Psychosocial and Inflammatory Consequences of Secondary Intention Healing After Mohs Surgery: Implications for Multidisciplinary Postoperative Care

Secondary intention healing after Mohs micrographic surgery (MMS) is often chosen for complex or concave sites, preserving tissue and enabling recurrence surveillance. However, secondary intention healing is associated with prolonged healing, visible scarring, and psychosocial distress. Psychological stress impairs repair through neuroendocrine activation, elevating cortisol and catecholamines that disrupt immune function and delay inflammatory resolution. Inflammation, in turn, hinders fibroblast activity, extracellular matrix remodelling and collagen organization, further slowing closure. Emerging evidence supports a 'psychosocial-inflammatory feedback loop' in which visible wounds heighten distress, distress amplifies inflammation and inflammation delays healing. This review integrates in vitro, animal, and clinical findings demonstrating the biological plausibility and clinical relevance of this loop in Mohs micrographic surgery. We propose a framework combining psychoneuroimmunology and wound biology to explain prolonged recoveries in some secondary intention healing patients. Recognising this interplay can inform closure selection, patient counselling and postoperative care-especially for wounds in highly visible areas. Multidisciplinary strategies combining optimal closure techniques, targeted anti-inflammatory therapies and psychological support may disrupt the cycle, accelerate healing and improve quality of life.