What is the typical recovery and downtime from Mohs surgery? What should I expect for after care needs?
Mohs Surgery Recovery
Doctor Answers 29
Wound healing after Mohs and reconstructive surgery
Typical recovery depends on the location of the cancer, the size of the defect, what type of reconstruction was required, and whether there are any complicating factors. Most of our patients return the day after surgery at which time the pressure bandage is removed the surgery site evaluated. After that the patient cleans the site twice daily with hydrogen peroxide; applies and antibiotic salve and a non-stick bandage. Sutures are removed for most sites at a week, and by then the site tends to be healing quite well. However, I tell patients that it takes a full 6-12 months to get the final cosmetic result after surgery, during which time we have them use sunscreens and possibly topical silicone gels to further improve the final result.
Expectations after Mohs
Depending on the location and extent of your cancer, you can expect swelling and bruising, tenderness and tightness. I tend to have patients wear a bandage for 7 days after surgery and most wounds require some sort of wound care for 2-3 weeks. Depending on the type of reconstruction after the cancer is removed by Mohs, you may have lumpiness or bumps from tissue redundancy or dissolvable sutures for 3-5 weeks after surgery. Generally you can expect soreness for 24-48 hours, but most patients are surprised that the surgical site is less tender than they expected. One of the best things you can expect after Mohs is a smaller wound defect and higher cure rate compared to any other surgical method used to treat skin cancers.
Although large skin cancers can be seen with the naked...
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.
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Recovery and after care following Mohs surgery
1) Head and neck: One week of light activity and twice daily wound care to the surgery site.
2) Other areas or if a flap or graft was performed: 2 weeks of light activity and twice daily wound care.
Proper wound care is to clean the site with soapy water and gently apply a hydrogen peroxide soaked gauze for 15 minutes. Afterward antibiotic ointment and a non-stick bandage is applied. The surgery site should remain moist with ointment and covered with a bandage at all times when not doing wound care.
We prefer to use sutures that dissolve whenever possibly, however, we still ask our patients to come in for a check up at 2 wks following surgery to ensure that the skin is healing properly. The suture line will take up to a year to completely heal and attain the best cosmetic result. During the healing process patients may pursue laser treatments to further improve the appearance.
Recovery from Mohs
The actual Mohs procedure uses precise microscopic margin control to remove your cancer with the best cure rate and the most narrow margins. Once the cancer is out, your Mohs surgeon will discuss the best repair option for you...this should give you the best cosmetic result and take into account your lifestyle and ability to care for your wound. You should leave with specific directions about how to care for your wound, what you will need, and emergency contact information for the physician. Most facial repairs will throb a bit the night after surgery and leave some swelling and/or bruising around the incision site. Any repair above the eyebrows will likely give you a black eye or two. Sutures are typically removed in 7 days and the scar will settle and mature and fade over the next 3-12 months. Repairs on the trunk and extremities may feel tighter, can also cause bruising and swelling and may require you to remain inactive while sutures are in place, about 2 weeks. Repairs on the leg are more likely to open up and become infected without the proper wound care and can take the longest to heal.
I like to see all my surgical patients 3 months post to make sure we are both happy with the outcome of the repair and see if any "tweaks" need to be done. I expect that at 3 months, most scars will have flattened out and be a little pink. That discoloration typically fades over the next few months and the scar should just blend and not be noticeable. It is important to have a trusting relationship with your surgeon, open communication, realistic expectations, and patience.
Recovery after Mohs Micrographic Surgery
I am often asked, "What can I expect after Mohs'?" The simple answer is that everyone will get a scar as any time that the skin is cut, a scar will result. Sometimes it heals so well the scar is barely noticeable, while at other times it is very obvious. Mohs' surgery is a method of tumor removal only. In some cases, the wound may be left to heal without any stitches, which takes anywhere from several weeks (for small thin lesions on the face) to three or more months (for larger wounds on the legs). Most patients choose to have the wound closed using Plastic Surgery. The final result is very dependent upon the surgeon, as well as many other factors. Choosing a reconstructive surgeon is an extremely important variable in determining one's cosmetic outcome.
For any closure one can expect some, all, or none the following:
- mild discomfort
- mild bruising
- mild spotting of blood on the bandage
For wounds left to heal without stitches, one can expect the following:
- mild to moderate discomfort
- healing that may take 3 weeks to over 3 months requiring daily wound care
- the wound will usually fill in from the bottom and close in from the sides
- a scar that usually will become white with time
- mild to moderate swelling (especially with leg wounds)
For skin grafts, one can expect the following:
- the graft is usually bandaged in a way that it must remain dry for one week
- the graft will sometimes look like a patch on a tire, although often the results can be very acceptable depending upon many factors which are too numerous to discuss here, but should be discussed with your surgeon.
- Less pain compared to second intention, if the donor site (where the graft is taken from) is closed using stitches.
- mild to moderate discomfort at the donor site if stitches are not used
- There is always a risk that the graft will not survive, which may result in more scar.
Plan for Mohs surgery aftercare
• Your surgical wound will require care during the weeks following the surgery.
• You should plan on wearing a bandage for 10-14 days.
• Plan to avoid strenuous physical activity for 2 weeks.
• You may experience a sensation of tightness across the area of your surgery that improves with time.
• Skin cancers frequently involve small superficial nerves, and months may pass before your skin sensation returns to normal. A numb sensation may be expected over the area. This is common and usually expected, but typically will return to normal with time. In very rare instances, the numbness may be permanent.
• Complete healing of the scar takes place over 3-12 months.
• During the first few months the site may feel “thick, swollen or lumpy”, and there may be some redness. Gentle massage of the area (starting about one month after your surgery and excluding grafts) will speed the healing process.
• The defect created by the removal of the skin cancer may be larger than anticipated. There is no way to predict prior to surgery the exact size of the final defect.
• There will be a scar at the site of removal. Unfortunately, there is no way to remove a skin cancer without some degree of scarring. However, having your scar look as small and as good as possible after cancer removal is important to the Mohs surgeon as well. Every effort is made to obtain optimal cosmetic results, but the primary goal is to remove the entire tumor. Again, Mohs surgery will leave you with the smallest wound, thus creating the best opportunity for optimal cosmetic results.
• There is a small chance that your tumor may re-grow after surgery. Previously treated tumors and large, longstanding tumors have the greatest chance of recurrence.
Plain vaseline or Aquaphor may be preferable for wound care to minimize allergy
More and more dermatologic surgeons are moving to just plain vaseline or Aquaphor for post-op wound care as there is significant prevalence of allergy to neomycin, bacitracin and/or polysporin. Sometimes it may not be easy to distinguish wound infection vs. allergic reaction to topical antibiotics. The hallmark of infection is pain and the hallmark for allergic reaction is itching. Prophylactic oral antibiotics may not always be necessary; however if one experiences pain in surgery site after first 3-4 days, you should call your Mohs surgeon for consideration of oral antibiotics and re-evaluation to rule out post-op infection or hematoma (entrapment of blood drainage).
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