Mohs surgery is a two-step, same day procedure performed under local anesthesia. The first step involves surgical removal of the tumor followed by complete microscopic examination of all the tissue margins as well as a detailed, color-coded mapping technique to allow the surgeon to remove every cancer cell. This process is repeated in stages until the surgeon has histologically confirmed negative tissue margins.
Immediately after the tumor is completely removed, the second step is deciding how to address the resultant defect. The surgeon will then choose, 1) to leave the wound to heal on its own, 2) to repair the wound with stitches, or 3) to reconstruct the area with a skin graft or flap. The decision is based on the safest method that will provide the best cosmetic result.
What are the advantages of Mohs surgery?
Mohs surgery is an approach to skin cancer removal that offers: 1) the highest possible cure rates and 2) the smallest possible defect by minimizing the removal of as little normal skin as possible.
What are my chances of cure?
Using Mohs surgery, the percentage of cure is more than 99% for many skin cancers, even when other forms of treatment have failed.
Will I be hospitalized?
No. Mohs surgery is performed in office under local anesthesia. You may return home the same day.
What happens the day of surgery?
The surgeon will inject local anesthesia to the area around the skin cancer. Once the area is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the surgeon and taken to the adjacent laboratory where the technician will immediately process the microscope slides.
You will have a temporary dressing placed over the wound, and you will then be able to wait comfortably in the room. The surgical removal of the skin cancer takes only 15-20 minutes. However, it can take up to 1 hour to prepare and microscopically examine the tissues.
Several surgical stages and microscopic examinations may be required, and you will need to wait between stages until the cancer is completely cleared. There is no way to predict before surgery how many stages will be necessary, however most cancers are removed in three stages or less.
You may want to bring reading material to occupy your time while waiting for the microscope slides to be processed and examined. Since there is no way of knowing in advance how much time is necessary to remove the cancer and repair the wound, you should plan to be in the office for several hours and you should not make other commitments that day.
Will the surgery leave a scar?
Yes. Any form of surgical treatment will leave a scar. Because Mohs surgery removes as little normal tissue as possible, scarring is minimized.
Will I have pain after the surgery?
If there is any discomfort, Extra Strength Tylenol is all that is typically necessary for relief. A stronger pain medication can be prescribed, if needed.
Preparing for Surgery
- Please discontinue any vitamins, herbal supplements or over-the-counter pain relievers (such as, Aspirin, Ibuprofen, or Aleve) 1-2 weeks prior to surgery. Vitamin E, Gingko, Garlic, Fish Oil, and other supplements have been shown to increase bleeding and bruising. Tylenol does not increase bleeding and is okay to continue.
- Prescribed Blood Thinners (such as, Plavix, Coumadin, etc.) – Please check with your prescribing physician to determine whether it is safe for you to discontinue these prescribed blood thinners.
Alcohol & Smoking:
- Please avoid alcohol, as alcohol can increase the risk of bleeding and bruising.
- Stop smoking! Smoking will increase your risk of complications and infection from surgery. Even cutting back will help, but the best choice is to stop completely.
Schedule Your Consultation
Dr. Alan Heller is a Mohs surgeon who is a Fellow of the American College of Mohs Surgery (ACMS). He has over 30 years of experience successfully treating skin cancers using the Mohs technique.
If you are interested in learning more about Mohs Surgery, please call Heller Dermatology & Aesthetic Surgery to schedule your consultation!