Signs of infection after Mohs surgery, and when to call

Most wounds from Mohs micrographic surgery heal cleanly, and a true infection is uncommon. Still, the days after the procedure are when a small problem is easiest to fix, so knowing the difference between ordinary healing and a warning sign lets you act early rather than wait and worry. The reassuring reality is that the signals of trouble are specific and easy to learn, and that a quick phone call almost always sorts them out. For the full recovery picture, see Mohs recovery and scar care.

Normal healing has a predictable look. In the first few days, expect some redness right at the wound edges, mild swelling, bruising, tenderness, and a little clear or pink-tinged drainage. Keeping the wound moist with a plain petrolatum ointment and covered with a clean dressing, exactly as your surgeon directs, is what supports a clean result. The key pattern is direction: normal healing improves a little each day, so soreness and redness should be easing by the third or fourth day, not building. Some tightness and itching as the skin knits is expected and is not a cause for alarm, and larger repairs such as a flap or graft can look more dramatic early without anything being wrong, as covered in reconstruction after Mohs surgery.

The warning signs of infection. Call your surgeon if you notice redness that spreads outward beyond the wound edges, pain that increases rather than decreases after the second or third day, warmth around the site, swelling that worsens, or thick yellow or green drainage that looks like pus. A foul odor, a fever or chills, or red streaks radiating away from the wound all point to infection and deserve prompt attention. Red streaks spreading up an arm or leg, a sign of a deeper skin infection, should be treated as urgent. The American Academy of Dermatology notes that infection after Mohs is uncommon but treatable when caught early, which is exactly why these signs are worth knowing (AAD on Mohs surgery).

When to call, and when to go in. Surgical-site infections typically appear about four to seven days after a procedure, so a wound that seemed fine at first can still turn. Do not wait for your scheduled follow-up if something looks wrong; a same-day call lets the team start antibiotics or see you if needed. Go to urgent care or an emergency room for a high fever, spreading redness with red streaks, or feeling generally unwell, since these can signal an infection that has moved beyond the skin. General guidance on recognizing and caring for wound problems is available through the NIH (MedlinePlus: wounds and injuries).

Bleeding is a separate problem. A little oozing in the first day is normal, but steady bleeding is not. If a wound bleeds through the dressing, sit down, stay calm, and press firmly and continuously on the spot for a full fifteen to twenty minutes without peeking, which stops the great majority of post-op bleeding. If it soaks through despite firm pressure, call your surgeon. Patients on blood thinners are more prone to this and should mention it, though most people are advised to keep taking medically necessary anticoagulants because stopping them carries its own risks. Discomfort itself is usually mild and manageable, as described in is Mohs surgery painful.

If the wound opens. Occasionally the edges of a repair separate slightly, called dehiscence, often after too much activity too soon. It looks alarming but is rarely an emergency: cover the area with a clean dressing, avoid stretching or straining it, and call your surgeon for guidance on whether it needs to be seen. Sutures that loosen or a small area that reopens can usually be managed simply when reported early.

Who is at higher risk. Certain factors make careful watching more important: diabetes, a suppressed immune system, current smoking, poor circulation, and larger repairs on the lower legs, where healing is naturally slower. If any of these apply to you, follow the wound-care instructions especially closely and have a low threshold to call. The American College of Mohs Surgery is a useful patient resource for what to expect and questions to ask (American College of Mohs Surgery).

How to lower your risk. Wash your hands before touching the wound, keep it clean, moist, and covered as instructed, and resist the urge to pick at scabs or crusts. Avoid soaking the site in baths, pools, or hot tubs until you are cleared, and hold off on strenuous activity for the period your surgeon sets so the repair can hold. These simple habits, more than anything else, are what keep a Mohs wound on the smooth path to healing.

The takeaway is a calm one. Infection after Mohs is unusual, the warning signs are clear, and early action almost always resolves the problem. Watch for redness that spreads, pain that grows, pus, odor, or fever, keep your surgeon's number handy, and call sooner rather than later. Trusting that instinct is the single best thing you can do for a clean, well-healed result (Mayo Clinic on Mohs surgery).