What You Should Know About Mohs Surgery Recovery, Aftercare and Follow-Up

Mohs surgery is a minimally invasive procedure that offers the best chance of returning to normal life after a skin cancer diagnosis. The complete removal of all malignant cells may produce a sizable wound in a conspicuous body part. So, naturally, recovery and cosmetic outcome are two of the biggest patient concerns when they are advised to undergo this minor operation.

At BHSkin Dermatology, our medical experts understand the impact of such information on treatment decisions. This article explains the most important aspects of the Mohs surgery recovery process to guide and empower patients considering this therapeutic option.

What Is Mohs Surgery?

Mohs micrographic surgery, or simply “Mohs surgery,” is a technique that entails cutting away at a skin tumor serially in thin layers until it is totally removed. It is usually performed by a dermatologist specially trained in this method. It is the gold standard of treatment for non-melanoma skin cancer because of its advantages.

• The Mohs procedure has the highest cure rates compared to wide excision and other forms of skin cancer treatment.
• It is the most cost-effective therapy for non-melanoma skin cancer.
• The Mohs technique preserves the greatest volume of healthy skin. Therefore, it is best for lesions on the eyelids, nose, lips, ears, fingers, toes, and genital area—sites where tissue-sparing is crucial to cosmesis or function.

About 80% of patients who undergo Mohs surgery have basal cell carcinoma, while 20% have squamous cell carcinoma. Both malignancies are less aggressive than melanoma, so they respond better to this minimally invasive approach. However, its use in melanoma management has also increased over the last few years because of cure rates reaching 98%.

What Can You Expect When Undergoing Mohs Surgery?

At the start of the procedure, the Mohs surgeon will mark the incision site, clean it and inject local anesthesia. Once the site is numb, the doctor will scrape off the bulk of the tumor then cut out the first layer of cancerous tissue.

The removed tissue will then be frozen and examined microscopically. The surgeon will check its edges for the presence of cancer cells and map out the remainder of the tumor. More tissue will be excised until no more malignant cells are found. A thin, cancer-free margin is also taken out.

Removing the cancerous tissue and closing up the surgical wound are quick. However, the entire session can take hours because of the freezing process and microscopic examination.  You may use your gadget, read magazines, etc. while waiting. Patients generally leave an entire day open when scheduled for Mohs surgery. Some tumors may even require stage-wise removal, which can take a few sessions.

Is Mohs Surgery Painful?

The procedure is typically done under local anesthesia, so it is essentially painless. The needle prick from injecting the numbing medication is tolerable. However, you may need oral pain relievers after the surgery, which usually causes some inflammation.

Can You Drive Home After a Mohs Procedure?

For most patients, it is safe to drive home after the operation. Local anesthesia does not cause drowsiness, and the surgical wound is not expected to restrict body movement.

Still, if this is a concern, you may discuss it with your surgeon before you get discharged. At BHSkin Dermatology, patient safety is our top priority. Our doctors will give you a quick, thorough check before clearing you for driving and sending you home.

How Long Does It Take to Heal from Mohs Surgery?

As in any operation, recovery from Mohs surgery depends on the factors affecting wound healing. For individuals without other health risks, the surgeon’s technique and the postop wound’s size, shape and location are the main ones.

• Small sutured incisions generally take about 1-2 weeks to dry up and close.
• Other wounds may take at least 3-4 weeks to heal.
• Round surgical wounds resulting from a Mohs procedure may be left without sutures and allowed to close on their own. This process is called “healing by secondary intention,” which can take time.
• In some cases, the surgeon may instead perform “Mohs reconstruction,” closing the surgical defect immediately using a skin flap or skin graft. Big or complex surgical wounds will be closed temporarily and referred to a reconstructive surgeon for delayed repair. The timing and extent of reconstruction can also affect the duration of healing and recovery.
• Movement and heavy pressure (e. g. bearing weight) on the postop wound also delay skin repair.

Additionally, certain patient factors can slow down recovery from Mohs surgery. Smoking, diabetes, malnutrition, connective tissue disease and clotting disorders can all prolong wound healing. For people with skin cancer, the following conditions are common, which can also impede recovery:

• Advanced age
• Receiving treatment for another type of cancer
• Intake of immunosuppressive medications, e. g. in an organ or tissue transplant patient
• Illnesses that compromise the immune system, e.g. HIV

Your dermatologist will give you a full examination and determine whether or not you are fit for Mohs surgery. You will be offered an alternative skin cancer treatment if the doctor thinks you may encounter problems after the operation.

What Else Can a Patient Expect after Having Mohs Surgery?

Special attention is given to the post-treatment period to ensure the cosmetic and therapeutic success of your skin cancer surgery. The most important concerns that your Mohs surgeon will discuss with you are the following:

Aftercare

Proper wound care prevents complications. Your surgeon will teach you how to treat your surgical wound at home. Generally, the following measures are included:

• The surgeon will leave a pressure dressing in place to help close the wound properly. You have to keep this on for 24 hours.
• The day after the procedure, you may clean the wound gently with water and mild soap when you take a bath.
• Apply an antimicrobial solution before dressing the wound again.
• Your surgeon may prescribe an oral antibiotic to prevent skin infection.
• Protect and elevate the area while you sleep.
• Avoid sun exposure, which may produce a big scar or pigmentation problems in the area.
• Avoid putting makeup and harsh chemicals on the wound site until it has closed up completely.
• Scar formation may be a problem if you have a tendency to develop keloids. Your surgeon may advise you to apply a silicone gel formulation like Skinstyle’s Silagen Scar Refinement System right after suture removal. Silicone-based treatments are highly effective in preventing excessive scar tissue growth.

Diligent postop wound care improves your chances of a speedy recovery and good cosmetic outcome.

Downtime

The downtime depends on the postop wound’s size and complexity. Most patients are advised to refrain from strenuous activities in the first 1-2 weeks after a Mohs procedure. This helps avoid postop wound reopening, which may lead to bleeding, infection and significant scarring.

Potential Complications

Your surgeon will discuss these risks with you before consenting to the procedure. They include, but are not limited to the following:

• Hypersensitivity to the medications during and after Mohs surgery
• Bleeding
• Bruising
• Swelling
• Severe pain
• Wound reopening
• Delayed healing or failure to heal
• Bad scars
• Infection

However, in the hands of highly-trained experts, the risks of Mohs surgery become insignificant. Proper wound care at home also helps prevent these problems. Still, at the end of your session, you will be reminded to call your doctor for intolerable side effects.

Combination Therapy

Some patients require radiotherapy or chemotherapy right after Mohs surgery. This depends on the extent and type of skin cancer. These treatments eliminate occult cancerous cells from your body. Your Mohs surgeon will work with your primary care physician and other specialists to ensure that you get all your treatments on time.

The Need for Scar Treatments or Reconstructive Surgery

Scar tissue formation does not slow down until the 6th month postop. Removal procedures may just worsen the scarring if done prematurely. So, it is best to wait until the 6th month after your Mohs surgery to assess the need for more aggressive scar treatments.

The dermatologist can take care of most scars resulting from a Mohs procedure. However, complex scars need revision procedures, which are in the realm of plastic surgery.

Possible Skin Cancer Recurrence

Skin cancer has a very small chance of coming back after a Mohs procedure. However, when that happens, further tests may be done to look for sites of spread. Recurrences are treated immediately and with a regimen that may be more aggressive than the first.

Your primary doctor or dermatologist will schedule you for yearly follow-up visits to check for new skin cancer. They may also advise you about self-examination techniques. Self-examination can help you spot a recurrence or distant spread even before your scheduled follow-up visit.

By following your doctor’s post-treatment instructions carefully, recovery from Mohs surgery can be problem-free. Additionally, entrusting it to our skincare experts at BHSkin Dermatology guarantees the best therapeutic and cosmetic results.

Conclusion

Mohs surgery is a skin cancer removal procedure that spares as much healthy tissue as possible. The recovery process is typically uneventful, although various factors make the experience unique for every patient. The surgical wound created can be closed in several ways, each of which affects skin repair mechanisms differently. The patient’s health status can also influence the speed of wound healing.

Mohs skin cancer surgery has superior cure rates and cosmetic outcomes. Its success depends on both the expert’s skill and the patient’s diligent adherence to the post-surgical plan. Entrusting your Mohs surgery to the right dermatologist helps ensure that you get the most out of the procedure. Proper wound care, temporary limitation of activities, patience with the healing process and vigilance also help reduce the risk of scarring and recurrence.

Want to Get Rid of Skin Cancer? Don’t Leave It to Chance!

Mohs micrographic surgery is a technique that requires expertise. If done right, it can make you cancer-free without having to worry about disfiguring scars. At BHSkin Dermatology, our award-winning dermatologists are the best in handling such a delicate procedure. Our patients are happy knowing that they chose the right specialists to deal with this problem. You may visit us at our Encino or Glendale clinic or use our virtual portal to consult with one of our doctors.

You are in good hands at BHSkin Dermatology. Book your appointment today!

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online