Background: Second-intention healing (SIH) is a common and acceptable method of wound care following Mohs micrographic surgery. Objective: To compare the efficacy and tolerability of a topical trolamine/sodium alginate emulsion (TAE) and bacitracin zinc/polymyxin B sulfate (BPB) ointment for SIH in patients requiring Mohs micrographic surgery for nonmelanoma skin cancers of the face. Methods: Eligible patients (N=25) were randomized to treatment with either a TAE or BPB ointment applied once daily for 6 weeks in an investigator-blinded study. Patients were assessed for 12 weeks postoperatively. Results: The topical TAE appeared to reduce wound size more rapidly than BPB ointment during the first 6 weeks of the study, although differences between the treatments were not statistically significant. The investigator's global assessment of treatment also indicated a trend in favor of the TAE. Both topical preparations were well tolerated. Conclusions: The topical TAE appears to be equally or more efficacious than BPB ointment for SIH in patients undergoing Mohs micrographic surgery for nonmelanoma skin cancers. Further research with larger study groups is needed to confirm the potential of a TAE in this setting.