Postoperative Wound Care in Mohs Micrographic Surgery: Tradition, Variation, and the Evidence.

Abstract

Postoperative wound care following Mohs micrographic surgery (MMS) has high variability and surprisingly limited real-world evidence. Despite over one million MMS procedures performed annually in the United States, recommendations for topical agents, pressure dressings, wound cleansing, dressing change frequency, activity restrictions, and wound check intervals vary substantially across practices and are frequently based on training tradition rather than clinical data. This narrative review critically evaluates 15 common post-Mohs wound care practices, characterizing the evidence quality for each. Six practices are supported by at least Level III evidence, most notably plain petrolatum over topical antibiotics and over multi-ingredient ointments such as Aquaphor, gentle soap-and-water cleansing, the safety of early showering, targeted acetic acid soaks for hypergranulation tissue, and virtual wound checks. Evidence discourages cytotoxic antiseptics such as hydrogen peroxide and Dakin's solution. Most other common postoperative practices, including pressure dressings, activity restrictions, and dressing change frequency, remain understudied in MMS. Standardizing established practices while transparently acknowledging areas of uncertainty may reduce patient confusion, improve outcomes, and highlight priorities for future prospective research in dermatologic surgery.