What can I expect during Mohs Surgery recovery?

Your recovery after your Mohs surgery will be a function of whether surgical defect is allowed to heal on its own or whether it is stitched. Stitches on the face will result in a suture removal in approximately 5 to 7 days. After this time, the area should be closed and well on its way to healing. It will be safe to apply makeup,  sunscreen, etc at this time and there will be no need for bandages. If it is allowed to heal on its own (no stitches) it may take anywhere from 3 to 5 weeks and will need to be covered with Vaseline and a bandage. FYI a large head-to-head study of Vaseline versus antibiotic ointment showed similar infection rates however the people using the antibiotic ointment developed an allergic reaction approximately 15% of the time. Therefore, there is no advantage to antibiotic ointment over pure petrolatum ointment

If your wound is closed by some means, the recovery is more simple because you don't have an open wound to manage. If, however, the wound is left open to heal secondarily by itself, there are dressing changes to deal with and a few weeks of inconvenience dealing with the healing wound.

Mohs is a technique for removal of skin cancers by a specially trained group of dermatologists (often called Mohs specialists or Mohs surgeons). The principle advantage of the Mohs technique is that the same physician that removes the skin cancer also subsequently examines the removed skin cancer and surrounding margin of normal skin under a microscope to make sure that the skin cancer has been completely removed. The patient is kept in the Mohs specialists' office and the wound is not repaired until the skin cancer has been completely removed. The Mohs specialist therefore acts as both the dermatologist and the pathologist. After successful removal of the skin cancer reconstructive surgery is performed to repair the hole (defect). Depending on a number factors such as patient preference, size and location of the defect, complexity of the defect, aesthetic expectations of the patient, and need for sedation, the resulting defect may be either repaired by a plastic surgeon or by the Mohs specialist.

The Mohs technique allows for mapping of the removed tumor so that when a portion of the tumor is left behind, it can be seen under the microscope and it can be determined roughly where in the wound it is located. If the tumor was not completely removed the first time, more tissue is removed (this is called the second stage) and again subsequently examined until the skin cancer has been completely removed.

This process can take several stages and many hours to complete but offers the patient a very high (close to 97%) success rate in removal of the skin cancer as measured by lack of recurrence (meaning the skin cancer coming back in the same spot in a few years).

The dermatologist performing the Mohs procedure may also perform the reconstruction (plastic surgery repair) of the defect left after removal of the cancer. The decision of whether the Mohs specialist or a plastic surgeon performs the reconstruction depends on a number of factors:

• Patient preference
• Size of defect
• Complexity of defect
• Location of defect
• Aesthetic expectations
• Need for sedation

Recovery (measured in terms of time off from work or social activities) can take between several days to several weeks based on the size, complexity, and location of the defect.

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Although large skin cancers can be seen with the naked eye, it takes a microscope to visualize cancer at the cellular level. The only way to prevent recurrence of localized skin cancer is to remove each and every cell; otherwise any remaining skin cancer cells can reproduce and cause a regrowth of the cancer.

Mohs surgery is a specialized method to remove skin cancer. It is named in honor of Frederick Mohs, the physician who developed the technique. Mohs surgery differs from other methods of treating skin cancer by the use of detailed mapping techniques and onsite microscopic examination of the surgically removed skin. Mohs skin cancer surgery allows for the tissue to be examined during the operation through a microscope to ensure that all of the cancer cells have been removed adequately, and that removal of healthy, cancer-free tissue is minimized. Using the Mohs microscopic surgery technique there is a 95% cure rate.

Mohs skin cancer surgery is then followed by careful reconstructive surgery to repair the defect (hole) and to yield an aesthetically pleasing result.

Your recovery from MOHS surgery will depend on the extent and depth of the area that was removed and the method in which is was "closed". Larger areas may require that your surgeon create flaps of skin that are rotated or otherwise moved around to reposition or redrape the skin in order to close the area of the defect (the hole). In other instances, a graft of skin may need to be taken from another area of your body and sutured into place in order to cover the area. Sometimes the surgeon will create a "purse-string" to cinch the hole closed.

Your surgeon may cover the area with a bandage, a patch, a pressure dressing, or other type of dressing to prevent shearing forces, bleeding, fluid collection, or dirt in the wound. Sometimes, the area is only closed with a few stitches and recovery is no more complicated that applying antibiotic ointment, keeping the wound clean and dry, and avoiding sun.

Regardless of the extent of the surgery, you should not smoke or use nicotine which decreases oxygen supply to the wound and will impair healing. Depending on the area, stitches usually come out in 5-7 days on the face or eyelids, or 7-14 days on the torso or extremities.

For the long term, you should remember to apply broad coverage sunblock everyday (even if it's cloudy) and avoid sun exposure during peak hours (10am-2pm) to stave off more sun damage which could lead to future skin cancer.