Mohs Postoperative Instructions

How will my pain be managed and what can I expect?

Generally, we are able to keep our patients very comfortable during surgery with local anesthetics. These last for approximately 2 hours after surgery, which allows you to get home in comfort before they wear off. In the vast majority of cases, the subsequent pain is well managed with alternating Acetaminophen and Ibuprofen. However, in some cases, this is not adequate or not tolerated by the patient. We will then discuss a pain management plan in detail before you leave the office. We always strive to keep our patients comfortable while bearing in mind the potentially devastating side effects of Opioid Pain Medications.

Generally, pain is the most severe the first night home, after approximately 24 hours it greatly improves and is well tolerated despite daily activities. In special sites on the body or if the lesion is very large, this can be different but we can address your case individually before you go home.

Will I be able to drive myself home?

Most of the time yes. You will not be sedated or medicated, so as long as it is not a long-distance, it’s generally reasonable. However, please consider that if a bandage is anywhere near an eye or you will be tired or uncomfortable we would strongly recommend that you bring a companion and driver.

How long can I expect to need to recover or take time off work?

This will greatly vary depending on the size of the tumor, the location, and the patient. Generally if small and discrete, many patients will feel comfortable going back to work within 24 hours. However, if the site is large, or the patient is in the public eye they may choose not to go to work for up to 7 days while the bruising is most significant and the sutures are still in place. Please discuss this with us beforehand so we can try to give you some idea of what to expect. We can also assist with notes for your job if needed.

Is there anything I can do to make the scar less noticeable?

Many factors contribute to how a scar heals. Everyone will have a scar when the skin is cut. A patient’s genetics, the location of the surgery, the size and depth of the lesion, the surgeon’s skill, the patient’s level of activity, and post-operative complications can all affect how that scar heals.

We ask that you wait at least 7 days to resume normal levels of activity. The less tension on the wound, the better the wound will heal. We would ask that you do not submerse your wound in any natural bodies of water (lakes, Hood Canal, or ocean) for at least 7 days to decrease the risk of dangerous infections. I would also prefer that you avoid submersion in chlorinated public pools for 7 days.

We would also ask you to avoid cardio and weight lifting for at least 7 days. This might be longer depending on the site, for example on the lower leg. Light walking or hiking without a lot of exertion or sweating is acceptable when you feel up to it.

We would ask that you avoid all sun exposure. This has been well documented to make scars more noticeable. If you are going to be in the sun, the site needs to be completely covered with a bandage and/or sunscreen even a year later.

We would ask that you keep the wound moist (with vaseline primarily). While this can take longer to heal, the occlusion allows a more organized scar. This is generally for about 1 week, although it can vary based on the wound. Please avoid allowing a dry crust at the site, this can cause healing to stop all together.

We recommend the use of a Silicone Gel Sheeting product such as Scar Away once the sutures/stitches are removed. This can be applied up to 24 hours/day with improvement documented even out to a year. This can be purchased at many retailers, generally located with bandages. I prefer this to Vitamin E Oil, Mederma, and the Silicone Gel Products that are not sheeting.

Why Vaseline and not Neosporin?

This is a common question. Neosporin contains a highly allergenic antibiotic called Neomycin. It can cause a severe even blistering allergic reaction around your surgical wound. It is slightly more likely that you will develop a reaction when the skin has been recently cut, even if you have never had an issue in the past. If you prefer an antibacterial ointment, I would recommend Polysporin or Bacitracin instead.

What kind of follow-up do I need after Mohs Surgery?

In general, we will see you 1 week after your Mohs surgery. We will remove any sutures/stitches at this appointment and do a wound check to ensure that you are healing as we expect. If there are any residual issues, we will schedule further follow-ups at that time. We will follow you closely to address anything unexpected that arises.

If you have any issues immediately after surgery you will have our after office hours contact information.

If all is well, you will then be referred back to your regular Dermatologist who referred you to us. It is important that you continue to follow with them for routine skin checks as you do have an increased risk of another skin cancer.

We appreciate your understanding that we cannot accept you as a patient if you have been referred to us for Mohs Surgery from another of our colleagues. We greatly respect our local Dermatologists, and this is considered courteous.