Mohs Surgery Post Operative Information

You have had Moh’s surgery or microscopically controlled surgery performed in order to remove your skin cancer. This is performed only on patients who have had a recurrence of their skin cancer or who are at high risk of recurrence if more traditional methods of removal are used. This procedure, involving step-wise removal of tissue and immediate microscopic examination of specimens enables us to remove the tumor cells while preserving as much normal tissue as possible.

Your treated site will be allowed to heal in various ways:

1. Most sites will be CLOSED PRIMARILY, i.e. via simple closure or more complex flaps or grafts, since they are small enough and shaped correctly to allow for this approach. There will be stitches visible on the surface once the dressings are removed. The stitches will need to be removed in __________ days.

You should leave the dressing in place for ______days. For the first two days try to keep your activities to a minimum and apply ice bag compress to the surrounding tissue. Take only Tylenol or your prescribed medicine for pain. If antibiotics have been prescribed, take them as directed. If the dressings loosen, simply reinforce with additional tape. Gently remove all dressings after thoroughly soaking them under warm water. If the gauze is stuck, wet it and wait 15 minutes and try again. Any visible crusting should be gently removed either with tap water or hydrogen peroxide.

Apply a thin layer of Polysporin ointment and cover with a dry Telfa pad. Do this daily. Signs of infection are drainage of pus, painful red swelling beneath or around the incision, or red streaking extending beyond the site. Bruising is fairly common, but this quickly fades over a one week period. If you have questions, call us.

If a SKIN GRAFT has been used in the repair, the dressings at this site should be kept dry and left in place until removed by the doctor. On the day you return for suture removal dampen the graft site in the shower to facilitate dressing removal. Please be very careful with the graft site! Avoid any accidental trauma.

2. Some sites are allowed to heal in by Granulation or secondary intention. This process is slow and will require more daily care on your part. You will be instructed and dressing changes demonstrated to you prior to leaving the office.

Appropriate dressings will be applied and these should be left in place for 2 days. Once you begin changing your dressings I recommend dampening the entire dressing 15 minutes prior to removing the old dressings. If stuck, re-wet the dressing and wait another 15 minutes. Clean off any crust or ooze with either tap water or hydrogen peroxide solution. Don’t be too aggressive in your cleaning, but realize anything that gently rolls off should be wiped clean. Pat the area dry and clean off any tape or grease on the skin surrounding the wound.

Initially you want to apply Polysporin to the entire defect. You then will apply one layer of Vaseline gauze to the wound bed, then enough dry gauze on top to “fill” the defect. As the wound begins to heal it is OK to switch to a Telfa pad dressing or Band-Aid instead of the gauze layers. Most people can shift to a Telfa dressing in 2 weeks. As the area begins to heal you will notice a pebbly, raspberry red, moist surface appear in the base of the defect. This is granulation tissue. It has a rich blood supply and will occasionally bleed when you clean the wound. Do not panic! Apply a little pressure with a clean, dry gauze until it stops and proceed with the ointment.

Once the granulation tissue fills the defect you will begin to notice the defect becoming ”smaller” in size. What is happening is that the normal skin layer surrounding the site is now mobilizing and literally “crawling” over the bed of granulation. Be very gentle when cleaning the edges of the wound at this point. The average defect takes about one month to entirely fill in and close. This varies according to the size, the location, and your care.

In rare cases, there may be the need to refer large defects on for closure in the operating room. Usually these are anticipated in advance and the follow-up repair has been scheduled either later that same day or the next.

• Startup supplies will be provided but virtually all can be obtained if needed at your local pharmacy. For pain, please take either Acetaminophen (Tylenol) or your prescribed pain medication. Do not take aspirin or ibuprofen (Motrin, Advil) as this analgesic tends to cause more post-op bleeding and bruising.
• Any questions, please call (408) 972-3590. A nurse will take a message and we will call you back.
• If you have any bleeding which you cannot stop with firm, even pressure for 20 minutes, call your dermatologist or go to your nearest Kaiser Hospital Emergency Room for assistance. If it during regular workday hours and you are able to return to see us, please call in advance at 408-972-3590 to make sure one of the Mohs doctors is still in the Mohs Unit to see you.

Follow-up care will either be arranged with our department or your own dermatologist.

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