Mohs Surgery

MohsWhat is Mohs Surgery?

Developed by Dr. Frederic Mohs, Mohs Surgery is a highly effective technique for treating skin cancer in cosmetically and functionally sensitive areas, such as the face.

This technique is different from other methods in that the surgeon uses a detailed mapping technique and microscopic examination during the procedure to ensure complete removal of cancerous cells.

After local anesthesia, visible cancerous tissues and a very thin layer of healthy-appearing skin is removed. This specimen is prepared as a frozen section and microscopically examined by the doctor for evidence of remaining cancer cells at the margins. This step may be repeated as many times as needed to ensure that the cancer is completely excised.

What happens on the day of surgery?

Once you arrive, a member of our staff will escort you to the surgical suite, where the doctor will identify the surgical site and a medical assistant will numb the area around the cancerous tissue. After that, the visible cancer and a thin layer of tissue will be excised. The surgeon will then carefully map and code the tissue. The tissue specimen will then be processed by the laboratory technician on microscope slides for examination by the physician. A temporary bandage will be placed on the wound. You will then return to the waiting area while the slides are examined and it is determined if the cancer is completely removed or if another layer is necessary. It takes a minimum of 45 minutes to prepare the slides for examination after each surgical layer. This step may be repeated as many times as needed to ensure that the cancer is completely excised. Once the cancer is completely removed, the doctor will surgically repair and bandage the wound. This may take an additional 30-90 minutes.

Will I have to stay overnight in the hospital?

Mohs Surgery is an outpatient procedure performed in the office at Dermatology Associates of Coastal Carolina.

What are the benefits of Mohs Surgery?

The detailed mapping technique and microscope allows the surgeon to precisely identify cancerous areas that are not visible to the naked eye. As a result, the smallest roots of cancerous tissue can be excised, while removing the least amount of non-cancerous skin as possible. The goal with this procedure is to completely remove the cancerous cells, minimize the amount of healthy tissue removed and maximize the cosmetic results.

Will I have a scar?

There will be a scar after any surgical treatment for skin cancer. Mohs surgery minimizes the scar by removing a minimal amount of healthy skin. You may have a scar that is larger than anticipated for a small spot of cancer because proper wound closure for the best cosmetic results may require the removal of additional tissue. Your doctor will decide the safest method of wound closure that will provide the best cosmetic effect. Closure methods may involve skin grafts, skin flaps, suturing or allowing the wound to heal by itself. Complicated wounds involving sites such as the eyelids, may be referred to other specialists for reconstruction.

What are my chances for recovery?

For previously untreated skin cancers, the cure rate using Mohs Surgery is up to 99 percent.

Is there a possibility I could be diagnosed with skin cancer again?

Statistically speaking, patients who have had a skin cancer have a 40 percent chance of developing another new skin cancer within three years. It is very important that you follow your doctor's recommendations for follow-up examinations.

Will I need a follow-up appointment?

Your follow-up appointment will be within one to four weeks. We will schedule this for you so that we can examine the wound and remove stitches if necessary.

How can I protect myself from developing more skin cancer?

You can prevent further sun damage by:

  • Avoiding the mid-day sun (between 10 a.m. and 4 p.m.)
  • Wearing a hat and protective clothing.
  • Using a sun block with an SPF of 30 daily and reapply every 2 hours when outdoors.

Pre-Operative Instructions

If you notice a significant increase in the size of the skin cancer between the time we see you and the scheduled date for surgery, we advise you that it is your responsibility to notify the office so we may re-evaluate the area.

There are several things you must do to prepare for your scheduled excision.

  1. On the morning of surgery:
    1. Eat a light breakfast (and lunch if surgery is in the afternoon). You may wish to bring a snack or lunch in case your procedure involves multiple layers. This can take several hours.
    2. Take the daily medications prescribed by your physician(s). Avoid aspirin and products that contain aspirin or ibuprofen since these can prolong bleeding.
    3. Wear loose fitting attire that is comfortable, but do not wear clothing that you must pull over your head, as this may interfere with the post-operative bandaging. You may wish to bring a sweater or jacket for comfort while waiting in the clinic.
    4. If surgery involves your face, please do not wear any cosmetic makeup.
    5. Be sure to shower and shampoo prior to surgery. Your wound and dressing must remain dry for 24 hours following the procedure.
    6. Arrive 15 minutes before your scheduled surgery time.
  2. If you take a blood thinner like Coumadin, please let your doctor or a staff member know on the day of your surgery. DO NOT STOP COUMADIN ON YOUR OWN!
  3. Avoid alcohol 48 hours before surgery.
  4. After the surgery is complete, we will thoroughly review wound care instructions with you. Remember your bandage and stitches must remain dry for 24 hours. Bruising and swelling may occur around the stitches and may remain for a week or more.
  5. We may have to remove your stitches within one to three weeks. Your physician will determine the appropriate time. We will schedule an appointment before you leave the clinic.
  6. If you need to reschedule, please inform us as soon as possible by calling (252) 633-4461. Thank you.