Mohs Surgery FAQs

Your surgical team will provide specific instructions before your appointment. In general, patients should:

• Eat a normal breakfast unless instructed otherwise
• Take their usual medications unless specifically told otherwise
• Wear comfortable clothing
• Avoid applying makeup directly over the surgical area
• Bring something to read or do during waiting periods
• Plan to spend several hours at the office

Make sure your surgeon knows about your medications, supplements, allergies, implanted medical devices, and any previous problems with surgery or local anesthesia.

If you take a medically necessary blood thinner, do not stop it on your own. Any potential changes should be discussed with your prescribing physician and surgical team.

The treatment area is first cleaned and numbed with local anesthetic. The injection may briefly sting or burn, but after the area is numb, you should not feel sharp pain during surgery. The surgeon then removes the visible skin cancer along with a thin layer of surrounding tissue.

The tissue is carefully mapped and examined under a microscope. If the margins are clear, the cancer has been completely removed. If cancer cells remain, another thin layer is taken specifically from the area where they were found. This process continues until the examined margins are free of cancer.

It is difficult to predict exactly how long an individual procedure will take. Removing each layer is generally relatively quick. Much of the appointment is spent processing and examining the tissue. Some cancers are cleared after one stage, while others require several stages.

Patients should generally plan to spend several hours at the office and avoid scheduling important commitments immediately afterward. Needing additional stages does not necessarily mean that something is wrong. It simply means that additional cancer cells were identified and need to be removed.

Most patients tolerate Mohs surgery very well. The local anesthetic injection is usually the most uncomfortable part. Once the skin is numb, you may feel pressure or movement during the procedure, but you should not feel sharp pain. Additional local anesthetic can be given if needed. After surgery, mild soreness is common. Swelling and bruising can also occur, particularly after procedures around the eyes or other areas of the face.

After the margins are confirmed to be clear, your surgeon evaluates the wound and determines the best method of repair. Depending on its size and location, the wound may be:

• Closed directly with stitches
• Allowed to heal naturally
• Repaired with a skin flap
• Repaired with a skin graft

Occasionally, reconstruction may be coordinated with another surgical specialist.

Recovery depends on the size and location of the surgery and how the wound was repaired. Most patients can return to many normal daily activities relatively quickly. However, you may temporarily need to avoid strenuous exercise, heavy lifting, bending, swimming, or activities that place tension on the surgical site.

Your surgical team will provide detailed wound-care instructions. These may include keeping the area clean, applying petroleum ointment or another recommended wound treatment, keeping the wound covered, and returning for suture removal when necessary. Following these instructions carefully helps promote proper healing and reduce the risk of complications.

Every surgery that cuts through the skin leaves a scar, but scars change considerably during the healing process. Initially, a surgical scar may appear red, pink, raised, firm, or more noticeable than expected. Over the following months, most scars gradually flatten, soften, and fade.

Mohs surgery is designed to preserve as much normal tissue as possible, which can be particularly helpful when treating cancers on cosmetically sensitive areas. Your dermatologist may also recommend specific scar-care measures after the wound has healed sufficiently.

Some soreness, bruising, swelling, and minor drainage can be normal after surgery. Your surgical team will provide instructions about when to contact the office. Concerns may include significant or persistent bleeding, increasing pain, worsening redness, drainage suggestive of infection, fever, or problems with the surgical wound. Fortunately, serious complications following Mohs surgery are uncommon.

Yes. Mohs surgery treats the skin cancer that is present, but it does not eliminate your risk of developing another skin cancer in the future. Patients who have already developed a basal cell or squamous cell carcinoma are at increased risk for additional skin cancers.

Many patients with a history of skin cancer benefit from full-body skin examinations every six to twelve months, although the appropriate schedule varies based on individual risk. You should also contact your dermatologist between scheduled examinations if you notice a new growth, non-healing sore, bleeding lesion, changing mole, or change around a previous skin cancer site.