Mohs Surgery Post-Operative Wound Care Instructions

You will be given this information as a printed copy from your medical team as it contains sections and instructions that have to be completed by the team.

Dressing information

Mohs surgery is most commonly used to treat skin cancers on the head and neck. Depending on the reconstruction your surgeon has performed, you may have more than one dressing to look after. It is important that dressings are kept dry for the specified period advised. Specific instructions will be provided by the team as to when to remove each dressing(s).

Hypafix (adhesive) tape will be supplied to you. If the dressing(s) starts to lift away at the edges, please keep applying the tape provided to keep it secure until it is ready for taking down.

Mohs dressings can be very bulky, however please be reassured that these dressings are to protect the surgical reconstruction / repair and to help minimise any bleeding, bruising, and swelling.

Specific instructions will be provided by the Mohs surgeon/ nursing team based upon your individual case – it is therefore important that you adhere to the bespoke instructions provided. Please refer to this booklet for guidance and for any specific individual written instructions.

Rest and recovery

Resting after Mohs surgery is crucial. Keeping your head up and not bending over is extremely important. Bending over puts unnecessary strain on your surgical site, which can increase the risk of reopening incisions (wound dehiscence), cause bleeding (haematoma), and worsen swelling. If possible, we recommend having someone at home to look after you and call upon if needed, ideally for at least a day or two after the surgery.

Further instructions

If you are advised to remove the dressing(s) at home, please do so slowly and gently. Do not worry, the dressings used are designed to cause minimal disruption to the underlying wound, so you won’t do any harm by taking the dressing off yourself. With facial dressings when it comes to removal, feel free to get them wet in the shower as this will make them easier to remove. Once removed, we advise you to gently pat the wound dry with a clean towel. Do not rub the area.

Once all dressing(s) are removed we recommend that you apply a thin layer of newly opened petroleum jelly (Vaseline), or antibiotic ointment (if it has been prescribed for you) directly over your wound with clean fingers or a cotton bud. This ensures the wound(s) are kept moist and prevent scabs from forming. Individual instructions will be provided for specific sites / areas.

Please ensure you wash your hands before and after each application.

Please do not wear make-up or apply any of your normal creams to your wounds until all areas have fully healed. Further follow-up appointments will be organised where necessary with further aftercare being provided to you along your journey. You will be advised when you can resume normal activity and exercise and apply your usual skin products during your follow-up visits.

Reconstruction planned elsewhere after Mohs surgery

Specific post operative instructions will be provided for patients attending for Mohs surgery on C4 who are scheduled to have their reconstruction planned elsewhere. These appointments are carefully planned and organised in advance of your Mohs surgical date. The dressing will need to remain in place until you attend your reconstruction appointment elsewhere. It is important that you adhere to these specific instructions given by the team as your next appointment will be at a different hospital / location.

Any additional instructions will be discussed at discharge

For wound checks / follow up appointments

Please see the information given in your printed copy.

As your skin heals, please note that it is natural for your wound to itch – this is part of the healing process. If your stitches cause you pain or discomfort, please contact the Dermatology Department for advice. See the contact details below for phone numbers.

Driving

We recommend all patients attending for Mohs Surgery must organise a lift home. The team will advise you when it is suitable for you to drive after your surgery. It is not recommended to drive with any dressing on the head or neck, as this may obscure your vision, limit your movement and compromise your safety.

Signs of infection – what to look out for

It is expected that your wound will be slightly red and tender to touch for the first couple of days after your surgery. If the wound becomes very painful, extremely hot, red, and swollen with a yellow-coloured discharge, these are signs of an infection, and you may need antibiotics.

Please contact the Dermatology department who will advise you on how to care for your wound and organise an appointment to be seen.

Bleeding / Bruising / Swelling

Bleeding can occur following surgery. To reduce this possibility, please follow these instructions:

• No physical activity for at least three weeks (or longer if advised). Gentle walks are allowed, however nothing that will cause your heart rate to increase.
• Avoid bending over and no strenuous lifting.
• Please sleep with 3-4 pillows behind you for at least 48 hours after surgery.
• Avoid taking blood thinners, aspirin, or ibuprofen-based products for 24 hours after surgery unless advised by your doctor to continue with them.
• Avoid alcoholic beverages for 24 hours.

We will discuss with you any additional instructions.

If you are taking anticoagulants we will discuss with you when to restart taking your tablets.

It is unlikely that your wound will bleed, but if this happens, do not worry. Depending on the type of reconstruction performed we will have provided specific advice on how and where to apply pressure if bleeding occurs. For most areas of the head and neck, it is safe to press firmly over the dressing for twenty continuous minutes; however, we will individually advise you how to manage any bleeding specific to your surgery and reconstruction. Please do not put pressure directly on the eye itself.

If bleeding persists or you are worried, please phone the Dermatology Department and they will advise you on how to care for your wound and if it would be best for you to be reviewed in the department.

In the very unlikely event, you have bleeding that you cannot stop, please phone the numbers in the contacts section, or go to your local Emergency department.

With Mohs surgery you may experience some localised swelling and bruising, which may not be at its worst until three to four days after surgery. Swelling and bruising localised to the wound is normal, please be reassured this should improve within a week to 10 days but occasionally may take longer.

Pain

The local anaesthetic will begin to wear off about one to two hours after the procedure. If you experience any pain or discomfort, you may take paracetamol. Please take as directed on the instructions. Avoid aspirin or ibuprofen-based products for 24 hours, unless prescribed as a regular medication by your GP.

Please note: if you are already taking medications such as co-codamol or codydramol that contain paracetamol, then no further paracetamol should be taken. Please follow the instructions on the packet and consult your pharmacist if you have any queries or allergies.

Always read your medication instructions. If you are unsure, speak to your pharmacist or GP.

Mohs Specific Sites

Facial surgery around or on the lip area can cause swelling which may last for several days post-surgery. We encourage that you have a soft diet, use straws for drinking and minimise mouth movement for the first 48 hours.

Facial surgery around the eye area may cause swelling and bruising. You may have some discomfort and not able to open your eye fully the following day. This will settle down after a few days and is normal around this area. Your aftercare will be specific to your location and we will advise about the use of ice as a cold compress.

Diet

Good nutrition is always important, but it is even more important after surgery when your body is recovering. Focus on the basics of healthy eating:

• Avoid processed foods that are high in sugar and unhealthy fat such as biscuits, cakes, sweets, crisps, deep fried foods.
• Maintain an adequate protein intake (fish and seafood, chicken, meat, dairy products like Greek yoghurt and cottage cheese).
• Plenty of fresh vegetables.

These simple steps will give your body the building blocks it needs to heal and recover.

Exercise

Try to avoid any strenuous exercise and exertion for at least three weeks. No running or heavy physical activities are recommended until your surgeon advises. If you have any concerns, please discuss with your Mohs team.

Smoking

Smoking significantly delays wound healing, increases the risk of infection, and can contribute to a more prominent scar. If you would like help giving up smoking, please speak to your Practice Nurse or call the NHS Smoking Helpline on: 0300 123 1044.

Scar massage

You will be provided with individual aftercare instructions specific to your surgery and the type of reconstruction performed. In many cases, scar massage can be started about three weeks after the procedure. It can help the scar heal more quickly and reduce its appearance in the long term. You will be shown how to care for your wound and when to commence scar massage by the Mohs team individually.

In general, use a slow, circular motion to massage the skin around your scar. Use firm pressure, but do not pull or tear at the skin. The use of petroleum jelly or a moisturiser is helpful. This can be done 3-4 times a day for 5-10 minutes at a time. If you have questions regarding silicone scar products and ‘Bio-oil’, please do discuss with your surgeon and the Mohs team during your follow-up visits.

Sun exposure

The skin that forms as a scar is very delicate. Avoid sun exposure and apply sunscreen to help keep the scar from burning and minimise discolouration. Use a broad-spectrum sunscreen with UVA and UVB protection to help protect all your exposed skin. Wear a wide brim hat and stay out of the sun between the hours of 11am and 3pm.

Contact us

If you have any questions or concerns regarding your procedure, please contact: