Search
Close this search box.

Mohs

Mohs surgery patient in Scottsdale dermatology

What is Mohs micrographic surgery?

Mohs surgery is a detailed surgical technique developed to treat skin cancer. During Mohs surgery, multiple stages of tissue removal and lab work are performed while the patient stays in the office. Small areas of the cancerous skin are removed in intervals. Lab work and examination occur until only healthy tissue is present. This yields the total removal of the cancerous skin while saving healthy skin and leaving a small scar.

Start your journey
to Beautiful skin!

What Types of Cancer Does Mohs Surgery Treat?

Mohs surgery is known for treating various forms of skin cancer, including melanoma, basal cell carcinomas, and squamous cell carcinomas. These types of skin cancer are the most common.

How is Mohs Surgery Different from Other Techniques?

Mohs surgery aims to remove as much skin cancer as possible layer by layer while doing minimal damage to the surrounding healthy tissue. Mohs surgery is a less invasive improvement to standard excisional cancer procedures. Customary cancer removal procedures involve removing the visible cancer and a portion of the surrounding healthy tissue.

Mohs surgery allows for lab testing and evaluation to confirm complete cancer cell removal at the time of the surgery. This increases the probability of a cure at the time of surgery and decreases the likelihood of additional surgery.

Procedure

A topical anesthetic is administered to the skin during surgery to numb the treatment area. After the area is numb, your doctor will use a scalpel to remove visible areas of the cancer. The doctor will remove a thin area of tissue underneath the area and surrounding the cancer. A bandage is applied to the site, and the removed tissue is taken to the lab for testing. The tissue sample is cut into sections and looked at with a microscope. The surgeon maps out the tissue to track where each piece is on the skin. This ensures that the surgeon knows where to continue the procedure.

If additional cancer is detected in the tests, the surgeon will continue the procedure by removing another layer of skin from the involved section. The process repeats until the last tissue sample removed and tested is cancer-free.

After

After the cancer tissue has been eliminated from the skin, your doctor will decide how to close the wound. Options include stitches, using skin to cover the wound, and letting the wound heal naturally. Mohs micrographic surgery is typically performed outpatient, allowing you to go home after surgery.

After surgery, you may notice pain and tenderness at the surgery site and mild bleeding. Over-the-counter pain medications can help to diminish unwanted pain. You will be instructed to wear a bandage over the area for at least a week after the procedure. You may need to schedule a follow-up appointment after surgery to ensure the wound is healing as expected.

Results

Knowing that the skin cancer is entirely removed at the time of appointment is a significant advantage of Mohs surgery. Not only does Mohs surgery preserve your healthy skin, but it also uses in-depth examination techniques at the time of surgery to thoroughly remove the skin cancer.

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

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.

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

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.

 

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. Call Us Here

Contact Us