About MOHS Surgery

Mohs surgery is a highly specialized treatment for the total removal of skin cancer. This method differs from all other methods of treating skin cancer by the use of Complete Microscopic Examination of all the tissues removed surgically as well as detailed mapping techniques to allow the surgeon to remove all the roots and extensions of the skin cancer. The procedure begins after the skin is injected with a local anesthetic to make it completely numb. Then the visible cancer and a very thin layer surrounding the skin are removed with a scalpel, carefully mapped, and examined microscopically. If there is still cancer seen under the microscope, another very thin layer of skin is removed from that exact location. This may be repeated as often as necessary to completely remove the cancer. Once the cancer is removed, the wound is closed.
Dr. Frederic Mohs developed this technique about 60 years ago. The procedure has been modified and refined over the years. Practitioners of the technique have kept Dr. Mohs’ name in respect for his contribution. Mohs surgery has other names including Mohs chemosurgery, Mohs microscopically controlled surgery, and Mohs micrographic 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 result is: 1) the removal of as little normal skin as possible and 2) the highest possibility for curing cancer.
Using Mohs surgery, the percentage of cure is more than 99 percent for most skin cancers, even when other forms of treatment have failed.
No. Mohs surgery is performed in a pleasant outpatient surgical suite with local anesthesia and you may return home the same day.

Healing Process and Follow Up

Yes. We recommend that the patient take it easy for the week after surgery which includes no exertion, heavy lifting, bending or straining.
Bleeding and infection are the two primary complications. Both of these are uncommon. We will discuss how to recognize and deal with these problems on the day of surgery.

Most patients do not complain of pain. If there is discomfort, Tylenol or Acetominophen is all that is usually necessary for relief. Avoid taking medications containing aspirin (unless prescribed) as they may cause bleeding. You may have some bruising around the wound especially if the surgery is close to the eye. We advise you to rest after your procedure and ice the area to reduce swelling. We would like you to keep your physical activity to a minimum for one week after surgery, this includes no heaving lifting, bending or strenuous exercise.
Yes. Any form of treatment will leave a scar. However, 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 by itself, 2) to repair the wound with stitches or 3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result. We may advise a touch-up surgery later with the laser or dermabrasion to improve any visible marks.

Usually a follow up appointment is needed to remove stitches or to examine the healing surgical site. As each surgery is different the factors of your surgery will determine what follow up is needed. When your care is complete we stress the importance of seeing your general dermatologist for annual full body skin examinations. If you would like a referral to a dermatologist please speak with our staff and we would be happy to provide this.

A follow up period of five years for the treated cancer is essential. After having one skin cancer, statistics show that you have a greater chance of developing a second skin cancer. You should have your skin checked by your referring physician at least once each year, not only to examine the treated skin cancer, but also to check for new skin cancers.

Preparing for the Surgery

The length of surgery depends on the extent of the tumor. Often surgery lasts half a day or longer. Much of the time is spent waiting for tissue to be processed. Bring reading materials, needlework, etc., with you to help pass the time.
If you have to travel a great distance, you may want to spend the night before surgery in Seattle or nearby. There are several moderately priced hotels near our clinic that offer special patient rates and shuttle service. You will find a list of some available options under the “patient info” section.
You are welcome and encouraged to bring someone with you on your day of surgery. Sometimes, even after a minor surgery, patients do not feel up to driving. However, patients are generally able to drive themselves home unless the wound is near the eye or if they take a sedative prior to surgery. Please have a driver available if these apply to you. If you have questions regarding your surgery site and driving please call us.
Wear comfortable clothes and avoid “pullover” clothing. If we are operating on the face please do not wear make-up or lotions on or around the area the day of the procedure.
We suggest that you eat a normal breakfast unless you have made a same day reconstruction appointment with another doctor. In this case you should follow the pre-op instructions that they give you.
Yes. Continue any medications prescribed by your doctor. However, aspirin is a drug that may prolong bleeding. We ask that you avoid aspirin unless you have had a history of heart problems or this is prescribed to take by your doctor (including Anacin, Bufferin, Excedrin, Alka Selzer, Percodan, Motrin, Advil and Naprosyn) for one week prior to surgery. If you are taking any blood thinners (Coumadin) please call our office before your scheduled surgery. In addition, alcohol will also promote bleeding, so avoid alcoholic beverages 24 hours before surgery.
Most insurance policies cover the cost of Mohs surgery, however you should check with your carrier for exact information related to their schedule of payments. On your first visit, please bring your photo I.D. and insurance card.