Recovery after Mohs surgery: healing stage by stage

This is a general picture assembled from British Association of Dermatologists information and two NHS trust aftercare leaflets for skin surgery. The Mohs team will tell you which closure was used, and that decides much of what follows. A wound allowed to heal naturally is cared for differently from a stitched wound, a graft or a flap.

Another reason to rely on your own written advice is the site. A wound on the face, hand, leg or scalp has its own precautions, and Oxford's leaflet gives separate advice for each. The operation is described in the guide to Mohs surgery.

Cambridge says to leave the first dressing for 48 hours, then remove it carefully or replace it lightly, and to wait the full 48 hours before bathing, avoiding direct water or soaking and patting dry. The British Association of Dermatologists likewise advises keeping dressings dry for at least 48 hours.

Pain relief with paracetamol is usually enough, according to Cambridge. A little blood seeping through the dressing is expected. For heavier bleeding Cambridge advises firm pressure over the dressing for fifteen minutes and an ice pack for a further fifteen, then contacting the GP or emergency department if it persists, while Oxford advises pressure for about ten minutes without stopping to look.

Oxford describes the skin around a numbed wound looking white, which is the local anaesthetic and passes. Slight swelling and bruising should gradually settle, and for facial wounds an extra pillow for the first nights helps.

The British Association of Dermatologists says driving after surgery is inadvisable and Skin Health Info suggests avoiding it for several days. GOV.UK says to ask your doctor if you are unsure how an operation will affect driving. Many Mohs wounds are on the face, where a dressing can restrict vision or head movement, so it is the ability to look and react safely that counts.

The British Association of Dermatologists says to return to work when comfortable, and gives one to two weeks following major reconstruction. Oxford says you can take up to seven days off without a sick note, and the surgeon can provide one if you need longer.

• Avoid smoking for two weeks before and after surgery where possible, as the British Association of Dermatologists suggests.

• Avoid bending, straining and lifting heavy objects early on, according to Cambridge.

• Keep to the specific site advice in your leaflet for face, scalp, hand or lower leg.

Cambridge says to avoid vigorous exercise, swimming, running, contact sports and gym work until stitches are out and healing is complete. Oxford advises taking things easily for 48 hours and avoiding activities that might stretch the wound open for the first week, after which normal activity can resume unless the surgeon says otherwise.

If the repair was a graft or flap, the surgeon may set stricter limits, so follow those over this general guide.

Cambridge describes permanent scarring, red at first and fading to pale pink over months, and says some scars become raised and may need steroid treatment. Oxford says all wounds will be weak for up to six weeks, then mature in quality and colour for over a year, and that moisturising and massaging the healed scar daily and using factor 50 sun protection can help.

Skin Health Info recommends monthly self-checks of the skin, and your team will say whether you need follow-up appointments. Signs of infection include increasing redness, heat, throbbing, worsening pain despite painkillers, leaking from the wound or fever, and Cambridge advises seeking prompt help. Contact the dermatology unit or your GP, use NHS 111 out of hours, and attend an emergency department for bleeding that will not stop.