Mohs Micrographic Surgery Overview
What is Mohs Surgery?
Mohs surgery, short for Mohs micrographic surgery, is a highly specialized treatment for the removal of skin cancer. It was developed by Dr. Frederick Mohs in the early 1940’s. Mohs surgery eliminates the guesswork used with all other methods of treating skin cancer. It allows a detailed microscopic evaluation of all edges of the skin cancer by the Mohs surgeon, ensuring complete removal. By using detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. This results in complete removal of the skin cancer while removing as little normal skin as possible. The cure rate for Mohs surgery is 97-99%, even when other forms of treatment have failed.
Who Performs Mohs Surgery?
The Mohs surgical team includes specially trained physicians, nurses, medical assistants, and histology technicians. The physician leading the team is fellowship trained and is recognized by the American College of Mohs Surgery. The histology technician prepares the tissue slides, which are examined under the microscope by the Mohs surgeon.
How Do I Prepare for the Day of Surgery?
The morning of surgery
Please shower and wash your hair. Avoid wearing make-up, using hair products, or wearing jewelry. Eat your normal breakfast, unless otherwise specified. Wear comfortable clothing. Also, because the day may be quite tiring, we suggest you arrange to have a companion drive you to and from the office.
What to pack
You will be in the office for most of the day; therefore, you may want to bring a snack or sandwich. Please bring a book or something to do during the waiting period. Once the surgery has begun, you will need to remain in the office. If you require oxygen, be sure to bring enough to last the entire day.
You will be asked to review your medical history when you arrive the morning of the surgery. Bring a list of medications and illnesses. Please arrive at least 15 minutes before your scheduled appointment to allow time to complete any necessary paperwork.
Continue all prescribed medications, including blood thinners like Coumadin, Eliquis, Plavix, and aspirin. However, if you are taking aspirin, ibuprofen, or supplements (including Vitamin E, fish oil) without your doctor’s orders, then discontinue them 10 days prior to your surgery. Call the office if you are unsure. Avoid alcoholic beverages 48 hours before surgery as they can promote bleeding.
What Happens the Day of Surgery?
Upon arrival, check in at the front desk. You will be escorted to the procedure room where your medical history, medications, and allergies will be reviewed.
After all of your questions are answered and the correct surgical site has been confirmed, the skin is cleansed and numbing medication is injected. After the area is numbed, the visible cancer will be removed by the surgeon. This usually only takes a few minutes. A temporary bandage is placed and you will return to the waiting room while the tissue is processed. Tissue processing and mapping often takes 1-2 hours. If the surgeon sees cancerous cells under the microscope, the entire process is repeated.
Once the surgeon is certain that the entire tumor is removed, she will discuss with you what kind of reconstructive surgery, if any, is necessary. We may choose to (1) let the wound heal by itself, (2) repair the wound with stitches, or (3) close the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result. Once all surgery is completed, a bandage will be applied and wound care instructions will be provided. Follow-up appointments for wound checks or suture removal can be scheduled before you leave.
The most difficult part of the procedure is waiting for the results from our laboratory. Since we do not know in advance how much time is necessary to remove your skin cancer and repair the wound, plan to be in the office the entire day and make no other commitments.
What Can I Expect After the Surgery?
For most patients, wound care is simple and consists of daily cleansing of the wound with tap water, applying Vaseline with a clean Q-tip, and covering the wound with a bandage. Written wound care instructions will be provided the day of surgery. You will need to refrain from strenuous activity for 1-2 weeks following the surgery. Most patients can return to work the day after surgery, though you will have a bulky dressing in place. An appointment for follow up and suture removal, if necessary, will be scheduled.
Most people are concerned about pain. The majority of patients will experience very little pain after surgery. Extra strength Tylenol is recommended for pain and, if needed, a stronger pain reliever can be prescribed.
A small number of patients will experience some post-operative bleeding. It can usually be controlled by applying firm pressure to the wound. If bleeding persists, see your wound care instructions for further instructions.
Swelling and bruising
Swelling and bruising are common following Mohs surgery, especially around the eyes and mouth. Sometimes these can occur even up to 3 days following the procedure. Keeping the affected area elevated while lounging or sleeping can help minimize swelling. Compression stockings should be worn for at least one month after surgery on the lower legs.
Although every effort will be made to offer the best possible cosmetic result, any form of surgery will result in a scar. Mohs surgery removes as little normal tissue as possible, so scarring is minimized. The scar can be also be minimized by the proper care of your wound and avoiding smoking.
Complications after Mohs surgery are rare, but may include bleeding or infection. For any complications or questions following surgery, please review the written instruction sheet we provide you on the day of surgery.
For more information, please visit the American College of Mohs Surgery website.