What is Mohs Surgery?
Mohs surgery is an advanced technique where the physician serves as the surgeon, pathologist, and reconstructive surgeon. During the initial portion of the procedure, the surgeon removes a layer of skin around the visible portion of the tumor. Immediate microscopic examination of the tissue removed allows the surgeon to map out the skin cancer, beyond what is visible to the naked eye, and remove additional tissue from only the areas that are involved with the tumor. The removal process stops when there is no longer any evidence of cancer remaining in the surgical site.
The Mohs technique provides a 95% to 99% cure rate for all lesions treated. It removes only the tissue involved with the tumor, which minimizes the postoperative defect and results in a better cosmetic result.
What to Expect
The Mohs surgery procedure is done under local anesthesia. Photographs are taken before, during and after surgery. The majority of your time will be spent waiting for the slide preparation and interpretation. Once the tissue has been surgically removed, the wound is dressed with a temporary bandage and you will be escorted to a private waiting area to rest while the tissue is being processed. Our tranquil Mohs waiting area offers HDTV, Wifi, and a breakfast bar. The number of times you return to the surgical suite for removal of tissue is determined by the results of microscopic examination of the tissue. The tumor may require only one stage for complete removal or multiple stages. The surgery is continued until the tumor is completely removed by the microscopic examination. You should plan to spend the entire day in the clinic. The procedure may last from a couple of hours to several hours, rarely running into the next day.
History of Mohs Surgery
Mohs surgery was developed by Dr Frederic E. Mohs, whose pioneering work was performed at the University of Wisconsin in the 1930s and first published in 1941. Initially, Dr. Mohs removed tumors with a chemosurgical technique using zinc chloride. Thin layers of chemically fixed tissue were excised for pathological examination. He developed a unique technique of color-coding excised specimens and created a mapping process to accurately identify the location of remaining cancerous cells.
Over 30 years ago, the tissue-processing procedure for Mohs surgery evolved from a zinc chloride-based, fixed tissue technique to a fresh-frozen tissue technique, an innovation initially performed by Dr Mohs in 1953 but later described in detail by Tromovitch & Stegman in 1974. This innovation reduced the normal treatment time to one visit and allowed for immediate reconstruction of the wound. The heart of the procedure — the color-coded mapping of excised specimens and their thorough microscopic examination – remains the definitive and unique part of the Mohs surgical procedure.
- Cotton tip applicators (Q-tips)
- Non-stick dressing (Telfa or Release)
- Paper tape
- Petrolatum (Vaseline) ointment
- Soap and water (any bath or hand soap)
- Wash hands and remove original dressing in 24 hours.
- Gently clean wound with soap and water. Rinse with water and pat the wound dry with gauze or a dry cloth.
- Apply a thin layer of Vaseline ointment with Q-tip.
- Cut Telfa to fit over the wound. If the wound is large or draining, place some gauze over the Telfa.
- Secure the dressing with paper tape.
- Change dressing once daily. It is important that the wound stays moist with the ointment and that a scab does not form.
What to expect after surgery:
The surgical site may be sore for several days after surgery. You may take Tylenol (acetaminophen), as directed on the bottle, if needed for discomfort. Do not take aspirin, aspirin-containing pain medicines, ibuprofen (Advil, Motrin), or other NSAIDs (Alleve) since these may cause bleeding.
Most bleeding can be stopped by applying firm constant pressure to the dressing with a dry, clean gauze to the surgical site for 30 minutes (NON-STOP). If the bleeding does not stop after applying pressure for 30 minutes, please call Dr. Spencer. Please leave a number you can be reached at and remember to speak slowly and clearly. If you are unable to reach the doctor, go to the Emergency Room.
Swelling and redness may occur around the wound for several days. If surgery is done around the eyes such as the nose or on the forehead or scalp, the area around the eyes is often quite swollen and discolored for several days. The eyes may even be swollen shut which will affect the ability to work or drive. This may not peak until 48 hours after surgery. Drainage is to be expected in wounds that are not stitched and allowed to heal on their own. The drainage may be yellow-green and have a slight odor. It usually begins several days after surgery.
As the wound heals, you may feel skin tightening, itching of the scar or small sharp pains in the scar. These feelings are normal and will lessen as time passes. Massaging the scar (after stitches are removed) will often help flatten, soften and decrease itching of the scar. Scars are pink for several months after surgery and eventually turn white. The surrounding area may feel numb. This is usually temporary lasting 6 to 12months. The deep stitches may feel like “lumps” under the skin which will also go away over the next several months.
If the skin around the surgical site develops expanding redness, swelling, and pain and the wound begins to drain pus, you may have an infection. Please call the doctor.
If stitches were placed, please avoid heavy lifting and exercise till the stitches are removed.
Please resume your over the counter medications and NON prescribed aspirin one (1) week after surgery. Please continue your presciption medicines as directed by your physician.
You may get the area wet by showering or washing your face after 24 hours, but afterward, be sure to clean the wound as directed above. If stitches were placed, please no soaking wound in bathtub or swimming pool until stitches are removed.
Do not shave near the area with stitches.