In this section, we'll help you learn what to expect before, during and after Mohs surgery.
- What Happens During Mohs Surgery
- How to Prepare for Mohs Surgery
- Reconstruction After Surgery
- Follow-Up Exams
What happens during Mohs Surgery?
The surgeon removes the cancer-containing tissue and marks the edges with colored dyes to create a map of the affected area.
A specially trained clinical lab technician (histotechnician) processes the tissue onto microscope slides in our onsite lab. Next, the surgeon carefully examines the slides under a microscope to identify and map any remaining microscopic roots of the cancer.
If cancer cells are identified, we remove additional tissue only in areas where the cancer remains, preserving normal skin.
Once the cancer has been removed, the surgeon will explain wound care options including:
- healing naturally (granulation)
- stitching the wound together using a side-to-side closure
- using a skin flap or graft
In most cases this repair, or reconstruction, can be done the same day. Sometimes other surgical specialists be called upon for special skills, which might require coming in another day to complete reconstruction.
Will the procedure be painful?
Mohs surgery is done safely under local anesthesia. When the anesthetic is first injected, you may experience some discomfort but in most cases this lasts only seconds. Once the area to be treated is numb from the anesthetic, the surgery itself should not be painful.
After the surgery, you may experience soreness around the area you had surgery. Tylenol can be used to help treat discomfort. In some cases, prescription pain medication may be needed for 1-2 days after surgery.
How to Prepare for Mohs Surgery
Unless specifically instructed otherwise during consultation, please:
- Please take your normal medications the morning of Mohs surgery. If you are currently taking blood thinners or aspirin prescribed by a doctor, please continue taking these medications unless instructed otherwise by your doctor.
- If taking Coumadin/Warfarin: Complete an INR (coumadin) blood test within 10 days of surgery. Typically INR (Coumadin) levels greater than 3 will prompt us to reschedule your surgery.
- Bring an updated list of your medications and allergies the day of your surgery.
- If you have a pacemaker or defibrillator, please specify this on your medical history, and notify the surgical nurse on the day of your surgery.
- Eat a normal breakfast on the day of surgery and bring snacks/food for eating. Exception: Some patients have same-day surgery/reconstruction planned with another surgeon. If so, follow their directions for eating that day.
- Please wash the area to be treated and the surrounding area with an antibacterial cleanser such as Lever 2000, Dial, or Cetaphil, twice a day, for two days prior to surgery.
- Do not apply makeup on the surgical site and surrounding area.
- Avoid perfumes.
- Wear loose, comfortable clothing easy to remove without disrupting a bandage.
The Day of Surgery
- Have someone accompany you or be available to drive you home. Sometimes even with a minor procedure, a patient will not feel up to driving after the surgery, or a bandage near the eye may disrupt vision. Please contact our office at 206-860-5595 if you have questions.
- If you are having Mohs surgery for a skin cancer, your wait time may vary for receiving laboratory results.
- Do not plan anything else on surgery day. Sometimes the surgery can be more time-consuming or extensive than anticipated. Mohs surgery commonly takes much or all of the morning, and may take most of the day. While you are waiting, we provide access to wireless internet and magazines. Feel free to bring books or other items you would enjoy.
- Limit physical activity (e.g.: raising heart rate, exercising, gardening, bending over, etc.) for approximately one week after your surgery.
- You may have some bruising or swelling around the wound, especially if the surgery is close to the eye. Resting after the procedure will help limit this possibility.
- If you have to travel, you may want to spend the night after the surgery in Seattle or nearby. There are several moderately priced hotels near our clinic that offer good rates and shuttle service.
- Most people are able to control any discomfort after surgery with medications like Tylenol. Occasionally your doctor will prescribe stronger pain medications to help.
Reconstruction After Mohs Surgery
The decision on how best to manage the wound after Mohs surgery depends on the size and depth of the wound. We evaluate final cosmetic outcome, healing time, risks of bleeding or pain or contraction of the wound pulling on nearby structures like an eyelid, and patient preference. Options can include:
- Allowing the wound to heal without stitches, also called second intention healing. Results in some cases can be as good as or better than sewing the wound. Risks can include wound contraction, distorting nearby areas such as the eyelid, nostril or lip.
- Sewing the wound closed directly, or primary closure. This results in a straight line of stitches. Often in order to remove the “darts” or bulges created by pulling the wound together, the line is longer than the original wound. The goal is for these lines to fade over time by carefully placing and orienting the stitches.
- Making a further incision near the wound edge to transfer surrounding skin into the wound, also called flap or tissue transfer. This approach uses stitches but the shape may resemble a letter such as “T,” “L” or “C.” Again, the goal is to have the stitch lines fade over time.
- Borrowing skin from another area to replace what is missing, also known as skin graft. There are several types of skin grafts available. Talk to your surgeon about options best for you.
In most cases, we can take care of the wound on the same day. However, some cases may require other surgical specialists with unique skills to close the defect. In these cases, reconstruction can be delayed by a day or more. There is no harm in this delay.
Recovery Time and Wound Healing
Recovery and wound healing time depends on the type of reconstruction.
- Stitches are typically removed after a week (on the face) and two weeks (on the body). Stitch lines may initially appear pink and bumpy but gradually improves over time. Occasionally stitch lines may benefit from dermabrasion. Stitched wounds will continue to improve (redness, bumpiness) up to a full year after surgery. Most patients are pleased with the final results after surgery.
- Makeup, including camouflage products, can be used once the wound is fully sealed (typically 1-2 weeks after surgery). This helps hide the stitch lines while they are still healing. You are encouraged to come in for a follow-up visit at 6-8 weeks for discussion of expected outcomes and possible treatments.
If you have stitches, you will typically need to return to have those removed in 6-7 days (on the face) and 10-14 days on the body or scalp.
All surgery will leave a scar. However, because Mohs surgery removes as little normal skin as possible, scarring is minimized. It is typical for any redness or bumpiness associated with the stitch lines to improve with time and you are invited to return for a followup as needed to evaluate the healing. On occasion we may advise a touch up surgery or dermabrasion to improve any visible marks.
After your surgery, it’s important to schedule regular follow up visits with a general dermatologist or your primary care provider. While Mohs surgery has a high cure rate for skin cancer, there may be a small risk of cancer recurrence or developing another skin cancer. Once diagnosed with skin cancer, there is an increased risk of recurrence compared to those who have never had skin cancer.