Should You Take Antibiotics After This Common Skin Cancer Treatment? We Break Down the Pros and Cons

For routine, uncomplicated cases, antibiotics are generally not required after Mohs surgery on the face. They may be considered on a case-by-case basis for patients with factors putting them at increased infection risk.

Mohs surgery is a specialized technique used to treat common types of skin cancer. During this procedure, thin layers of cancerous tissue are progressively removed and examined until only cancer-free tissue remains. Mohs surgery allows surgeons to pinpoint areas involved with cancer while preserving as much healthy tissue as possible.

The surgery is typically done on an outpatient basis under local anesthesia. The face is the most common area treated with Mohs surgery due to its frequent sun exposure and cosmetic sensitivity.

Are Antibiotics Typically Needed After Mohs Surgery?

The short answer is no - for most routine Mohs surgery, antibiotics are not required.

In fact, a survey of U.S. Mohs surgeons found that the majority do not prescribe oral antibiotics after uncomplicated facial surgery. They are typically reserved for special circumstances based on a patient's unique risk factors.

So if your Mohs surgery on the face was relatively straightforward without complications, antibiotics are usually not prescribed. But there are some situations where your doctor may recommend a short course as a preventative measure.

When Might My Doctor Prescribe Antibiotics After Mohs?

Here are some scenarios where your dermatologist may advise taking oral antibiotics following Mohs surgery on the face:

To Prevent Surgical Site Infections

Patients with certain risk factors have a higher chance of developing an infection at the surgical site after Mohs. Diabetes, obesity, smoking, or immunocompromised state can increase infection risk.

For high-risk patients, your doctor may prescribe a 3-5 day course of an antibiotic like cephalexin as a preventative measure. This is more likely if you needed extensive reconstruction after Mohs.

Pre-operative nasal cultures to identify staph carriers with decolonization treatment is also used by some surgeons.

To Prevent Endocarditis

Endocarditis is an infection of the heart's inner lining that can occur after procedures. Patients with heart conditions like damaged valves or artificial valves require antibiotics before certain dental work.

To Prevent Prosthetic Joint Infections

For those with artificial joints near the surgical site, antibiotics may help prevent the spread of bacteria to implantable devices.

This is most relevant for knee/hip replacements located close to where Mohs was performed.

For Other Patient-Specific Risk Factors

Beyond the reasons listed above, your doctor may suggest antibiotics after weighing your individual risk factors, such as:

• Immunocompromised state
• Prior radiation therapy
• Extensive or complex repair after Mohs
• History of keloid scarring

Risk Factor	Reason for Antibiotics
High risk for surgical site infection	Prevent postoperative infections
Significant valvular heart disease	Prevent endocarditis
Artificial joint near surgical site	Prevent prosthetic joint infections
Immunocompromised state	Increased infection risk
Prior radiation therapy	Impaired healing
Extensive Mohs repair	Larger wounds
History of keloids	Reduce scarring

Your Mohs surgeon may also recommend antibiotic prophylaxis to prevent endocarditis if you have significant valvular heart disease.

The decision is made on a case-by-case basis to determine if potential benefits outweigh possible downsides of antibiotic overuse.

What Antibiotics Are Commonly Prescribed After Mohs?

If your dermatologist does recommend antibiotics after Mohs on the face, some of the most commonly prescribed options include:

• Cephalexin: A first-generation cephalosporin often prescribed after dermatologic procedures due to its activity against Staph aureus. Typical dosage is 500mg twice daily for 3-5 days.
• Doxycycline: A tetracycline-class antibiotic with good skin penetration. Dosage is usually 100mg twice daily for 3-5 days after Mohs surgery.

The choice between these antibiotics depends on your specific risk factors, such as previous MRSA infections. Topical antibiotics like mupirocin are also frequently used along with oral antibiotics.

For most patients requiring prophylaxis, a relatively short course of 3-5 days is considered sufficient to lower infection risk after Mohs.

What Are the Potential Downsides of Antibiotic Overuse I Should Know?

While antibiotics certainly have an important role in select cases, it's important to be aware of the possible disadvantages of over-prescribing them, including:

Antibiotic resistance

Increased use promotes resistant bacteria which can then spread within communities.

C. difficile infection

Antibiotics kill good gut bacteria needed to prevent dangerous C. diff overgrowth.

Allergic reactions

Up to 10% of patients are allergic to certain antibiotics like penicillin. Reactions can be mild to life-threatening.

Medication interactions

Antibiotics can interact with other drugs you may be taking.

Dysbiosis

Disruption of normal microflora can lead to digestive issues like diarrhea.

Being aware of these risks highlights the need for antibiotics only when potential benefits are likely to outweigh the harms.

Conclusion

While antibiotics are certainly helpful medications in many circumstances, the decision to use them after Mohs surgery on the face requires carefully weighing the risks and benefits for each individual.

Routine antibiotic prophylaxis is generally not recommended, but a short course may be advised for select patients with high-risk factors for surgical site infections or to prevent endocarditis/prosthetic infections.