Mohs Surgery

Mohs Surgery Q&A

What is Mohs Skin Cancer Surgery:

For more information and a visual explanation, please visit: www.mohs.org

Mohs Surgery is a surgical technique which removes skin cancer in its entirety while preserving the surrounding normal tissue. Your surgeon will start by surgically removing the visible tissue portion of the tumor. While you wait, the tissue is taken to the lab, processed by a technician that day, and evaluated by the Mohs surgeon under the microscope; this process can take up to 45-90 minutes for each later of tissue that is taken. 100% of the edges are visualized – which is why it is the most effective treatment for skin cancers! If the surgeon sees any of the tumor left, she will sparingly remove additional tissue where the cancer remains while leaving the normal tissue alone. This will continue until the cancer is completely removed.

Once the tumor is removed, the surgeon will repair the area damaged by the skin cancer. This can be done by closing the skin directly in a straight line, rearranging the skin around it (flap), or with skin taken from another area (a graft); almost all techniques involve sutures. Alternatively, small/shallow wounds or those on the leg are frequently allowed to heal on their own (second intention). Occasionally your reconstruction may be performed by another surgeon who is also trained in reconstruction. All surgical removals of cancer will result in a scar, the goal is to make is aesthetically pleasing as possible.

 

What to keep in mind when scheduling Mohs Surgery:

• Plan to be at the office 4-8 hours. Each tumor is different and more complex cases take additional time. We recommend you do not schedule other meetings or appointments the same day as your Mohs surgery.
• If you have an artificial joint placed within the last 2 years or an artificial heart valve that requires premedication prior to dentist visits, please let us know right away. Antibiotics may be sent in to your pharmacy before your procedure date or we may send in antibiotics after your procedure.
• Choose a day where you will be able to stay in town for at least 2 weeks after the procedure so that we can address suture removals, wound checks and any complications such as infection or bleeding.
• Select a day where you will be able to refrain from ANY physical activity for AT LEAST 2 weeks (including but not limited to golf, yoga/bending, weight lifting, power-walking, hiking, etc) or exposure to standing water (baths, pools, lakes, etc)
• You will most likely have swelling and/or bruising around the surgical site (possibly even a black eye) which may impact your desire to attend social functions or participate on any zoom calls. Also need to keep the surgical site free of make-up and covered with a bandage for at least 7-14 days so please plan accordingly.
• If your surgery is around/near your eye, please arrange for somebody to drive you to/from the procedure and bandages/swelling any impair your ability to drive safely.

 

How to prepare for Mohs Surgery:

Following these instructions will directly impact your surgical procedure, the risk for post-operative complications, and your healing/scarring outcome.

• STOP SMOKING – This will negatively impact all aspects of healing/scarring.
• Two weeks (14 days) prior to surgery:
  • Avoid taking any NSAIDS (Bayer/aspirin, Motrin/Ibuprofen, Aleve/naproxen, Excedrin, Midol), unless prescribed by your primary care doctor or cardiologist. Tylenol is okay to take.
  • Stop all herbal/homeopathic supplements (especially Vit E, garlic, ginger, ginko, ginsent, kava, etc.)
  • DO NOT STOP any of your prescribed medications such as Coumadin/warfarin, Plavix, Aggrenox, Eliquix, Xarelto.
• Two (2) days prior to surgery:
  • Avoid alcohol – it thins the blood and increases bleeding/bruising which increases pain
• The day of surgery: Again plan to spend the entire day with us.
  • Bathe the morning of surgery (you will need to keep the surgical site dry for 24-48 hours after)
  • Eat a good breakfast or lunch prior – YOU DO NOT NEED TO FAST PRIOR TO SURGERY
  • Take all your prescribed medications
  • If your surgery is on the face, do no wear make-up (especially on the area to be treated)
  • Wear comfortable, layered clothing (our office can be quite chilly)
  • If you are ill the day of surgery (cough, fever, chills, etc) please call to reschedule.
  • Arrive 15-20 minutes prior to your appointment time for the appropriate check in.
• What to pack/bring with:
  • If you are diabetic or have PRN medications, please bring them with you (i.e. insulin)
  • A snack or beverage (as mentioned above, the procedure can be up to several hours)
  • Cases for hearing aides or glasses (we frequently ask you to remove them)
  • Entertainment (books, magazines, movies, tablets/ipads, work, etc.) And, as stated above, the day can take several hours (most of it will be spent waiting)

 

You will be given a list of post-operative instructions on the day of surgery.