Mohs Surgery

Mohs micro­graph­ic surgery is a step-wise sur­gi­cal tech­nique to remove skin can­cer. This process was first devel­oped by Dr. Fred­er­ic Mohs in the 1930s at the Uni­ver­si­ty of Wis­con­sin-Madi­son. Mohs surgery offers the high­est cure rate for local­ized skin can­cer, up to 99 per­cent for skin can­cers that have not been pre­vi­ous­ly treat­ed. Mohs surgery is pri­mar­i­ly used to treat basal cell car­ci­no­ma and squa­mous cell car­ci­no­ma and is appro­pri­ate for skin can­cers locat­ed on the scalp, face, neck, hands, feet and gen­i­tals where it is impor­tant to pre­serve healthy tis­sue. Oth­er indi­ca­tions include skin can­cers in areas of pri­or radi­a­tion, skin can­cers that have been pre­vi­ous­ly treat­ed and have regrown, aggres­sive skin can­cers, skin can­cers that are grow­ing rapid­ly and skin can­cers in immuno­com­pro­mised patients. Your physi­cian will dis­cuss with you if Mohs micro­graph­ic surgery is the appro­pri­ate treat­ment for your skin can­cer based on skin can­cer type, loca­tion and size. 

How to Pre­pare for Mohs Surgery

1. On the day of your surgery, plan to spend at least 3 – 4 hours in our office. In com­plex cas­es, you may be with us for most of the day.
2. On the morn­ing of your surgery, please eat a nor­mal break­fast. Food will not inter­fere with your surgery. If you have an after­noon appoint­ment, please eat lunch.
3. Please take all of your med­ica­tions as pre­scribed on the day of your surgery. If you take blood thin­ning med­ica­tions such as Coumadin^®, Plav­ix^®, Eliquis^® or Aspirin, please con­tin­ue tak­ing these medications.
4. Please take a show­er and wash your hair on the day of surgery.
5. Please do not apply make­up, per­fume or cologne on the day of your surgery.
6. Con­sid­er wear­ing cloth­ing with but­tons and bring lay­ers as the sur­gi­cal suite may be cold.
7. On the day of surgery, please arrive 15 min­utes pri­or to your sched­uled appoint­ment to com­plete any nec­es­sary paperwork.
8. Con­sid­er bring­ing a book, iPad^®, fam­i­ly mem­ber or friend to help pass time through­out the sur­gi­cal day.
9. Most patients can dri­ve them­selves to and from clin­ic on the day of surgery, how­ev­er, if the skin can­cer is locat­ed around the eye, please plan to have a dri­ver with you.

What to Expect Dur­ing Mohs Surgery

The surgery is per­formed under local anes­the­sia at a Duly Health and Care office. You will be asked to con­firm the sur­gi­cal site. The area sur­round­ing the skin can­cer will be cleaned and a local anes­thet­ic will be used to numb the sur­gi­cal site. A thin lay­er of tis­sue will be removed around the skin can­cer. The removed tis­sue will be processed in a lab into col­or-cod­ed, frozen sec­tion slides while you wait in a wait­ing room with a tem­po­rary ban­dage. The removed tis­sue will be ana­lyzed by your physi­cian, a map will be drawn and any remain­ing can­cer cells will be locat­ed. If can­cer remains, you will be brought back to the pro­ce­dure room and the entire process will be repeat­ed until you are can­cer free. Once you are can­cer free, your physi­cian will dis­cuss your recon­struc­tion options. 

Fol­low­ing Mohs surgery, recon­struc­tion options include:

• If your sur­gi­cal wound is small, it may be left to heal with­out stitch­es on its own.
• Many wounds may be closed with stitch­es in a straight line.
• Some wounds may be larg­er and require a local skin flap or graft to pro­vide the best func­tion­al and cos­met­ic outcome.
• If a wound is very large, your physi­cian may con­tact anoth­er sur­geon to assist with your reconstruction.
• All of your options will be dis­cussed and you will have time to ask questions.

What to Expect After Mohs Surgery

Detailed wound care instruc­tions will be reviewed ver­bal­ly on the day of the surgery. You will receive the same instruc­tions in writ­ing as well. Depend­ing on the extent of surgery, your lim­i­ta­tions may vary and this will be dis­cussed on the day of surgery. Stitch­es will remain in place between 7 – 21 days, depend­ing on the loca­tion and size of the surgery site.

Please be aware that any skin can­cers treat­ed on the top of the head, fore­head, around the eyes, cheeks, nose or oth­er areas may lead to swelling and poten­tial­ly bruis­ing around the eyes. This can be exten­sive and sig­nif­i­cant. If your surgery is around your lips or your mouth, you may have swelling that takes weeks or longer to resolve.

Please do not sched­ule surgery around a social oblig­a­tion (ie, wed­ding, vaca­tion), work oblig­a­tion, or any oth­er spe­cial event. 

Pain man­age­ment will be reviewed on the day of surgery. 

If you have any ques­tions or con­cerns, please call the clin­ic or our office and ask to speak with a Mohs Surgery clin­i­cal staff mem­ber. We look for­ward to see­ing you on your surgery day.