What is Mohs micrographic surgery?

Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, thin layers of cancer-containing skin are removed and examined until only cancer-free tissue remains.

The goal of Mohs surgery is to remove as much of the skin cancer as possible, while doing minimal damage to surrounding healthy tissue. Mohs surgery is an improvement to standard excisional surgery, which involves removing the visible cancer and a small margin of surrounding healthy tissue all at once. Mohs surgery allows for verification that all cancer cells have been removed at the time of the procedure. This maximizes the chance of a cure and reduces the need for additional surgery.

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What are the advantages of Mohs surgery?

Compared to standard excision, 100% of the margins are evaluated allowing for a higher cure rates while minimizing the removal of normal, healthy skin.  This is particularly important on cosmetically sensitive areas on the head and neck. The procedure is cost effective and under most circumstances, reconstruction of the surgical defect will follow immediately after Mohs surgery.

For more information regarding the reconstruction process, please click here.

https://www.skincancermohssurgery.org/about-mohs-surgery/reconstruction

Why choose a fellowship trained Mohs surgeon?

To ensure optimal care, our surgeons have completed a fellowship in procedural dermatology/Mohs surgery.  The standards for this fellowship are rigorous and include involvement in over 500 Mohs surgical cases, development of expertise by interpreting tissue samples removed during the procedure, reconstructive techniques, and other cutaneous procedures.

For additional information including frequently asked questions and what to expect on the day of your surgery, please visit https://www.skincancermohssurgery.org

For more information:

https://www.upmc.com/services/dermatology/department-of-derm/skin-cancer-program

What to Expect On the Day of Surgery: Preparing for Mohs surgery and frequently asked questions

What should I do to prepare for Mohs surgery?

One to two weeks prior to surgery

Unless prescribed by a physician, we recommend stopping aspirin or aspirin containing medications 1 week prior to surgery.  If you take aspirin for a medical condition or prescribed by a physician, you should continue this medication.  We also recommend stopping herbal supplements including gingko biloba, ginseng, garlic, Vitamin E, Vitamin C, and fish oil which may increase your risk of bleeding.  If you are taking a blood thinner, we DO NOT routinely recommend stopping this medication.

If you are a current smoker, we recommend smoking cessation 2 weeks prior and 2 weeks after surgery to optimize wound healing.

Day of surgery

Please continue taking all medications as prescribed.  We also recommend eating a light breakfast on the day of surgery.

What should I bring to the visit?

We recommend wearing comfortable clothing and bringing a jacket in case you are cold.  We also recommend bringing a snack or reading material as there will be down time when the tissue is processing in the lab.

What are the risks of Mohs surgery?

While Mohs surgery is a safe procedure, it has risks like any other surgical procedure including pain, bruising, bleeding, wound infection, and nerve damage.  Your Mohs surgeon will discuss specific risks on the day of your procedure.

How long does the procedure take?

It is hard to predict the exact amount of time your procedure will take.   On average, Mohs surgery can last anywhere between 2-4 hours, but in rare cases, a full day.  We recommend clearing your schedule for the day.  The initial “stage” typically takes 15-20 minutes.  Afterwards, we will bandage you and direct you the waiting room to wait while the tissue is being processed in our laboratory.  This part of the procedure typically takes 45 minutes to 1 hour.  Additional “stages” (typically 1-3) may be required if skin cancer is still seen on the margins.  Your Mohs surgeon precisely maps out tissue and will only remove tissue where skin cancer is still present.  Once you are clear of your skin cancer, you will discuss repair options with your Mohs surgeon.

What happens after the skin cancer is removed?

You and your Mohs surgeon will discuss how to best repair the wound.  This includes letting the wound heal on its own (second intention), using stitches to close the wound, utilizing skin from an adjacent area (flap), or using a skin graft from another part of the body to cover the wound.

What should I expect after Mohs surgery?

Most patients will experience minor pain and swelling which typically peak 48-72 hours after surgery.  While Mohs surgery is a well-tolerated procedure, we will generally recommend Extra Strength Tylenol taken to help minimize any minor discomfort after the procedure.  Cold packs or ice can also be helpful (not directly applied to wound) to alleviate pain or swelling after the procedure.  Bruising, swelling, and minor drainage are common after Mohs surgery and typically subside over the following week.  You should call your surgeon or go to the nearest emergency room if you are experiencing significant bleeding which does not stop after applying direct pressure for 20-30 minutes.  Similarly, while infection is rare after Mohs surgery, you should call your surgeon if you are experiencing worsening pain after 48 hours, foul smelling drainage, or increasing redness around wound site.

How should I take care of my wound?

You and your Mohs surgeon will discuss wound care extensively on the day of surgery.  In most cases, we will apply a “bulky” bandage immediately after your surgery which we recommend leaving in place and keeping dry for 48 hours.  After 48 hours, we recommend removing the bandage and washing the Mohs surgical site with warm water and gentle soap such as Dove.  Afterwards, we recommend applying a liberal layer of Vaseline or Aquaphor and covering the site with a bandage.  Typically, this process is repeated daily until you return in 1 week for suture removal.

Do I need to limit activity after Mohs surgery?

Most people are able to return to work or school the day following Mohs surgery. We recommend avoiding strenuous activity after Mohs surgery including lifting anything more than 10 lbs.  While we recommend against strenuous exercise, light walking can be continued while the stitches are in place. Swimming and other water sports are not recommended as they may increase the risk of infection.

Will I have a scar?

Yes.  Any surgical procedure will inevitably result in some form of scar; however, Mohs surgery removes skin cancer while preserving normal, healthy tissue thus minimizing the appearance of scarring.  Most importantly, scars continue to improve up to 1 year after a surgical procedure and will become less noticeable over time.

What happens after the stitches are removed?

We will discuss additional wound care if necessary. While Mohs surgery offers the highest cure rate of any other skin cancer treatment option, recurrence is still possible. We recommend skin checks every 6 months to monitor for any recurrence.

If you have any more questions, please do not hesitate to call our office.

To book a consultation click here or call (480) 398-1550.