What Should I Know About Infection After Mohs Surgery?

Understanding the Risks, Signs, and Prevention of Postoperative Infections

Navigating the path of skin cancer treatment can be daunting, especially when considering the potential complications. Among these, surgical site infections (SSIs) stand out as the most common complication following Mohs micrographic surgery (MMS).

Notably, lower extremity surgical sites are at an increased risk for developing SSIs, and infection rates are significantly higher with wounds closed by flaps or grafts than those closed by linear repair or secondary intention.

This article serves as your guide to recognizing and managing an infection after Mohs surgery, empowering you with the knowledge to navigate your recovery journey with confidence and peace of mind.

What is Mohs Surgery?

Mohs surgery, also known as Mohs micrographic surgery, is a highly specialized and precise surgical technique used primarily for the treatment of common types of skin cancer, such as basal cell carcinoma and squamous cell carcinoma. This surgical procedure is named after Dr. Frederic E. Mohs, who developed it in the 1930s.

The main distinguishing feature of Mohs surgery is its unique ability to analyze and remove the entire tumor, layer by layer while minimizing the removal of healthy surrounding tissue.

The procedure involves the surgeon removing the visible tumor along with a thin layer of tissue surrounding it. The removed tissue is then meticulously examined under a microscope to assess the presence of cancerous cells.

If cancer cells are found in the margins of the removed tissue, indicating that not all cancerous cells have been removed, the surgeon continues to remove additional layers of tissue from the affected area. This process is repeated until no cancer cells are present, ensuring the highest possible cure rate and minimizing the risk of recurrence.

Benefits of Mohs Surgery

Mohs surgery offers multiple benefits. These include:

• High cure rates, with a very low rate of adverse events
• Precise results
• Cost-effectiveness
• Outpatient setting
• Local anesthesia
• Tissue conservation

It is particularly advantageous for tumors located in sensitive areas, such as the face, where tissue preservation and precise removal of cancer cells are crucial to maintaining both functionality and aesthetics.

Infection After Mohs Surgery

Surgical wounds are susceptible to bacterial infections, especially in the days following the surgery when the immune response may be compromised. 

After undergoing Mohs surgery, patients may be at risk for developing an infection at the surgical site. While infection rates after Mohs surgery are generally low, it is still important to be aware of the potential risks and take necessary precautions to prevent complications.

Risk Factors for Developing an Infection After Mohs Surgery

While Mohs surgery boasts impressive cure rates and excellent cosmetic outcomes, there is always a risk of infection following any surgical procedure. Identifying the risk factors associated with infection after Mohs surgery is crucial in order to prevent complications and ensure optimal healing.

1. Immunocompromised Patients

Patients who have weakened immune systems, either because of diseases like diabetes or HIV or as a result of certain medications, are more prone to bacterial infections. The body's ability to defend against invading pathogens is compromised, which increases the chances of wound infection compared to immunocompetent patients.

2. Age of Patients

Elderly patients also face a higher risk of infection following Mohs surgery. As we age, our immune systems naturally weaken, making us more vulnerable to infections. Additionally, elderly patients may have other underlying health conditions or comorbidities that can further compromise their ability to combat bacterial invaders.

3. Poor wound care

Proper wound care plays a critical role in reducing the risk of infection after skin surgery. Following your healthcare provider's instructions for wound care, including cleaning and dressing changes, is essential. Keeping the surgical site clean, dry, and protected helps to minimize the risk of bacterial colonization and subsequent infection.

4. The Clinic or Surgical Facility

Surgical wound infection rates can also vary depending on the clinic or surgical facility. Factors such as adherence to strict infection prevention protocols, proper sterilization techniques, and overall cleanliness of the facility can all impact the risk of infection. It is crucial to choose a reputable and well-established clinic with a track record of low infection rates to minimize your chances of developing a postoperative infection.

5. Extent and Location of the Tumor

The extent and location of the tumor play a crucial role in determining the treatment approach and potential outcomes. Understanding the characteristics of the tumor, such as its size, depth, and proximity to important structures, is vital for the dermatologic surgeon to adequately plan and execute the procedure.

Tumors located in areas that are functionally or aesthetically important, such as the face or hands, require extra consideration to preserve both the structural integrity and cosmetic outcome. Additionally, tumors near critical structures, such as the eyes or nose, may pose a higher risk of complications if not managed appropriately.

6. Proper Activity Restrictions Following the Procedure

Proper activity restrictions following Mohs surgery are crucial for optimal wound healing and to minimize the risk of postoperative complications, including infection. Mohs surgery is a delicate procedure that involves the removal of skin cancer in a layered manner, ensuring the complete excision of cancerous cells while preserving healthy tissue. 

It is important to avoid the following activities:

• Heavy lifting
• Vigorous exercise
• Activities that put excessive strain on the surgical area

These can disrupt the wound and compromise its integrity. This can increase the risk of wound dehiscence, delayed healing, and potentially lead to infection.

7. Uncontrolled Diabetes or Other Health Conditions

These conditions can weaken the immune system, making it harder for the body to fight off infections. They can impair the body's ability to prevent or combat bacteria and other harmful pathogens.

For instance, patients with uncontrolled diabetes can compromise the circulation and proper oxygenation of tissues. This can make it difficult for important nutrients and oxygen to reach the surgical site, slowing down healing and making the wound more likely to get infected. Elevated glucose levels also provide a favorable environment for bacterial growth, further heightening the risk.

Signs and Symptoms of Infection After Mohs Surgery

After undergoing Mohs surgery, it is important to be aware of the signs and symptoms of infection. It's normal to feel some discomfort and see redness on the treated area. However, there are certain symptoms that could indicate an infection, and it's important to seek immediate medical attention if you experience them.

1. Increased surgical site pain or tenderness

This can be accompanied by swelling, warmth, and redness that extends beyond the immediate area of the incision. In some cases, there may be oozing or drainage of pus from the wound, indicating the presence of bacteria.

2. Fever or chills

If you notice an elevated body temperature or experience sudden shaking chills, it is important to notify your dermatologic surgeon as this may be a sign of a more serious infection.

3. Changes in the appearance of the surgical wound

If you see that the wound is becoming more red, sore, or swollen, or if there is a foul odor coming from the area, this may indicate an infection. Additionally, if you notice the presence of increasing scar tissue or delayed healing, these can also be signs that an infection is present.

4. Drainage from the Incision Site

Drainage from the incision site is a concerning sign days after surgery and may indicate the presence of an infection. When an infection occurs, bacteria can invade the surgical wound, leading to a buildup of pus or fluid that needs to be drained. 

Drainage can present in various forms, including:

• Pus - a thick, yellowish, or greenish fluid that indicates the presence of infectious material.
• Serous fluid - a clear or slightly yellowish fluid that is part of the body's natural healing response.

While some degree of drainage is normal in the early stages of healing, any changes in color, consistency, or odor should raise concerns. Excessive or foul-smelling drainage from the incision site should be evaluated by a dermatologic surgeon as soon as possible.

Preventative Measures to Avoid Infection After Mohs Surgery

It is crucial to take preventive measures to avoid infection after surgery. A key factor to avoid infection is maintaining proper wound care. Some tips that you may follow include:

Preventative Measures

Keep the area clean by gently washing it with mild soap and water, and then patting it dry.

Avoid using harsh chemicals or antiseptics that may cause skin irritation.

Change dressings regularly to prevent infection. Your surgeon may recommend using sterile dressings or gauze pads to cover the incision site.

Wash your hands thoroughly before and after changing dressings to minimize the risk of introducing harmful organisms to the incision site.

Adhere to prescribed antibiotic prophylaxis to reduce the risk of infection after Mohs surgery, especially for immunosuppressed patients or those with specific medical conditions that impair their ability to fight off infections.

Do not soak the wound in water, such as swimming pools, hot tubs, or baths, until your surgeon advises it is safe to do so.

Be cautious of exposing the surgical site to excessive sunlight, as this may delay the healing process.

Regular follow-up appointments with your dermatologic surgeon are crucial in monitoring the progress of your wound healing and identifying any signs of infection.

When to Seek Professional Treatment for a Postoperative Infection

If you suspect an infection after Mohs surgery, it's important to contact your dermatologist or surgeon promptly. Symptoms that should prompt immediate contact include severe pain, uncontrolled bleeding, pus or cloudy liquid drainage, or an open wound that can't be held together by stitches.

If a bacterial infection is diagnosed, antibiotic therapy will likely be prescribed. It's crucial to follow the prescription directions exactly and continue taking the medication for the entire recommended duration. Most antibiotic courses last between seven to ten days.

If the infection is severe, more aggressive treatment may be necessary. This might include removing infected tissue, which is called debridement, and cleansing the wound with a saline solution. The wound is then dressed with saline-soaked dressings and covered with a bandage.

Choose Dermatology and Skin Health for Your Mohs Surgery Needs

When it comes to your skin health, don't settle for less. At Dermatology and Skin Health, our experienced team specializes in Mohs micrographic surgery, offering you the highest level of care. We understand the importance of minimizing postoperative infections and will guide you through each step of the process, from initial consultation to recovery.

Don't leave your skin health to chance. Trust in our expertise and commitment to patient care. Contact Dermatology and Skin Health today and take the first step towards a healthier, cancer-free future. Your peace of mind and well-being are our top priorities.