A Day with Advanced Dermasurgery Associates

March 25, 2019
By: Dr. Posten

Learn about the experience most common for patients undergoing Mohs surgery.

The thought of surgery can be stressful for some, and we want every patient to feel as comfortable and informed about the process as possible. In an effort to educate those and the families of those receiving treatment we’ll discuss what a typical experience looks like for an average patient.

You will want to wear comfortable clothes. Your doctor may allow you to keep your own clothes on during the procedure but in some cases a hospital gown may be better suited for the area and will be provided. You will be taken to the surgical area and made comfortable.

Prior to your surgery, you may be asked to discontinue some medications that may interfere with blood clotting. See surgery preparation guidelines for more information.

The procedure will be performed in the doctor’s office. Do not schedule anything else on this day as it generally takes up to four hours, sometimes longer, to perform the procedure. For this reason, it is imperative that you do not schedule any other activities for that date. The doctor may suggest bringing something to eat for a snack.

Depending on the size and location of the affected area, there are different surgical procedures available. The method used is determined on a case by case basis. A simple excision can remove a relatively small skin cancer. Curettage and electrodesiccation (scraping and burning) can remove small basal cell and squamous cell cancers. Cryosurgery (freezing) is another alternative method. If the skin cancer is a significant size, it may be necessary to perform Mohs Surgery. This method is the most effective and least scarring procedure available.

If Mohs surgery is necessary, the doctor and/or assistant will begin by cleaning the area around the skin cancer. The doctor will then inject a local anesthetic. You will be awake during the entire procedure. After the area is prepped properly, the doctor will cut away a section of skin tissue to remove the skin cancer. This will take about 20 minutes to perform. The tissue will then be frozen and prepared into slides. This may take about an hour to prepare. The doctor will review the slides under a microscope. If the tissue slides show that not all the cancer was removed, the entire procedure will be repeated until all the tissue edges are free from cancer cells and the skin cancer has been successfully removed.

After Mohs Surgery

After the surgical procedure, the open wound may be small enough to heal on its own. Sutures may be used to close the wound until healing is complete. If the wound is large, a skin flap can be used. This involves taking skin from an adjacent area and bringing it around to close the wound. A skin graft involves removing skin from another area, possibly from behind the ear, or near the shoulder, to cover the open wound. If the wound is too large for the doctor to close, you would be referred to a plastic surgeon to perform reconstructive surgery. In this instance, arrangements would most likely be made in advance to coordinate the surgeries.

Your doctor is a trained professional and will use care in closing the wound to ensure the least amount of scarring. Regardless of which surgical procedure is selected, and which closure method is used, there will be some scarring at the site of the cancer removal.

Healing and wound care will be explained in depth to you following Mohs Surgery. In general, wounds tend to heal better when covered with ointment and a bandage. We usually recommend the use of plain Vaseline as a covering ointment to be applied 1-2 times per day.

It is common to experience mild pain for several days following the Mohs Surgery procedure. Usually over-the-counter Tylenol (acetaminophen) taken at recommended doses is enough to relieve the pain. If you are still having pain, please contact our office so we can evaluate your symptoms.

It is also common to feel fatigue for 1-2 days following Mohs Surgery and most people elect to rest and not work during this time.

Look for signs of infection including tenderness, warmth, fever, and pus at the wound site. If you notice these or other signs, please contact our office immediately.

Your doctor will follow you in the weeks and months after your procedure. He will make sure you are healing properly and without complication. You must also be vigilant and have examinations for future episodes of skin cancer, as you can have a recurrence or new skin cancers occur.

It is important to make an appointment and see your referring dermatologist or physician for a complete skin check 3-6 months after completion of the Mohs Surgery. Regular skin surveillance is critical for early detection and prevention of skin cancer.

Still have questions? Contact your local, Advanced Dermasurgery Associates location today!