Mohs Surgery

What is Mohs Surgery

Mohs surgery is a procedure used to treat skin cancer. It is often used to treat common types of skin cancer, such as basal cell carcinoma and squamous cell carcinoma. In this procedure, cancerous skin cells are carefully cut away layer by layer.

The goal is to remove all cancerous tissue while removing as little of the healthy skin around it as possible. This keeps scarring to a minimum and allows for a better cosmetic outcome.

Mohs surgery is used to treat skin cancer in areas where it is important to save as much of the normal skin as possible. These areas include the face, nose, ears, lips, and genitals. This procedure may be done if:

  • Your skin cancer has returned after another type of treatment was done.
  • The cancer is likely to return.
  • The cancerous area is large.
  • The cancerous area has edges that are not clearly defined.
  • The cancer is growing rapidly.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures, such as nerves.

What happens before the procedure?

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • Ask your health care provider how your surgical site will be marked or identified.
  • You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • You will be given a medicine to numb the area (local anesthetic).
  • A layer of cancerous tissue will be removed with a scalpel. The layer removed will contain a small amount of the healthy tissue surrounding the cancerous tissue.
  • The layer of removed tissue will be frozen right away and then examined under a microscope. The surgeon will note the exact location of the cancerous cells.
  • Another layer of tissue may be removed from an area with any remaining cancerous cells. This layer will be frozen and examined in the same way.
  • More layers of cancerous tissue may be removed, one by one, and examined until no evidence of cancer remains.
  • Depending on the size and location of the surgical wound, it may be closed with stitches (sutures) or left open to heal on its own.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Return to your normal activities as told by your health care provider.

Mohs Surgery, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain or discomfort at the site of the surgery.
  • Some swelling or bruising at the site of the surgery.

Follow these instructions at home:

Wound care

  • Follow instructions from your health care provider about:
    • How to take care of your surgical wound. You should keep the site clean, dry, and protected for at least 48 hours.
    • When and how you should change your bandage (dressing).
    • When you should remove your dressing.
    • Removing whatever was used to close your surgical site.
  • Check the surgical site every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.
  • For bleeding, apply gentle but firm pressure to the area using a folded towel for 20 minutes.
  • Follow instructions from your health care provider about how to minimize scarring. Avoid sun exposure until the area has healed. Scarring should lessen over time.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if your condition improves.
  • Avoid high-impact exercise and activities until the stitches (sutures) are removed or the area heals.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have a fever.
  • You have more redness, swelling, or pain at your surgical site.
  • You have more fluid or blood coming from your surgical site.
  • Your surgical site feels warm to the touch.
  • You have pus or a bad smell coming from your surgical site.
  • You have ongoing bleeding at your surgical site.
  • You have pain that does not improve in 2–3 days after your procedure.
  • You notice skin irregularities or changes in sensation.
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