Mohs micrographic surgery is a precise technique used to remove skin cancer layer by layer, ensuring all cancerous cells are excised while preserving the maximum amount of healthy tissue. Achieving the best possible outcome depends on diligent adherence to post-operative instructions. The healing phase requires temporary changes to a patient’s routine to prevent complications like bleeding, infection, and compromised scar formation. Understanding these specific prohibitions and precautions is fundamental to a smooth recovery.
Restrictions on Physical Activity and Strain
Strenuous activity is strictly prohibited in the initial one to two weeks following Mohs surgery because it significantly increases blood pressure and heart rate. This rise in pressure can cause fragile blood vessels around the surgical site to rupture, leading to bleeding or hematoma formation. Patients must avoid intense cardiovascular exercise, such as running, cycling, or high-impact aerobics, during this initial recovery period.
Lifting heavy objects, generally defined as anything over five to ten pounds, must also be avoided. The muscular exertion required for heavy lifting creates tension beneath the skin, which may pull on the stitches and cause the wound to separate. Actions that involve bending over, such as picking up items from the floor, should be modified. Bending can cause blood to rush to the head, which is hazardous for wounds on the face, scalp, or neck. Instead of bending at the waist, patients should squat or kneel to maintain head elevation.
For patients with wounds on the head or face, sleeping with the head elevated on several pillows is recommended for the first few days. This uses gravity to help minimize post-operative swelling, which peaks around 48 to 72 hours after the procedure. Minimizing physical strain allows the wound to heal undisturbed. Resuming a normal exercise routine should be gradual and only begin after receiving explicit clearance from the Mohs surgeon.
Mistakes to Avoid During Wound Care
Improper management of the surgical wound is a common cause of delayed healing or infection. Patients must not allow the initial pressure dressing to get wet for the first 24 to 48 hours, as moisture can create a breeding ground for bacteria. Once the surgeon approves the removal of the initial bandage, submerging the wound in water is prohibited until the wound is fully closed and sutures are removed. This includes taking a bath, swimming in a pool, or using a hot tub.
A frequent error is picking at or forcefully removing scabs or crusts that form over the healing tissue. Patients should never attempt to peel or scratch away this tissue, as it can tear newly formed skin cells and reopen the incision. Approved wound care protocols involve gentle washing with mild soap and water. This should be followed by the application of a simple, non-antibiotic ointment like petroleum jelly to keep the site continuously moist, which prevents the formation of a hard, thick scab.
Applying unapproved topical products directly to the incision can be detrimental. This includes cosmetic items like makeup, lotions, or creams, which can introduce irritants or bacteria into the wound. Patients should not use harsh antiseptics like hydrogen peroxide or rubbing alcohol, as these chemicals can damage the cells actively repairing the tissue. Never attempt to self-treat a suspected infection. Signs requiring immediate contact with the physician include:
- Increasing redness that spreads outward.
- Significant swelling or warmth.
- Severe pain.
- Yellow or foul-smelling drainage.
Medications and Supplements That Must Be Stopped
Common over-the-counter medications and dietary supplements interfere with the body’s clotting mechanism, substantially increasing the risk of post-operative bleeding. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as Ibuprofen (Advil, Motrin) and Naproxen (Aleve), function as mild blood thinners. They should be avoided for at least several days to a week after surgery, unless specifically directed otherwise. Aspirin and any aspirin-containing products must also be discontinued due to their irreversible effect on platelet function.
For managing mild discomfort, patients should use Acetaminophen (Tylenol) as the preferred pain reliever, since it does not carry the same risk of increased bleeding. Certain herbal and nutritional supplements possess mild anticoagulant properties and must be temporarily stopped. These typically include:
- High doses of Vitamin E.
- Fish Oil (Omega-3 fatty acids).
- Garlic.
- Ginkgo Biloba.
Coordination with all prescribing physicians is necessary for patients who take prescription blood thinners, such as Warfarin (Coumadin) or Clopidogrel (Plavix). Patients must never discontinue these medications on their own. Stopping a prescription blood thinner without the explicit clearance of the prescribing doctor can lead to serious cardiovascular events like stroke or heart attack.
Protecting the Site from Sun Exposure and Trauma
Exposing the healing wound or resulting scar to ultraviolet (UV) radiation is highly discouraged, as UV rays can cause post-inflammatory hyperpigmentation. This exposure can lead to the scar darkening permanently, making the final cosmetic outcome worse. Sun protection is a long-term restriction, often lasting several months to a year, until the scar tissue has fully matured.
Patients must implement a comprehensive sun-avoidance strategy, rather than relying on a simple hat for protection. This includes seeking shade, wearing wide-brimmed hats, and using protective clothing. Once the wound is completely closed and the surgeon has given permission, a broad-spectrum, mineral-based sunscreen with an SPF of 30 or greater should be applied daily over the area.
Accidental trauma to the surgical site must be prevented to avoid reopening the wound or damaging the developing scar tissue. Patients should exercise caution around pets or young children, whose sudden movements could cause injury. Wearing restrictive clothing, tight necklines, or jewelry that rubs against the incision site creates constant friction. This friction can irritate the new tissue, delay healing, and contribute to a wider, more raised scar formation.