What is the typical recovery and downtime from Mohs surgery? What should I expect for after care needs?

Thank you for your question. Recovery is always going to be different for everyone. Most patients report minimal pain/discomfort after surgery and require minimal or no pain medication. If patients experience a lot of pain, we will prescribe something for the pain. Most patients are able to return to work or school the next day after Mohs. Things to avoid while recovering include heavy lifting, straining, or strenuous exercise for seven to 21 days may be required depending on the area of surgery. Hope this was helpful, best of luck!Dhaval M. Patel Double board certified Plastic surgeonHoffman Estates BarringtonOakbrookChicago

Recovery after Mohs surgery can be very quick, depending on the anatomic location.  In general, surgery around the eyes, nose or lips can remain swollen longer than the forehead or face.  Although you may be healed, scars can be persistently red and inflamed for many months.  It is important to seek a qualified reconstructive surgeon after the Mohs excision that can assist with minimizing your scars

Without knowing the size or location of your skin cancer it's impossible to say how long your recovery will take. For small skin only defects, recovery can take about a week. For larger defects requiring complex multi-stage reconstruction, recovery can involve much longer periods of time. Your dermatologist and reconstructive surgeon should be able to give you a more accurate estimation.Stephen Weber MD, FACS

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).

Your recovery all depends on the location of the surgery, the extent of the removal and size of the defect prior to closure, the amount of tension and the type of closure. Swelling is more likely to occur around the eyes, as well as bruising. Lips tend to swell also. Ears may be more painful postoperatively than other sites. Usually within two to four weeks, the closure begins to look more presentable, but again, this all depends on the factors mentioned previously.

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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Recovery and downtime from Mohs depends on where the cancer what located and what type of suturing was done afterward. We our patients the following: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 after your Mohs procedure depends on the location of your cancer, the extent of the cancer, the size of the surgical defect, and the type of reconstruction that was performed to repair your surgical defect. For example, a 1 cm defect on your cheek in front of your ear that was repaired with a linear closure may feel sore or throb the night after surgery but should feel fine the day afterwards. A big cancer on your forehead that needed a large flap will likely cause bruising and swelling around your eyes that may last a week and give you a major headache that night. You may need pain medication in that case. 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.

Wound healing after Mohs surgery can be quite variable depending on the location, size of the defect, and type of repair. Typically, my younger patients are anxious to return to their jobs the next day which is appropriate in most cases; however, I let them know that they will have a fair amount of swelling/bruising and will need to wear a bandage for at least a week. The majority of swelling does subside significantly within the first week after surgery. A pre-operative consult with your Mohs surgeon can give you a better idea of the type of recovery, scar and healing you can expect for your individual skin cancer and treatment.

Hi, and thanks for your question. It's hard to say
definitively what your experience will be without knowing more
specific details such as the location, size and type of skin cancer that
you have. The good news is, Mohs surgery is the least invasive and most
effective treatment for most skin cancers, so your recovery should be quite
manageable. After the skin cancer has been completely removed, your
doctor will explain your options for healing and recovery. Depending on the
extent and location of your Mohs surgery, your options may include natural
healing (granulation), or stitching the wound together using either a
side-to-side closure, skin flap, or graft. It's not uncommon to experience
redness, swelling, and discomfort for a few days after the surgery around the
surgical site. You may also find that your scar goes through many changes in
appearance and texture as it heals. If your wound is allowed to heal naturally,
you may be caring for the wound for a few weeks. If your surgical
wound is closed with stitches, then you will likely be doing wound care for
7-10 days which is typically how long the stitches stay in before being
removed. The complete healing process can take several months to up to a year.
Good luck!