Learn about the experience most common for patients undergoing Mohs surgery.
The consultation with your dermatologist will verify if you do have skin cancer and the need to have it removed. If the skin cancer is caught in the early stages, your doctor will most likely recommend having a surgical procedure performed in his office. A convenient appointment will be scheduled for you. It is imperative that you do not schedule any other activities for that date.
Prior to your surgery, you may be asked to discontinue some medications that may interfere with blood clotting. Any blood thinners, such as Plavix or Coumadin, or supplements, such as Vitamin E or ginkgo, need to be stopped until after surgery. Otherwise, you may continue your regular medications. Learn more about surgery preparation here.
Depending on the size and location of the affected area, there are different surgical procedures available. 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.
The procedure will be performed in the doctor’s office. Do not schedule anything else on this day as it may take up to four hours, sometimes longer, to perform the procedure. Prior to your appointment, the doctor may suggest bringing something to eat for a snack.
You will want to wear comfortable clothes. Your doctor may allow you to keep your own clothes on during the procedure or possibly use a hospital gown. You will be taken to the surgical area and made comfortable.
The doctor and/or assistant will clean the area around the skin cancer. The doctor will 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 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.
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.
Regardless of which surgical procedure is selected, and which closure method is used, there will be a scar formed at the site of the cancer removal. Your doctor is a trained professional and will use care in closing the wound to ensure the least amount of scarring.
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.
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