The Path to Recovery: Healing After Mohs Surgery

Undergoing Mohs surgery is a significant step in the journey toward skin cancer treatment and recovery. This procedure allows the surgeon to combine surgical removal, histologic evaluation, and reconstruction in a single outpatient setting. As patients emerge from the procedure, a crucial phase begins – the healing process.  The healing process is dictated not only by what happens in the surgical suite, but just as importantly how patients approach this phase once leaving our office.  As a Mohs surgeon, I’ll use this blog to help you understand what to expect and how to care for your skin after Mohs surgery to help ensure a smooth and successful recovery.

Immediate Post-Operative Care:
Immediately after Mohs surgery, patients may experience swelling, redness, and discomfort at the surgical site.  Bruising may occur immediately at the time of surgery, or can be delayed for several days after the procedure.  Depending upon the location of the procedure, a black eye may also accompany the bruising.  However, it's important to note that these symptoms are generally normal and typically subside within the first few days to a week. Your dermatologic surgeon will provide specific post-operative care instructions, including how and when to remove the initial bandage, instructions for cleansing the skin after surgery, and specific wound care.  The wound care generally focuses on keeping incision lines or open wounds greasy with ointment, leading to the fastest healing.   We also recommend avoiding all alcohol for 48 hours after surgery for ideal healing and limiting smoking tobacco as much as possible.  If you notice increasing pain, drainage, warmth, redness, and swelling, with or without a fever, please notify your surgeon immediately.

Managing Discomfort:
Pain and discomfort, as well as a headache or “tight” feeling, can occur initially following Mohs surgery. Many patients, however, and even those who undergo very large surgical procedures and reconstruction often report minimal discomfort during the healing process. As recommended by your healthcare provider, over-the-counter pain medications like Tylenol or Ibuprofen can help alleviate discomfort or swelling. It's crucial to follow the prescribed pain management plan and contact your doctor if you experience severe or prolonged pain.

One of the most important yet underutilized tools for the reduction of swelling and, therefore, proper pain management is icing.  It is so simple yet effective, as the initial swelling after Mohs surgery is often what creates the most discomfort.  Your healthcare team will discuss how often to do this after surgery properly.  My favorite suggestion is generally using an ice pack consisting of a frozen bag of vegetables (like peas or carrots), which is malleable over the surgical site, and difficult convexities like the ears and nose.  You may continue to ice if it helps with discomfort after the first day, but this is not generally necessary.

Wound Care and Scar Management:
Proper wound care is essential for optimal healing.  Depending on the type of bandage and in most situations, patients are advised to keep the surgical site clean and moist with ointment (generally Aquaphor provided at your surgical visit), and to avoid harsh cleansing like hydrogen peroxide and sun exposure. Your healthcare provider may recommend specific ointments or dressings to aid in the healing process.

Once your initial bandage is  removed, you can gently cleanse the area with soap and water in the shower. Do not rub or exfoliate the surgical site for at least two weeks. Gently dry the area and apply a thick layer of Aquaphor/ Petrolatum or other recommended emollient to the site. Keep it greasy up to four times per day for the best wound healing. Place a clean gauze over the ointment and then tape this into place. Repeat this process daily until your sutures/staples are removed unless otherwise directed.

While some scarring is inevitable, the goal is always for the most subtle and well-concealed scar possible.   Interventions such as scar massage, silicone gel sheets, or treatments in the office like laser and steroid injections may be recommended depending upon your healing.  It is important to remember that everyone heals slightly differently and at different paces.  It truly is a marathon, not a race, and I will be there with you every step of the way.  You will not be discharged from my care until we are both happy with your healing . It's crucial to discuss scar management options and expectations with your dermatologic surgeon during follow-up appointments.

Follow-Up Appointments:
Regular follow-up appointments with your dermatologic surgeon are integral to monitoring the healing process and addressing any concerns. These appointments provide an opportunity for your healthcare provider to assess the surgical site, remove stitches when necessary, and discuss further steps in your recovery journey.

Emotional Healing:
In addition to physical healing, the emotional aspect of recovery after Mohs surgery is significant. Patients may experience a range of emotions, including relief, anxiety, or concerns about scarring. Seeking support from friends, family, or a healthcare professional can contribute to a positive emotional healing process. Remember, skin cancers that are appropriate for Mohs surgery and treated in this manner have a much lower likelihood of recurring, therefore contributing to a less difficult psychological burden for many patients.

Also remember, healing after Mohs surgery is a gradual journey that requires patience and self-care. Following your healthcare provider's guidance, practicing proper wound care, and prioritizing your overall well-being can pave the way for a successful recovery and embrace a healthier, cancer-free future.

If you are considering Mohs Surgery or have questions, call our office at 401-415-8586 to schedule a consultation with Dr. Findley.