What is Mohs Surgery?
Mohs surgery is a highly specialized treatment for the total removal of skin cancer. Mohs surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique. This method differs from all other methods of treating skin cancer by the use of complete microscopic examination of all of the tissues removed surgically as well as the detailed mapping techniques to allow the surgeon to remove every cancer cell.

What are the advantages of Mohs surgery?
By using these detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The results are 1)the removal of as little normal skin as possible, and 2)the highest possibility for curing the cancer.

What are my chances of cure?
Using Mohs surgery, the percentage of cure is more than 99% for many skin cancers, even when other forms of treatment have failed. Other methods of treatment may offer only a 50% chance of success if previous treatments have failed.

Will I be hospitalized?
No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day. Hospital facilities are available, but rarely necessary.

What happens the day of surgery?
Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite when the surgeon will numb the area around the skin cancer. Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the surgeon and taken to the adjacent laboratory where the technician will immediately process the microscope slides. You will have a temporary dressing placed over the wound and you will be free to return to the waiting room.

The surgical procedure alone takes only 10-15 minutes. However, it takes a minimum of 1-2 hours to prepare and microscopically examine the tissues.. Several surgical stages and microscopic examinations may be required, and you will be asked to wait in the patient waiting area between stages. Although there is no way to predict before surgery how many stages will be necessary, most cancers are removed in 3 stages or less.

You may want to bring reading material to occupy your time while waiting for the microscope slides to be processed and examined. Magazines and beverages will be available in the waiting room area. If your visit extends through the lunch hour, your companion may leave to bring you a snack or lunch. You are asked not to leave the waiting room of our office until all surgical procedures are completed.

The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be in the office essentially the entire day and that you make no other commitments.

Will the surgery leave a scar?
Yes. Any form of treatment will leave a scar. Because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose 1) to leave the wound to heal itself, 2) to repair the wound with stitches, or 3) to reconstruct the area with a skin graft or flap. The decision is based on the safest method that will provide the best cosmetic result.

Will I have pain after the surgery?
If there is any discomfort, Tylenol is all that is usually necessary for relief. A prescription for a stronger pain medication will be written if necessary.

Will I have a bandage?
Yes. Most patients can expect some sort of bandage to be necessary for a week. We will provide detailed wound care instructions.

Will my insurance cover the cost?
We accept assignment on Medicare policies. We will also submit a claim to any other insurance company for you. Expenses not covered include insurance deductibles and co-pay amounts. Please remember that your insurance is a contract between you and your insurance company, and some plans may have limited benefits (e.g., hospitalization-only coverage). Please check with your insurance company to see if pre-authorization is required. (This is not necessary if you are covered by Medicare.) 
We do not want anyone to be denied necessary medical care because of an inability to pay. If you have difficulties understanding or paying your bill, we encourage you to discuss your problem with the business office staff.

PREPARING FOR SURGERY

Medications: One to two weeks before surgery: stop taking ANY aspirin or over the counter pain medication products except Tylenol (acetominophen). Aspirin and other products such as ibuprofen (Advil) act as blood thinners and increase bleeding.

Also discontinue ANY vitamin or herbal supplements as certain products will increase bleeding or bruising. Vitamin E, ginko, garlic and other products have been shown to increase risk of bleeding complications. The ideal time to discontinue many of these supplements before surgery is not known. We would like to err on the side of caution, and suggest that you discontinue supplements 1 to 2 weeks before your surgery.

If you are taking blood thinners (Coumadin): We would like for you to discontinue your Coumadin a few days before surgery, but please check with your prescribing physician first.

Continue any other medications prescribed by your doctor.

Avoid alcoholic beverages for 24 hours before surgery because alcohol can also increase bleeding.

Stop smoking! Smoking will increase your risk of complications from surgery. Smoking can also interfere with normal wound healing and we want you to recover as quickly as possible. 

SCHEDULING: 

You will be seen for a consultation before your surgery. Some insurance plans and Medicare will allow your consultation to be performed on the same day as your surgery. We do start all surgeries early in the morning as we do not know how long the entire procedure will take. 

Transportation: If you feel that you may be anxious during your procedure, we can provide you with a medication to help you relax. If you are given a relaxant, however, you will not be allowed to drive yourself home. We encourage you to bring a companion along, or to have someone available to pick you up after surgery. If someone does come with you to your appointment, please restrict yourself to 1 or 2 companions, as we have limited seating in the waiting room. 

THE MORNING OF SURGERY:

Breakfast: eat your normal breakfast.

Please do not wear makeup, nail polish, or jewelry if it will cover the surgical site. (Women with cancer anywhere on the face, ear or neck should not wear makeup the day of surgery.)Also avoid using moisturizers on the surgical area the day of surgery.

Take your usual medications except any blood thinners, herbs, or vitamins as mentioned above.

Be prompt: Plan to arrive 15 minutes early if you have not already filled out our medical history form prior to your surgery.


ADDITIONAL INFORMATION:

Try these web sites on the internet:

www.mohscollege.org
www.asds-net.org
www.aad.org

FOR PATIENTS WITH A DIAGNOSIS OF MELANOMA OR LENTIGO MALIGNA:

Your diagnosis makes it desirable for us to use “permanent” section processing which takes 10-14 hours to process. We will remove the first layer exactly as described, but you will go home immediately thereafter. You will need to return the next morning to find out the results of the pathology. At that time we will know whether there are any “roots” left and if we have to take an additional layer of tissue. Once the margins are clear, we will be able to do whatever is necessary to repair the wound.. Therefore, you will need to plan on at least two (and possibly more) visits on sequential days for this type of cancer.