Specialties & Services  >  Dermatology

MOHS surgery is designed to remove cancers by tracking down and removing cancerous roots that are not seen on the surface. Some skin cancers are deceptively large, being far bigger under the skin than they appear to the eye. These cancers may send out roots in the skin or along blood vessels, nerves, or cartilage. Also, skin cancer that has grown back after previous treatments may send out extensions deep under the scar tissue that has formed. By removing cancerous roots, Mohs surgery is clearly the most complete and effective treatment for these types of cancers.

There are three steps to the procedure:

A local anesthetic completely numbs the skin and the visible cancer is removed. This procedure only takes a few minutes, and then the patient rests comfortably with a light dressing applied to the area. A detailed diagram of the removed specimen, called a Mohs map, is drawn. The specimen is carefully divided and color-coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on microscope slides and stained for examination under the microscope. These slides are carefully studies under the microscope and the entire surgical margin of the removed tissue is examined. This means the compete undersurface and edge of the specimen are examined and all microscopic roots of the cancer are identified and pinpointed on the Mohs map.

If cancer is found at the tissue margins of the microscopic slides, she then uses the Mohs map as a guide for removal of additional tissue from the patient only where cancer is present. Because there is no guesswork involved in deciding where to remove additional tissue, only tissue around the roots and extension of the cancer is removed. Therefore, this technique leaves the smallest possible surgical defect or final scar.

If you are on medications such as “blood thinners” like coumadin or aspirin for heart disease or stroke prevention, we will ask you to check with your cardiologist or internist as to whether you can temporarily stop taking them prior to surgery. Supplemental Vitamin E should be avoided beginning three days prior to surgery. Other medications are to be taken as you normally would. If you have a question about any regular medication you are taking, please don’t hesitate to ask us for instructions. Additionally, alcoholic beverages should be avoided seven days prior to surgery.

For certain medical conditions, you may require pre-operative and post-operative antibiotics. Often, you will know this because your primary physician may have discussed this with you on previous occasions. If you are needing these medications, please let us know during your initial visit.

- It is advisable to bathe or shower and wash your hair the evening before or the day of the surgery, especially since you will need to keep the wound dry after the procedure.

- You will also be spending considerable time in the office. Plan on eating a light meal before surgery and remember to bring reading materials to occupy your time while waiting for the results of the post-surgical tissue examination. If the tissue needs to be removed and examined in multiple stages, you may be staying through the lunch hour. Pack a few snacks and a lunch in case you get hungry.

- After the skin cancer is removed, we will plan to repair the surgical wound to best preserve function and aesthetic appearance. This reconstructive portion of the procedure may take between 45 to 60 minutes.

- It is a good idea to bring someone with you to drive or accompany you home.

Following surgery, you will receive specific instructions on how to care for your wound. Sometimes a wound can itch as healing occurs, and you may notice tightness from the tissue contracting, but this subsides over time. Redness may take 6 to 18 months to fade. Normal skin sensations gradually return. Exercising post surgery is restricted for several days to a few weeks, but due to individual differences, you will receive written instructions prior to leaving the office.

Most patients do not complain of significant pain. If there is discomfort, extra strength Tylenol is usually all that is necessary for relief. However, if the stronger pain medication is needed, it will be prescribed. There may be some bruising or swelling around the wound, especially if surgery is done close to the eyes. It helps to sleep with your head elevated during the first few days following surgery.

The sutures used during surgery will often require a follow-up visit to remove them. This will be scheduled one to two weeks after surgery. A site check is recommended in 3 to 6 months, followed by regular screenings. A five year follow-up period of observation is recommended. If the cancer reoccurs, it usually happens within the first year after surgery. Once the wound is completely healed, follow-up at least twice a year with your referring physician for examination. If you notice any new irregularities or detect a new lesion, contact our office as soon as possible.

Most cases can be completed in three or fewer stages; this often takes 3 to 4 hours. However, no one can predict how extensive the giving cancer is because the size of the skin cancers route cannot be estimated in advance; therefore you should plan nothing else for the day of surgery.

Yes. Any form of surgery leaves a scar; however, one of the advantages of Mohs surgery is that it leaves one of the smallest possible surgical defects, and therefore a smaller final scar. Dr. Bradley has a special interest in aesthetic repair and use the latest and surgical technique to repair the defect in the cosmetic fashion.

Normally suture removal is in one to two weeks. During this time normal daily activities such as walking and driving are allowed. Heavy exercise in strenuous activities during this time should be strictly avoided, as it may lead to complications and increased risk of scarring.