Mohs surgery is a precise technique for removing skin cancer layer by layer, allowing the surgeon to examine the tissue under a microscope until only cancer-free tissue remains. This method ensures complete removal of the malignancy while preserving healthy surrounding skin. Healing time varies significantly depending on the size, location, and method used to close the resulting wound. A small site closed with simple sutures heals much faster than a large defect or a wound requiring a skin graft or flap.
Immediate Recovery Timeline and Stages
Functional wound closure begins immediately, focusing on clot formation and minimizing swelling during the first 48 hours. A pressure dressing is applied to control initial bleeding and reduce bruising and swelling, which often peak within the first three days. Patients may experience mild discomfort, typically manageable with over-the-counter pain relievers.
The timeline for healing is heavily influenced by how the wound is closed. For small incisions closed with simple sutures, the wound is generally considered functionally closed within one to two weeks. Stitches on the face or neck are often removed within 7 to 10 days, while those on the limbs, scalp, or torso usually remain in place for up to 14 days.
A more extensive wound may require reconstruction, such as a skin graft or a flap. These complex repairs require a longer initial healing period; a skin flap needs two to three weeks, and a full-thickness skin graft requires a week for the initial take. Alternatively, wounds left open to heal by “secondary intention” can take several weeks for complete closure. Tissue repair continues for months after the wound is considered closed.
Managing the Surgical Site: Essential Care
Diligent post-operative care minimizes infection risk and optimizes the final cosmetic result. The initial dressing is typically kept in place and dry for the first 24 to 48 hours to protect the wound and encourage clotting. Patients are then instructed to begin daily dressing changes, gently cleaning the wound with mild soap and warm water.
Proper Mohs wound care requires maintaining a consistently moist environment to prevent scab formation, which delays healing and worsens scarring. This is achieved by applying a thick layer of a petrolatum-based ointment (Vaseline or Aquaphor) directly to the wound after cleaning. The area is then covered with a non-stick dressing, which must be changed at least once daily until the wound is sealed or sutures are removed.
Patients must adhere to specific activity restrictions to prevent tension on the healing tissue, which can widen the scar. Strenuous activity, heavy lifting, or movements that stretch the surgical site should be avoided for at least one to two weeks. Signs of potential complications, such as fever, excessive pain, or persistent bleeding, must be reported to the medical team immediately.
Full Healing: Scar Maturation and Final Results
Once the surface of the wound has closed and sutures are removed, the body enters the longest phase of healing: scar maturation. This process involves the remodeling of collagen fibers, which can continue for 12 to 18 months, or sometimes up to two years. Initially, the developing scar often appears raised, firm, and reddish or pink due to the high concentration of blood vessels repairing the site.
The scar typically looks its most prominent about four to eight weeks after the surgery. Over the following months, the scar gradually softens, flattens, and fades in color as the collagen reorganizes. Long-term scar appearance can be improved by gently massaging the area, starting around two months post-surgery, to help soften the internal scar tissue.
Continued sun protection is required during maturation to ensure the best cosmetic outcome. Exposing a new scar to ultraviolet radiation can cause hyperpigmentation, leading to a darker, more noticeable mark. Using a broad-spectrum sunscreen and wearing protective clothing support blending the new tissue with the surrounding skin.