Dark Spots in Graft After Mohs for Basal Cell Carcinoma (BCC)

Some grafts look very red,others purple or black for the first several weeks. The dead skin cells that normally peel away from our skin every day, are not allowed to shed if the skin graft was covered for a week so it is common to see this delayed shedding starting around the second week. Edges may look dried out and curl up. Many grafts looking very unusual for the initial period mature into very reasonable appearances. there is no perfect graft. The color usually fades to lighter but some grafts hyperpigment and can remain brown.

Your Mohs surgeon or reconstructive surgeon should be notified that you have a concern as they may want to see you and recommend a certain ointment or other treatment.There is always a risk of partial or full failure once a skin graft is done, but even if it does fail completely, surgeons allow it to scab and allow the body to heal for a while underneath. Often, this is all that is necessary to produce a reasonable result, but a second graft can be done later or more definitive reconstruction.

I am reticent to give advice based on a photo.  But, do not see any obvious reason for concern.  Black spots may represent dried blood or focal scab formation.  However, you should always follow-up in person with your treating dermatologic surgeon for any wound healing concerns as soon as you practically can.

It is difficult to tell for sure what the balck spots are on your photo. The best advice would be to have your surgeon evaluate the graft to insure that nothing needs to be done at this time.