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WHAT IS MOHS SURGERY?

 
MOHS surgery is considered to be the most effective technique for treating many Basal cell carcinomas and Squamous cell carcinomas.  Mohs surgery is done under local anesthesia,  in stages, including lab work and inspection, while the patient waits, all in the same day. Mohs surgery is so effective because it evaluates the tissue surrounding the cancer more thoroughly and immediately while sparing healthy tissue and making the smallest possible defect. The goal of Mohs surgery is to remove all of the skin cancer without hurting the healthy skin around it. This makes Mohs suitable for critical areas, such as the face and ears, where tissue preservation is crucial for functional and aesthetic reasons. Often, reconstruction is needed once all of the cancer is removed.
 
 
 
 

PREPARING FOR YOUR MOHS SURGERY

It is important to fully inform your surgical team about all of the medications you are taking before your surgery, including prescriptions, vitamins, minerals, herbs, drugs, or any other supplements. If you take anticoagulant medications (blood thinners), it is important to talk with your doctor 7 to 10 days prior to your scheduled Mohs surgery.  Post operative bleeding can complicate your surgery and prolong your healing and compromise your results. Your dermatologist or physician will instruct you how to manage your medications prior to and following the surgery. 

 
  • Unless your physician or surgeon instructed otherwise, avoid all NSAIDS for 2 weeks prior to surgery.  
  • Smoking should be avoided for a minimum of 2 weeks before surgery.
  • Alcohol should be avoided for 24 hrs prior to surgery
  • Shower the evening before or morning of surgery as showering the first day after may be difficult
  • Eat a meal before coming into the office as your normal routine. There will be light snacks offered as well.
  • Wear comfortable clothes and shoes
  • Bring any daily medications and a water bottle 
  • Bring a sweater (doctors offices get cold!) and a book to pass the time
  • Have a family member accompany you to your Mohs surgery. You will likely leave with a large bandage, and depending on the surgical site, this may restrict your vision or driving.

You should always talk to your doctor or healthcare team about your anticoagulation management when you have surgery.

 

WHAT TO EXPECT THE DAY OF YOUR MOHS

Mohs surgery appointments often begin in the morning hours. Because the number of layers needed to be removed is unpredictable, your length of time in the office is unfortunately, also unpredictable. The Mohs process can take only a few hours or it can last the majority of the day.
 
The Mohs surgeon begins by removing a thin layer of skin which is processed immediately by the in house lab.  Slides of the skin are then examined by the Mohs surgeon under the microscope to determine if any cancer remains. During this time, you may be escorted back to the waiting room.  If there are cancer cells still present on the margins (the rim of the tissue),  the surgeon will call you back into the room to remove another layer and repeat the process. This continues until all margins are clear and the area is cancer free. Once the margins are clear, you will be called back into a room for Dr. McDonald to close the wound.

 

RECONSTRUCTION AFTER MOHS SURGERY

Dr. W. Scott McDonald is a Board Certified Plastic Surgeon with almost 30 years in practice. Because the majority of Mohs cases are on highly visible areas such as the face and ears, Dr. McDonald’s plastic surgery knowledge and skill are vital to improving the aesthetic and function of the opening left by Mohs surgery.  Dr. McDonald examines the area and counsels the patients on the different options for Mohs reconstruction.  Mohs reconstruction often involves suturing the skin closed. Depending on the location and size of the defect, a skin graft may be optimal to cover and heal the area.  Dr. McDonald works with several Mohs dermatologists around South Florida.  If you are looking for a Mohs dermatologist, call our office for more information.
 
 

MOHS SURGERY POST-OP INSTRUCTIONS AND RECOVERY

Recovery from Mohs surgery is typically complete in 2 weeks.  Following Mohs surgery, most patients can expect to return to the office for at least 1 post op appointment to have the sutures removed. This post op appointment may be anywhere between 5 days and 14 days post procedure and is usually quick (much quicker than the day of surgery).  Skin grafts require more time in the healing process and in turn, additional post op visits for wound care and monitoring.

 

  • Leave the initial dressing in place for the first 2-3 days.
  • Apply an ice pack to the affected area for 15 minutes of every hour for the first day. The ice pack should also be used every 3 to 4 hours on the day following the surgery. 
  • Keep area elevated for the first 48 hours. Ice packs and elevation decrease swelling and tenderness in the surgical site.
  • Avoid strenuous activity for the first week.
  • Pain is usually minimal. If discomfort occurs, you may take Extra Strength Tylenol. 
  • Continue to avoid aspirin and NSAIDS for one week after surgery.
  • Alcoholic beverages should be avoided at least 48 hours post surgery to prevent bleeding.
  • Smoking should be avoided at least until the sutures are removed.

 

WOUND CARE AFTER SURGERY

  • Avoid getting the post-operative bandage wet during the first 48 hours.
  • Before showering, remove the bandage and discard it the trash.
  • Avoid water directly to wound until the incision is healed. Instead let the water hit other areas and run over the wound.
  • Pat the wound dry and apply a generous layer of  Vaseline or antibiotic ointment to the incision.
    Cover the wound with a gauze or bandage.
  • Repeat this process as needed until your post-op visit.
  • Avoid swimming and bathing until all incisions are completely closed.