What to Expect: Day of Surgery

Mohs surgery is a minor surgical procedure, performed on an outpatient basis in our office.  You should be prepared to spend the entire day with us.  Eat a good breakfast, take your normal medications unless directed otherwise, wear comfortable clothing.  Plan to arrive for your appointment 15-30 minutes early in order to complete any registration and check in requirements. You will be escorted to a consultation room where you will be asked a few routine, pre-operative questions and have all your questions answered.  Once your questions are answered, your consent for the surgery will be obtained.

Once in the room, a local anesthetic (usually lidocaine) will be injected to the area. This is generally the only part of the surgery that causes any discomfort and it is usually no worse than what was done when the lesion was biopsied. Once the area is numb, a small layer of tissue will be removed and a map of it will be made. The small amount of bleeding that may occur will be stopped with a cautery unit and a dressing will be placed on your wound. The tissue will then be processed.

During this time, the tissue will be frozen, stained and cut for microscopic slides. Your doctor will then review these slides under the microscope and create a map of any tumor remaining. In this manner, the exact location of any residual tumor may be determined and then removed, without having to remove any of the skin that appeared normal under the microscope.

Although the area should still be numb from the first stage, a little more anesthetic agent is added to keep the area numb for further stages and the reconstruction. Using the microscopic "map" of the skin cancer, only the area or areas seen as cancerous are then removed. The process is repeated until the entire skin cancer is removed. It is this process of systematically searching out and removing all of the "roots" of the skin cancer that gives Mohs surgery its cure rate of 98-99%.

Although some skin cancers are removed in one stage, the average tumor requires two or three stages for removal and some require several more. If your skin cancer should require more than one stage, try not to get discouraged. The intent is to remove the entire skin cancer and to preserve any uninvolved normal skin. To achieve these goals, the tissue must be removed in very small, conservative layers.

 

When the tumor has been completely removed, a decision will be made with you as to the best method to repair the wound. Depending on the size and location of the wound, it may be allowed to heal by itself, closed with sutures, or closed using a flap or graft. Although most wounds are repaired in our surgical suite on the day of surgery, it is occasionally necessary to utilize the unique skills of other surgical specialists. In these cases, the reconstruction will be arranged shortly after your surgery.

To review:

  • Eat a good breakfast

  • Bring something to do 

  • Take your normal medication

  • Bring a snack/lunch (refrigerator available)

  • Wear comfortable clothing

  • Arrive 15 - 30 minutes early

 

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