The Mohs Surgery Procedure: What to Expect

Upon arrival at Dermatology Consultants, the patient checks in as he/she would for a regular appointment. The patient is then called back by the nurse/assistant. Medical information is reviewed, photographs are taken of the site, vital signs are obtained, the consent form is signed, and the local anesthesia is administered. This is similar to the type of local anesthetic that the patient experienced at the time of his/her original biopsy. The area is then cleansed with a surgical wash. The first stage begins, and the Mohs surgeon then removes the first layer of tissue. Some blood vessels may require cauterization to prevent excessive bleeding. A pressure dressing is then applied to the site, and the patient is taken back to the waiting room.

While the patient waits, the tissue is processed, mounted on to slides, and reviewed by the physician under the microscope. Differentiating between normal skin cells and the skin cancer cells, the physician can assess the slides to determine if the margins are clear of any skin cancer. If the margins still show skin cancer cells, the patient is brought back to begin the second stage. The area is reinforced with local anesthesia, and the process is repeated, where a layer is taken at the affected margin. A dressing is re-applied, and the patient is taken back to the waiting area. These stages are repeated until all of the margins are free and clear of any skin cancer cells. On average, most skin cancers require one to two stages to be removed completely. If a skin cancer has been present for a long time, multiple stages may be necessary to treat the skin cancer in full. The number of stages required to remove all of the skin cancer determines the length of stay that the patient will have at the office. The average stay of most patients is 4 to 6 hours.

Once all of the margins are clear, the surgeon then discusses with the patient potential options for repair of the wound area so that the patient will have the best cosmetic outcome. In some cases, allowing the area to heal on its own may give the patient the best results. A linear closure or a skin flap may be the recommended treatment of choice. Sometimes a skin graft may be necessary to repair the area, which may be done the same day of the Mohs surgery, or it may be delayed a couple of weeks for optimal results.

If it is determined that the wound should heal on its own, a pressure dressing will be applied, and the patient will be given wound care instructions. A follow up appointment is then scheduled for 7-10 days with Dr. Pruden. If a different type of repair is necessary, the area is once again reinforced with local anesthesia, and cleansed with a surgical wash. The repair procedure is performed under sterile technique and can take anywhere from thirty minutes to a couple of hours. The patient will have sutures that will stay in for five to seven days. A pressure dressing is applied to the site, and wound care instructions are given to the patient and/or family members. A follow up appointment is then scheduled for 5-7 days later, when the sutures will be removed.