wound area wet after the initial 24 to 48 hours, but direct, forceful water pressure must be avoided. Soaking the wound in a bathtub, hot tub, or swimming pool is strictly prohibited until the wound is completely healed and all sutures are removed, as submersion introduces bacteria and increases infection risk. Protecting the healing tissue from the sun is important, as ultraviolet exposure can cause permanent hyperpigmentation and lead to a more noticeable scar.
Recognizing Warning Signs and Complications
While mild redness, tenderness, and clear or slightly pink drainage are part of the normal healing cascade, patients must be aware of warning signs indicating infection. The indicators of a wound infection are increasing pain not relieved by medication, excessive warmth, spreading redness or red streaks extending from the incision, and the presence of thick, yellow or green pus-like drainage. Infections most commonly appear around the third post-operative day.
Excessive bleeding requires immediate attention. A small amount of blood or oozing on the dressing is expected, but if the bandage becomes rapidly soaked, firm, continuous pressure must be applied directly to the site for 20 to 30 minutes without interruption. If bleeding persists, the surgeon should be contacted immediately or the patient should proceed to an emergency care facility.
If the wound was closed with sutures, monitor their integrity. If sutures appear loose or have fallen out prematurely, leading to partial or complete reopening of the wound, the surgeon should be notified. Any sudden, significant increase in pain, fever, or feeling unwell should prompt a call for an urgent evaluation.