Once your skin cancer has been removed through Mohs surgery, there will be an open wound. Two options are available for healing:
Allow the wound to heal on its own. This is appropriate if the wound is extremely small or in a location where a scar is cosmetically acceptable. Daily care of the wound is required. Depending upon the size, may take up to 4 to 6 weeks for the wound to heal completely, but infection, bleeding and pain are uncommon.
Close the wound with sutures (stitches). This option is appropriate when scarring must be kept to a minimum or when the natural healing process would be inadequate. Most reconstructive surgery can be performed on the same day as your Mohs surgery. The wound may be closed by shifting nearby tissue, or by taking skin from another area of your body (often in front of or behind the ear, or from the neck, collarbone region or thigh). Skin grafts may require a "bolster" dressing — a special bandage sutured over the area. This dressing remains over the graft for a week or until sutures are removed.
In some cases, wounds from Mohs surgery can be extensive and may require the assistance of another surgeon. We will help you find a SLUCare physician or a physician close to your home who can perform these procedures.
There may also be times when your personal physician refers you to SLUCare for Mohs surgery with a plan to perform reconstructive surgery for you shortly afterwards. A delay between your Mohs surgery with us and reconstructive surgery with another doctor may not be convenient, but it will not cause ill effects. It is often necessary as the Mohs surgery may require most of the day.
Following reconstruction, we will provide you with further written instructions for the care of your wound, along with verbal explanations from the doctor or nurse and phone numbers (both day and night) in case of questions.
You can expect minimal discomfort after Mohs surgery; pain can usually be managed well with acetaminophen (Tylenol). Significant discomfort should be reported to us.
You may experience some localized swelling and bruising, which may not be at its worst until three to four days after surgery. Some swelling and bruising is normal and should improve within a week.
If you have surgery on your forehead or nose, you may experience some swelling of your eyelids, which, at times, may nearly close them due to swelling and bruising settling in that area. Similarly, swelling and bruising may occur down the neck, and rarely the chest, when surgery is performed on the chin or jawline area. To help reduce swelling and bruising, apply an ice pack for 20 minutes each hour while awake for the first 48 hours following Mohs surgery.
While bleeding rarely occurs after Mohs surgery, a little blood or seepage on the dressing is normal. If you notice active bleeding (meaning the bandage is soaked with blood), remove the bandage and apply firm pressure over the area with dry gauze or a dry cloth for 20 minutes.
If bleeding continues, contact our office or the on-call dermatologist (after office hours). On rare occasions, it may be necessary to have the bleeding stopped by cauterization.
We recommend you limit vigorous physical activity, excessive bending over or exercise for seven days after your Mohs surgery to allow your wound to heal and prevent bleeding or damage to your stitches.
Sutures are usually removed five to 10 days after surgery. We will follow you through the post-operative period to assure you are healing well and to determine if additional procedures are necessary.
Scars tend to improve over the course of several months, with significant improvement noted during the first month. In some cases, scar revision or resurfacing of the scar may be of benefit after Mohs surgery.
If you are doing well at the time of suture removal, we may discharge you to the care of your referring dermatologist.
It is important that you keep regular follow-up examinations with your dermatologist. You are at increased risk of developing additional skin cancer and pre-cancers. Early diagnosis and treatment will benefit you. Examination of your surgical site is also needed to monitor for any recurrence of your treated skin cancer.