Mohs surgery is a precise technique for removing skin cancer, especially on sensitive areas like the scalp. It involves removing thin layers of skin and examining them under a microscope until all cancer is gone, preserving healthy tissue. This precision leads to high success rates, reaching up to 99% for new basal and squamous cell carcinomas. Understanding scalp recovery is important for managing expectations and promoting optimal healing.
Initial Recovery Steps
Immediately following Mohs surgery on the scalp, the surgical site will be covered with a dressing to protect the wound. Pain is common and can be managed with over-the-counter pain relievers like acetaminophen. Scalp sites may experience more discomfort compared to other body areas.
Some swelling and redness around the wound are expected, particularly peaking around 48 hours after the procedure. Applying cold compresses and keeping the head slightly elevated, even during sleep, can help minimize swelling and discomfort. After 24 hours, gently wash the wound with soap and water, dry carefully, and apply ointment as directed to keep it moist. Numbness around the surgical site is also common and typically resolves as the nerves heal.
Understanding the Healing Journey
The wound on the scalp progresses through several healing phases following Mohs surgery. In the initial granulation phase, typically within the first 3 to 5 days, new tissue begins to form at the base of the wound. This is followed by the contraction phase, usually lasting 2 to 4 weeks, where the wound edges gradually pull inward. During this period, some itching and skin tightening around the scar are normal sensations.
Full wound closure can vary, often taking between two to four weeks for smaller areas, but larger wounds on the scalp may require six weeks or more for complete healing. The appearance of the scar will evolve over time, initially appearing red and raised before gradually fading and flattening over 12 to 18 months as collagen remodels during the maturation phase. Hair regrowth in the surgical area depends on the depth and extent of tissue removal; in some cases, hair follicles may be permanently damaged, resulting in a hairless scar.
Daily Life During Recovery
Modifying daily activities is important to support healing after Mohs surgery on the scalp. Strenuous exercise, heavy lifting, and activities that involve bending over should be avoided, especially in the first 48 hours or as advised by your surgeon, to reduce the risk of bleeding and pressure on the wound. Showering is generally permissible after 24 hours, but direct water pressure on the surgical site should be avoided, and gentle cleansing is recommended. Soaking the wound in bathtubs or swimming pools should be avoided until the wound is fully healed.
Protecting the surgical site from sun exposure is important to prevent scar darkening and promote optimal healing. Wearing a wide-brimmed hat or other head covering can provide effective sun protection for the scalp. When sleeping, try to minimize direct pressure on the wound, which might involve adjusting your sleeping position.
When to Contact Your Doctor
Recognizing signs that require medical attention is important during the recovery period. Increasing redness, warmth, significant swelling, pus-like drainage from the wound, or a fever could indicate an infection. While some minor bleeding or oozing is normal in the first 48 hours, excessive bleeding that does not stop after applying firm, continuous pressure for 30 minutes warrants immediate contact with your surgeon.
Severe or worsening pain not controlled by prescribed or over-the-counter medication should also be reported. A sudden or significant increase in swelling, particularly if accompanied by other concerning symptoms, should prompt medical evaluation. The wound opening up, known as dehiscence, or persistent and unusual numbness, tingling, or weakness around the surgical area also necessitates contacting your medical provider for guidance.
Scar Management and Beyond
Once the initial wound has closed, long-term scar management can begin to optimize its appearance. Scar massage techniques, performed gently, can help soften and flatten the scar tissue over time by breaking down collagen fibers. Topical treatments, such as silicone sheets or gels, may be recommended by your doctor to improve scar texture and color. Continued sun protection remains important, as ultraviolet light can cause scars to darken and become more noticeable.
Scar maturation is a gradual process that can take many months to achieve its final appearance. If, after significant healing, the scar remains a concern, various scar revision options may be discussed with a dermatologist. These might include procedures like dermabrasion or laser treatments, which can further improve the scar’s texture and blend it more seamlessly with the surrounding skin.