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Mohs surgery has the highest cure rate of any skin cancer treatment. During the procedure, the Mohs surgeon examines skin tissue microscopically to create a detailed map of which cells are healthy, and which are cancerous. During each round of tissue removal, the surgeon will use the map to pinpoint and remove areas that still have cancer cells, while preserving as much healthy tissue as possible.
Mohs surgery is the gold standard for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), including those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for BCCs or SCCs that are large, aggressive or growing rapidly, that have indistinct edges, or have recurred after previous treatment.
How to prepare for Mohs Surgery
Preparing for Mohs surgery is similar to preparing for any other type of surgery, except that we do not use general anesthesia for this procedure. As such, we do not require that you refrain from eating 8 hours or more before the procedure. Before your Mohs surgery, you’ll want to remember to:
- Eat normally up to the time of your surgery.
- Try to get normal amounts of sleep so you are well-rested.
- Refrain from smoking at least one week before the procedure, if you are a smoker.
- Avoid taking any aspirin, ibuprofen, or naproxen.
- Refrain from drinking for at least 24 hours prior to your Mohs procedure.
On the day of your surgery, our staff will escort you to a surgical suite to review your current medications and answer any questions that you may have about the procedure. The doctor will then use a local anesthetic to numb the treatment area.
Once the area is numb, the surgeon will remove the visible cancer and a thin layer of healthy-looking skin surrounding it. The surgeon will take this tissue to the lab to examine and carefully map. A temporary bandage is placed over the wound.
The surgical removal usually takes only 10 – 15 minutes, but preparing and examining the tissue in the lab takes 45 – 60 minutes, possibly longer if the cancer is large. If the surgeon finds any remaining cancerous cells, they will repeat the procedure, reexamining each new tissue sample. Each patient is unique, but most cancers are completely removed in three layers or less.
For most patients, the entire procedure takes 3 – 4 hours. However, it’s impossible to predict exactly how much time our surgeons will need to remove the skin cancer and repair the wound. We ask that you plan for the possibility of being in our office for approximately 4 hours and refrain from making other commitments.
Your Mohs surgeon will review your aftercare instructions while you’re in our office and will send home written instructions with contact information that you can use for any follow-up questions. When you leave the office, you’ll have a large surgical dressing over the wound. The instructions provided explain how long the dressing should stay in place, most cases it is 24 hours but it can vary based on surgical closure.
It’s common for patients to experience bruising and swelling at the treatment site for a week or more. Resting will help keep swelling and bruising to a minimum for most patients. It’s important to avoid strenuous activity for around two weeks after your surgery unless your physician tells you otherwise. Performing exercises or activities that raise your heart rate and blood pressure can increase your chances of experiencing postoperative complications, such as bleeding or infections.
Mohs Surgery FAQ
Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery, layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. Mohs surgery is also known as Mohs micrographic surgery.
Mohs surgery removes as much skin cancer as possible while doing minimal damage to surrounding healthy tissue. It is usually done on an outpatient basis using a local anesthetic, so there is no need for general anesthesia.
The advantage of having Mohs surgery performed versus other surgical excision techniques is that there is minimal downtime and it can greatly minimize scarring while being performed on visible parts of the body. This is why Mohs is highly preferred for areas such as the face, legs, and arms.
Mohs surgery is an improvement to standard surgery (local excision), which involves removing the visible cancer and a small margin of healthy tissue all at once. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery. This increases the chance of a cure and reduces the need for additional treatments or additional surgery.