Mohs Surgery

Due to the time involved in the processing of the tissue and the possibility that more than one stage of removal may be required, the procedure can take two to four hours. Since much of the time will be spent in the patient lounge, it’s suggested patients bring something to read or an activity to pass the time. Surgery takes place in the early morning or early afternoon.

Any type of surgical treatment will leave a scar; however the Mohs procedure minimizes this.

Only local anesthetic is needed for the Mohs procedure.

It’s not required, but it’s a good idea to have someone who can drive you home should it become necessary.

The consultation is important because it allows the doctor to examine your skin cancer, review your medical history, explain the procedure, and determine if Mohs surgery is the best treatment for you. If a biopsy has not been taken, it can be done at the consultation. This is a simple five-minute procedure. Because all skin cancers are not alike, the course of treatment is determined by the type of skin cancer. Photographs are taken of the cancer and will be part of your medical record.

Try to get a good night's sleep. Fasting isn’t necessary, but don’t drink alcoholic beverages for 48-hours before surgery. At the consultation, the surgeon will advise the patient what medications, if any, should be temporarily stopped prior to surgery. In general, they include ibuprofen and vitamin E supplements for one week, aspirin and Plavix for two weeks and Coumadin for three to five.

Once the tumor is completely excised, the surgeon will evaluate the wound and discuss repair options that include stitches, allowing for natural healing, or placement of a skin flap or graft. With stitches or a graft, the wound will heal in one to two weeks, and, over a period of months, continuing cosmetic improvement will be seen. If the wound is allowed to heal naturally, the tissue will grow back slowly in four to six weeks.

Regardless of the choice of repair, the wound should not be allowed to dry up and scab. Daily application of antibacterial ointment is required. Patients will receive complete wound care instructions from the surgeon.

It’s rare that patients complain of pain after the procedure, but you may experience a headache or mild discomfort. In most cases, Tylenol or an ice pack lessens the discomfort. Aspirin and ibuprofen should be avoided.

Bleeding is rare after Mohs surgery but, if it happens, lie down and place steady, firm pressure over the bandage for 20 to 30 minutes. Do not remove the bandage to see if it’s still bleeding. If the bleeding persists, contact the dermatology office or go to the nearest hospital emergency room.

All wounds develop a small halo of redness. This is normal inflammation. Occasionally, a red, bumpy rash with severe itching may occur. This usually indicates an allergic reaction to either the tape or the antibacterial ointment. If this happens, contact the dermatology office immediately. Patients who’ve had surgery around the eyes can expect mild to moderate swelling and occasional bruising. The use of ice packs 24 to 48 hours after surgery for no more than 15 minutes each hour, may reduce swelling.

After the wound has healed, patients may experience redness and tightness which will gradually diminish. Sometimes, nerves in the surgical area are affected, resulting in numbness. Sensation may take a year or more to return, and the numbness rarely is permanent.

The Mohs surgeon will continue to see you until the wound is healed. Patients are then discharged back to their general dermatologist for follow-up.

Skin cancer patients have a 50 percent chance of recurrence. To catch new skin tumors in the early and most treatable stages, an annual full-skin exam with the dermatologist is advised.