Mohs micrographic surgery is a precise method for removing skin cancer that maximizes the removal of cancerous cells while preserving surrounding healthy skin. This technique is particularly beneficial for areas on the face or other cosmetically sensitive sites. Despite the procedure’s high success rate, the final outcome and quality of recovery depend on strict adherence to post-operative care instructions. Failing to follow these guidelines increases the risk of complications, including bleeding, infection, and poor cosmetic results.
Physical Activity Restrictions
Immediately following Mohs surgery, it is crucial to avoid activities that cause a sudden increase in heart rate or blood pressure, as this can force blood through newly sealed vessels and lead to bleeding or the formation of a hematoma. This risk is especially high within the first 48 hours but generally extends for about one to two weeks, depending on the wound size and location.
Patients must refrain from strenuous exercise, such as running, intense cardio, or heavy lifting, which typically means avoiding lifting anything over 5 to 10 pounds. The rapid increase in blood flow during these activities can put pressure on the delicate repair site, potentially causing the wound edges to separate or sutures to tear out. Even activities that involve straining or bending over, particularly if the surgical site is on the head or neck, should be minimized.
This physical restriction is also important to prevent tension across the wound, especially if a complex repair, such as a skin graft or a flap, was used to close the defect. Any pulling or stretching of the surrounding skin can compromise the blood supply to the graft or flap. It is important to prioritize rest and limit movement to allow the body’s natural clotting and healing mechanisms to work undisturbed.
Handling the Surgical Site
Avoid getting the surgical site wet to prevent the introduction of bacteria and to promote optimal scar formation. This means avoiding prolonged soaking in baths, hot tubs, or swimming pools for at least two weeks or until the surgeon approves. Water exposure, especially in public bodies of water, elevates the risk of bacterial infection, which is a primary cause of delayed healing.
Patients should also resist the urge to pick at any scabs or crust that form over the incision line. Removing scabs prematurely disrupts the skin’s attempt to close the wound and can lead to a wider, more noticeable scar. Similarly, the initial pressure dressing placed by the surgeon should not be removed or disturbed for the first 24 to 48 hours unless there is a specific instruction to change it earlier.
Applying unapproved topical products, such as certain creams, lotions, or makeup, directly onto the incision must be avoided unless specifically recommended by the surgical team. Many products contain ingredients that can irritate the healing tissue or create an environment conducive to infection. Sun exposure must be strictly prohibited on the healing site, as ultraviolet radiation can cause permanent hyperpigmentation and lead to a dark, noticeable scar.
Medications and Lifestyle Factors
Certain medications and lifestyle choices can undermine the body’s ability to clot blood and heal the wound effectively. Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, are generally prohibited unless cleared by the surgeon because they interfere with platelet function and increase the risk of post-operative bleeding. For pain management, acetaminophen is the recommended alternative, as it does not inhibit the clotting cascade.
Alcohol consumption should be limited or completely avoided following the procedure. Alcohol acts as a vasodilator, which causes blood vessels to widen, increasing blood flow to the skin and potentially leading to swelling and bleeding at the surgical site. Excessive alcohol intake can also impair the immune system and slow down the metabolic processes required for wound repair.
Smoking must be curtailed, ideally for at least two weeks post-surgery, due to its impact on wound healing. Nicotine is a vasoconstrictor, meaning it narrows blood vessels, which reduces the flow of oxygen and necessary nutrients to the wound bed. This lack of oxygen delays healing and raises the risk of wound dehiscence and infection.
Ignoring Signs of Complication
Do not dismiss or attempt to self-treat symptoms that indicate a complication during recovery. Patients must not ignore signs of infection, which typically appear five to seven days after the procedure. These signs include increasing pain, spreading redness, warmth around the site, and the presence of thick, cloudy, or foul-smelling drainage. Infections require immediate medical attention and professional treatment to prevent worsening damage to the tissue.
Ignoring uncontrolled or excessive bleeding is also critical. While minor oozing is normal, active bleeding that saturates the dressing and does not stop after applying firm, continuous pressure for 20 minutes with a clean, dry gauze pad signals an emergency. If this pressure technique fails, the patient must immediately contact their surgical team.
Any signs of an allergic reaction, such as a widespread rash, difficulty breathing, or severe new swelling, should not be ignored. These may indicate an adverse reaction to a medication or the materials used in the dressing. Seeking prompt guidance from the surgeon or an emergency department for these unexpected symptoms ensures a safe and successful recovery.