Mohs Surgery

Mohs surgery is an advanced treatment method, widely considered the most effective treatment for many types of skin cancer. It is both tissue-sparing, removing the least amount of normal tissue, and has the lowest recurrence rate for most types of skin cancer, therefore being the most effective treatment available. We provide excellence in Mohs surgery to all of our patients.

The area to be treated is injected with local anesthesia, like when the biopsy was performed. The visible skin cancer is removed with a small margin and taken into the laboratory in the office.  The tissue is processed in the lab on site. The doctor looks at the tissue under the microscope to see if there is any cancer left at the bottom or edges. If so, more tissue will be removed in a second layer, or stage, but only from those areas where there is still cancer remaining. This next section will also be analyzed in the lab. This process will be repeated until all cancer has been removed. It usually is one or two stages, or layers, but may sometimes require more.

Once the skin cancer has been removed, the doctor will review the options for healing. Most commonly, the wound is closed with stitches that same day. Most often, the wound is closed into a line of stitches. Sometimes, some nearby skin may need to be moved to help close the wound, which is called a skin flap. Other times, skin may need to be moved from a more distant site, which is a skin graft. The doctor can safely perform all these in the office. Sometimes, we allow the wound to heal on its own. It sometimes takes a long time, but may be a preferred option for some patients in select circumstances.

Patients should plan on being in the office for up to three to four hours. It may rarely be longer. They should have breakfast or lunch before coming, take their medication as usual, bring a book or electronic device for entertainment, and bring a sweater or sweatshirt in case they get cold. The risks of the surgery are small, including bleeding, low risk of infection, 1-3% recurrence of the cancer, and a thin scar. We recommend all Mohs patients to have a driver if the surgery will be performed on the face. There will likely be a bulky bandage on the area that may obstruct or partially obstruct vision for driving.

There will be a pressure bandage on the site.  It can generally be removed 48 hours after surgery. There is often little required wound care after that. Showering is fine after the pressure bandage has been removed. Activity like vigorous exercise, tennis, or golf may be limited during that time until stitches come out.  In addition, there can be no underwater submersion until the stitches have been removed.  This means no swimming or baths until then.  If there are special concerns or considerations, they can be reviewed the day of surgery.

The recovery process for Mohs surgery can vary depending on the extent of surgery performed. For most patients, wounds closed with sutures heal in about one week. For some patients, it can take 1-2 months for the treatment area to heal completely, and rarely longer. Fortunately, recovery from Mohs surgery is not often painful. You may expect some swelling and bruising in the treatment area, and most discomfort can usually be effectively managed with over the counter pain medications like acetaminophen or ibuprofen.