Mohs Surgery

Mohs micrographic surgery is a specialized procedure used to remove skin cancers. This treatment method differs from all other approaches because it allows the surgeon to track and remove all of the roots and extensions of the skin cancer in their entirety by removing skin lesions one layer at a time and performing a complete examination of all tissues removed under a microscope as they are removed. This thorough examination of each skin layer allows our surgeons to detect cancer cells, offering you the highest chance for recovery.

Mohs surgery has a very high cure rate of up to 96 to 99%, even when other forms of treatment have failed. The surgery is performed under local anesthesia in our outpatient clinic by our Mohs surgeons.

Frequently Asked Questions

How long does the surgery take?

Your surgery will be performed during one morning or afternoon session. Generally, you will be in the clinic for two to four hours depending on how many stages are required.

Am I awake?

Mohs surgery is performed under local anesthesia while you’re awake. In between stages, you’ll have a temporary bandage on, and you can sit up, talk, read, and go the bathroom.

How do I prepare for surgery?

Medications

• Take all of your medications as prescribed, unless specifically instructed otherwise by a physician.
• Please let us know if you take any of the following blood-thinning products (but don’t stop any of these medications unless instructed to do so): aspirin, Coumadin (Warfarin), Plavix (Clopidegrel), Vitamin E, fish oil.
• If you take ibuprofen (Advil, Motrin) or Naproxen (Naprosyn, Aleve) on an as-needed basis, please stop these medications seven days prior to your surgery. If you take any of these medications by prescription, please discuss this with your prescribing doctor first.
• You may take acetaminophen (Tylenol) for pain during this period.

Alcohol

• Three days prior to surgery, we ask that you avoid drinking alcohol as it may increase your risk of bleeding.

Breakfast, Companions, Makeup and Books

• Eat your normal breakfast (unless specifically instructed otherwise by a physician). It’s helpful to have someone with you to keep you company between stages.
• You’ll have a bulky bandage on after surgery, so we recommend having someone else drive you home.
• On the day of surgery, please do not apply any makeup or moisturizers.
• Because you’ll be with us for several hours, you and your companion may want to bring along a light snack and reading material or another quiet activity as there’s waiting time between stages.

Will I have a scar?

There’s always a scar after surgery. Your Mohs surgeon makes all efforts to hide the scar in the natural contours of your face and to preserve the shape and function of sensitive areas such as the nose and lips. Scars improve over weeks to months as scar tissue remodels, so it is important to give the scar time to mature.

Sometimes a second procedure may be needed to modify or smooth the scar. We’ll work with you to give you the most invisible scar possible. Our goal is for both you and your Mohs surgeon to be happy with your result.

What Can I Expect After Surgery?

Discomfort

• After the anesthetic wears off, there may be some soreness or aching. This usually improves within 24 hours and oftentimes there is very little pain.
• Rest, icing the area and Tylenol are usually sufficient to relieve any discomfort.
• Occasionally, stronger pain medication may be prescribed. Please avoid ibuprofen (Advil, Motrin, Aleve) as it may increase the risk of bleeding.

Activities

• In general, we recommend that you limit your activities for two to seven days after the surgery.
• Your surgery team will give you specific recommendations depending on how your wound was repaired.
• Activities such as bending, heavy lifting and strenuous exercise should be avoided as they can elevate your blood pressure and lead to bleeding, swelling or opening up of stitches.
• Please defer airplane travel for at least one to two weeks after your surgery as the rigors of travel may adversely affect healing.

Drinking alcohol

• Alcohol should be avoided for three days following surgery as it dilates the blood vessels and could lead to bleeding problems in the wound.

What is normal?

It’s normal to have some redness and swelling around the area. This generally improves over the first week. Bruising may occur as well, and can take one to two weeks to resolve.

What are the risks after surgery?

Bleeding

• Slight bleeding under the pressure dressing is normal and you may notice dried blood on your bandage when you remove it. More extensive bleeding is only rarely a problem after surgery.

If this occurs, you should apply moderate pressure continuously with a clean gauze or washcloth for 20 to 30 minutes. If there’s still active bleeding, please call the clinic or page the on-call dermatologist who will instruct you further.

• Medications and activity that increase your risk of bleeding include aspirin, other blood thinners, strenuous exercise and bleeding disorders.
• Infection is a risk after Mohs surgery but is uncommon. Infections usually appear several days after surgery with increased redness, tenderness, swelling and drainage.
• If you notice any of these symptoms, please call our office at 508-334-5979. We’ll generally have you come to the clinic to be checked. We’ll prescribe a topical or oral antibiotic if needed.
• Numbness or tingling may occur over the area even after the scar heals. Often the numbness improves over months as small nerves regrow into the area. Sometimes, especially with a skin graft, some degree of numbness can be permanent.
• Allergic reactions to the local anesthetic Lidocaine are extremely rare. Local allergic reactions to bacitracin ointment are more common, resulting in an itchy rash. In most cases, we recommend sterile Vaseline for your wound ointment instead of bacitracin to avoid such reactions. Occasionally people will develop itchy topical reactions from the irritation of the bandage or adhesive tape.
• Recurrence of tumor is 1 to 3% for tumors being treated the first time with Mohs surgery. If the tumor has previously been treated by another method and now is being treated with Mohs surgery, the risk of recurrence is slightly higher.