Developed in the 1930's by Dr. Frederic Mohs, Mohs surgery is a skin cancer removal technique that offers patients the most precise and efficient way to remove a variety of skin cancer types.
Further refined over the past several decades, the Mohs technique has become the most effective treatment for most skin cancers with cure rates up to 99%. These impressive cure rates are accomplished with a layer-by-layer removal process that utilizes microscopic examination of 100% of the surgical margins to ensure that the entire tumor is removed while sacrificing as little normal skin as possible.
On the day of surgery, the tissue is examined under the microscope after each stage of the procedure by the surgeon while you wait. Once the surgeon confirms with the microscope that all of the tumor cells are removed, different options for closing the wound are discussed.
Using this technique, the surgical removal, pathologic interpretation and reconstruction are all accomplished in one visit, making this technique both convenient and cost-effective.
For more information about Mohs Micrographic Surgery and the importance of choosing a fellowship-trained Mohs surgeon, please visit the American College of Mohs Surgery.
On the Day of Your Surgery
- It is suggested to have someone accompany you. Depending on the location of your tumor, there may be a large bandage that may interfere with driving home. Also, post-operative wound care in many instances must be performed by someone other than the patient. It is best that this person directly receives the wound care instructions from the nurse or doctor immediately following surgery.
- Shower the night before or the morning of your surgical appointment with antibacterial soap. Wash the site of your skin cancer.
- Eat breakfast.
- Take your daily medications as usual on the morning of your surgery. This includes blood pressure medications and prescription blood thinning medications.
- Plan to arrive 15 minutes prior to your appointment time.
- Bring with you:
- Reading materials and snacks
- Detailed list of all medications you are taking
- Insurance card & photo ID
- If you are on oxygen, please bring an extra tank
Frequently Asked Questions
Appointments for surgery are usually scheduled early in the day to allow us to finish that same day. You will be placed on the examining room table, and the area around your skin cancer will be anesthetized (numbed) with a local anesthetic. This step may be slightly uncomfortable for a few seconds, but usually this is the only discomfort you will experience during the procedure. Once the area is numbed, a thin layer of tissue is removed surgically and the bleeding can be controlled. The tissue will be mapped, color-coded and sent to the on-site Mohs laboratory to be processed into frozen-section microscopic slides.
A pressure dressing is applied, and you will be escorted back to the reception area. On average it takes an hour for the slides to be prepared and studied. For this reason, it is often a good idea to bring some reading material and snacks.
The surgeon then examines the processed tissue under the microscope. If tumor is present in the specimen, the Mohs surgeon marks its location on the map and then returns to the patient and removes more tissue in that area. This step is repeated, if necessary, until the tumor is completely removed.
After the tumor is removed, you will have a surgical wound. This wound will be dealt with in one of several ways. Your surgeon will discuss with you the options that will provide the best results. The possibilities include:
- Direct closure of the wound: in most cases, surgical wounds are sutured (sewn) closed. The procedure speeds healing and can offer a good cosmetic result. The size of the scar depends on the size of the tumor. The sutures will remain in place for 7-14 days. While the sutures are in place, there will be daily wound care and restrictions from activities that might pull on the sutures. The nursing personnel will teach you how to change the dressings daily and provide you with printed instructions.
- Skin graft: Occasionally it is necessary to remove skin from behind the ear or some other site to patch the wound.
- Second intention healing: The body has an excellent capacity to heal open wounds. This healing period is approximately four to eight weeks depending on the size of the wound. It requires regular wound care.
Please continue all prescribed blood thinning medications unless a doctor has specifically instructed you to hold them. For the most part, there is no need to discontinue prescription blood thinning medications prior to skin surgery. If you are on Coumadin/warfarin, you will need to have an INR checked no more than 1 week prior to your surgery day. If you are taking over-the-counter (OTC) supplements that thin the blood and a physician has not specifically prescribed or instructed you to take these, please consider stopping these 1 week before the procedure. Common OTC supplements that can thin the blood include:
- NSAID drugs (e.g. ibuprofen a.k.a Aleve and Motrin)
- Fish oil/Krill oil
- Vitamin C
- Vitamin E
- Gingko biloba