If you would feel more comfortable meeting our physicians and our staff, we welcome the opportunity for a preoperative consultation. However, if you feel comfortable with the explanation provided by this website and your referring doctor, feel free to schedule your surgery directly. If you take Coumadin or blood pressure medications or if you normally take an antibiotic prior to dental work, please bring this to our attention so that there is no delay in your surgery.
Before Mohs Micrographic Surgery
Be well rested and eat a good breakfast, unless directed otherwise. Take your usual medications, unless directed otherwise. Please do not take Ibuprofen (Motrin, Advil, etc.,) or Vitamin E supplements. These medications may "thin" your blood and cause more bleeding. You may substitute acetaminophen (Tylenol) if required. Do not drink any alcoholic beverages for 24 hours before surgery.
The Day of Mohs Surgery
Appointments for surgery are scheduled in the morning and early afternoon. It is a good idea to wear loose fitting clothing and avoid "pullover" clothing. Tylenol may be taken before surgery in order to reduce discomfort. Also, if the operative site is on the face, please do not wear make-up on or around the area and do not use any fragrance or scented toiletries. We will obtain your written consent for the procedure, photographs will be taken, and your blood pressure will be recorded. If you have any additional questions, please feel free to ask them at this time.
The area surrounding the skin cancer will be cleansed with an anti-bacterial soap. The doctor will then anesthetize (numb) the area of skin containing the cancer by a small local injection. This injection will probably be similiar to the one you received for your biopsy. We will be as gentle as we can when administering this. It usually takes 15 minutes to anesthetize the area and remove the tissue. After the tissue has been removed, it will be processed in our office laboratory.
Depending upon the amount of tissue removed, processing usually takes an additional 30-60 minutes. Your wound will be bandaged, and you will move to the waiting room while the tissue is processed, stained, and examined by the doctor. If the microscopic examination of the removed tissue reveals the presence of additional tumor, we will go back and remove more tissue. The Mohs technique allows us to precisely map out where the roots of the cancer remain. Most skin cancers are removed in 1-3 surgical stages.
After the skin cancer has been completely removed, a decision is made on the best method for treating the wound created by the surgery. These methods include letting the wound heal by itself, closing the wound in a side to side fashion with stitches, closing the wound with a skin graft or a flap. The best method is determined on an individual basis after the final defect is known. Rarely, other surgical specialists may be utilized for their unique skills if warranted. This is the rare exception rather than the rule as nearly all wound repairs are performed immediately.
After Mohs Micrographic Surgery
Your surgical wound will likely require care during the weeks following surgery. Bruising and swelling, for up to a week, is common after surgery. Detailed written instructions will be provided. Plan to return to our office in 5-7 days. You should also plan on wearing a bandage and avoiding strenuous physical activity for a week.
Most of our patients report minimal pain which responds readily to Tylenol. You may experience a sensation of tightness across the area of surgery. Skin cancers frequently involve nerves and months may pass before your skin sensation returns to normal. In rare instances, the numbness may be permanent. You may also experience itching after your wound has healed. Complete healing of the surgical scar takes place over 12-18 months. Especially during the first few months, the site may feel "thick," swollen, or lumpy, and there may be some redness. A gentle massage of the area (starting no sooner than 1 month after the surgery) will speed the healing process.
An indefinite follow-up period of observation is necessary after the wound has healed. You may be asked to return to ensure proper healing. Studies have shown that once you develop skin cancer, there is a strong possibility of developing other skin cancers in the future. Should you notice any suspicious areas, it is best to check with your dermatologist for a complete evaluation. You will be reminded to return to your dermatologist on a frequent basis for continued surveillance of your skin.
Risks of Mohs Micrographic Surgery
Because each patient is unique, it is impossible to discuss all the possible complications and risks in this format. The usual risks are discussed below. Our doctors will discuss any additional problems associated with your particular case. Please understand that these occurrences are the exception and not the rule.
- The defect created by the removal of the skin cancer may be larger than anticipated. There is no way to predict prior to surgery the exact size of the final defect.
- There will be a scar at the site of the removal. We will make every effort to obtain optimal cosmetic results, but our primary goal is to remove the entire tumor. Again, Mohs surgery will leave you with the smallest wound thus creating the best opportunity for optimal cosmetic results.
- There may be poor wound healing. At times, despite our best efforts, for various reasons (such as bleeding, poor physical condition, smoking, diabetes, or other diseases), healing is slow or the wound may reopen. Flaps and grafts utilized to repair the defect may at times fail. Under these circumstances, the wound will usually be left to heal on its own. The scar may be revised at a later date if necessary.
- There may be a loss of motor (muscle) or sensory (feeling) nerve function. Rarely, the tumor invades nerve fibers. When this is the case, the nerves must be removed along with the tumor. Prior to your surgery, the doctor will discuss with you any major nerves which might be near your tumor.
- The tumor may involve an important structure. Many are near or on vital structures such as the eyelids, nose, or lips. If the tumor involves these structures, portions of them may have to be removed with resulting cosmetic or functional deformities. Furthermore, repairing the resulting defect may involve some of these structures.
- Rarely, wounds become infected (fewer than 1%) and require antibiotic treatment. If you are at particular risk for infection, you may be given an antibiotic during surgery.
- There may be excessive bleeding from the wound. Such bleeding can usually be controlled during surgery. There may also be bleeding after surgery. We have never had a significant amount of blood loss, but bleeding into a sutured graft or flap may inhibit good wound healing.
- There may be an adverse reaction to medications used. We will carefully screen you for any history of problems with medications; however, new reactions to medications can occur.
- There is a small chance that your tumor may regrow after surgery. Previously treated tumors and large, longstanding tumors have the greatest chance for recurrence.