A skin cancer diagnosis can bring many questions, including what to expect from treatment and recovery. Mohs surgery is a common treatment for skin cancer that offers minimal side effects and maximal efficacy. According to Dr. Jessica Dorsey of U.S. Dermatology Partners Cedar Park, “Mohs surgery has numerous benefits, including minimizing risk of skin cancer spreading to surrounding areas and maximizing the amount of healthy skin that is saved when removing cancer cells. Because the procedure involves carefully removing cancerous tissue layer by layer, some bruising, swelling, or discoloration can occur afterward as part of the normal healing process. These effects are usually temporary, and there are several steps patients can take to support healing and improve comfort during recovery.” In this blog, Dr. Dorsey discusses how to treat bruises following Mohs surgery as well as providing general tips for better skin healing after surgery.
Is Bruising Normal After Mohs Surgery?
Bruising is a completely natural response to Mohs surgery, and this is especially true following treatment on areas with larger numbers of small blood vessels like the scalp, face, eyelids, and neck. Bruising is caused by damaging these blood vessels, leading to blood pooling under the skin that creates the discolored bruise. The face bruises more easily because of the density of blood vessels and thinner skin, making bruising more severe and noticeable. Additionally, gravity may pull the pooling blood down, leading to bruising that extends farther from the original surgical site. The risk of bruising is greatest during the first 5-7 days after surgery. Typical bruising should gradually improve within a week and only involve mild tenderness. Bruising after Mohs surgery that worsens quickly or becomes extremely painful may be indicative of more serious conditions that require immediate attention.
How Long Does Bruising Last After Mohs Surgery?
Dr. Dorsey says, “Patients often ask how long bruising lasts after Mohs surgery. Everyone heals differently, but there are some basic milestones that indicate skin is healing properly. Knowing what to except during healing makes it easier to spot concerns and seek treatment right away.” Most patients can expect the following Mohs surgery healing timeline.
Days 1–3: Swelling and Discoloration Increase
For the first three days, post-surgical swelling and discoloration increase. The surgical site may be tight, puffy, or tender to the touch. The bruise is typically red or purple colored, and it may spread slightly outside the treatment area. These are normal inflammatory responses that occur as skin heals. This process may be delayed in certain patients and may not occur until day 4 or 5.
Days 4–7: Bruising Darkens
From day four to seven, facial bruising after surgery may take on a deeper blue or purple hue. Swelling starts to improve and tenderness diminishes. This is the stage where symptoms may look worse, but they are getting better.
Days 7–14: Bruising Fades
In the second week of Mohs surgery recovery, the bruise should begin to take on a light brown, green, or yellow color. Swelling should be resolving, and the surgical site should return to typical appearance. All social activities can be resumed without concern, though you will still avoid strenuous activities until your doctor releases you back to exercising or lifting heavy objects.
What Affects the Severity of Bruising?
According to Dr. Dorsey, “There are numerous factors that affect how severe bruising will be and how long a bruise takes to heal. Following your dermatologist’s post-procedure care instructions can minimize bruising and improve healing.” Some of the many factors that impact bruising severity include:
- Location of surgery – facial areas like the nose, eyelids, lips, and cheeks have a rich blood supply, making bruising more substantial.
- Certain medications – blood thinners, aspirin, supplements like fish oil, garlic, ginkgo biloba, and vitamin E, and other medications can lead to increased bruising due to decreased blood clotting. In most cases, these over-the-counter medications and supplements should not be taken for a few days or longer before treatment. Your physician and dermatologist may need to discuss pausing prescription medications.
- Age – skin becomes thinner and blood vessels are more fragile as we age. This means bruising occurs more easily and may be more noticeable.
- Individual health – genetics, general wellbeing, and nutrition all play a part in how the body heals, including bruising severity.
How to Treat Bruises After Mohs Surgery (At-Home Care)
Following Mohs surgery, treatment for bruising and other symptoms may include:
- Cold compresses – cold constricts blood vessels and limits bleeding beneath skin, so apply a cold compress for twenty minutes at a time for the first two days after surgery. Never place ice directly on skin. Instead, wrap the cold compress in a cloth.
- Keep the head elevated – use pillows to sleep propped up after Mohs surgery on the scalp, face, or neck and avoid lying flat for the first few days. This prevents blood from pooling.
- Avoid strenuous activity – increased blood pressure during strenuous activity worsens bruising. For at least the first 1-2 weeks, minimize exercise, heavy lifting, bending, and twisting. Rest and give yourself plenty of time to heal.
- Follow dermatologist instructions – make sure to closely follow care instructions for cleaning the surgical site, using bandages, healing ointments, suture removal, and other specific recommendations.
What’s Normal vs. What’s Not
According to Dr. Dorsey, “Many symptoms are typical and expected following Mohs surgery, but some may indicate more serious concerns that require dermatologic intervention. Knowing the difference is key to ensuring quick, comfortable healing.” Below, Dr. Dorsey outlines typical symptoms and those that should prompt a call to the dermatologist.
Typical and Expected Symptoms
- Mild to moderate bruising at the treatment site and immediate surrounding tissues.
- Swelling around the surgical site.
- Tenderness or mild discomfort.
- Skin that feels tight.
- Discoloration and bruising.
Call Your Provider if You Notice
- Worsening swelling or inflammation.
- A firm “golf ball”-like lump under the surgical site.
- Severe pain.
- Redness or warmth around the treatment site.
- Pus or discharge from treatment area.
- Bleeding that does not stop after applying pressure or a cold compress.
- Signs of infection like fever or chills.
Tips for Feeling More Comfortable During Healing
Some common recommendations to make healing more comfortable following Mohs surgery include:
- Makeup – once your dermatologist clears you to use cosmetics, you can apply makeup to minimize the appearance of bruising.
- Anti-inflammatory – Arnica gel can help minimize bruising and discoloration from bruising. Avoid applying arnica gel to open wounds or broken/damaged skin.
- Sun care – keep skin safe from sun damage by minimizing exposure to UVA and UVB rays. Wear hats, gloves, long sleeve shirts, pants, and other protective clothing. Apply sunscreen to any area that will be exposed to sunlight.
- Plan social engagements – give yourself a week or two off from social events after surgery.
When to Contact Your Dermatologist
If you’re concerned about bruising or any other symptoms following Mohs surgery, you should never hesitate to reach out to your dermatologist. It’s essential to contact your dermatologist right away if:
- Bruising lasts longer than expected.
- Pain or swelling increase over time.
- Unexpected symptoms occur.
Expect Bruising Post-Procedure – Follow Dermatologist Instructions to Minimize
In conclusion, Dr. Dorsey says, “Bruising is a natural part of healing, but the good news is this side effect is temporary. Most people heal within just two weeks. Follow your dermatologist’s aftercare plan, keep the treatment site protected, and get plenty of rest to ensure your body has the best chance to heal. Overall, the few side effects are well worth the advantages Mohs surgery offers for skin cancer treatment.”
Schedule a Dermatology Consultation
When you’re ready to discuss Mohs surgery, skin cancer treatment options, or any other skin health concerns, the U.S. Dermatology Partners team has you covered. In just a few moments, you can fill out our online scheduling request form. A local dermatology team member will be in touch to finalize the details of your upcoming visit.
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