MOHS Skin Cancer Surgery

What is Mohs Surgery?

Mohs surgery was initially developed by Dr. Fredrich Mohs. It is a procedure that allows a skilledmohs dermatologic surgeon to remove a skin cancer, layer by layer, while microscopically examining each section. This allows more accurate removal of the cancer while preserving the maximum amount of healthy skin, thereby reducing the resulting wound & therefore the scar.  


How should I prepare for Mohs Surgery?

  • Eat your normal breakfast.
  • Plan to spend the morning with us.
  • You may bring up to 2 companions with you.
  • Bring a book, ipad, magazine,& a light jacket.  
  • You will be in a private waiting room with a TV, DVD player & radio. 


Should I continue my medications?

You can take any regular medications prescribed by your physician. But it is recommended to discontinue any non-prescribed agents, such as aspirin, ibuprofen, Aleve, herbal supplements,vitamin E, fish oil, ginko biloba, garlic for 14 days prior to surgery.  Prescription anticoagulants & daily aspirin therapy may be temporarily discontinued with the approval of your prescribing physician to decrease bleeding and bruising.  This will be discussed with you when the appointment is scheduled.


What are the benefits of Mohs Surgery?

It provides the highest cure rate for removal of a skin cancer (98-99%). Mohs surgery is performed with a local anesthetic only. The skin cancer is removed and examined microscopically to ensure all cancer cells are removed, allowing the preservation of the maximum amount of healthy tissue.


What happens on the day of Mohs Surgery?

A medical history will be obtained, and you will sign an informed consent. Your regular medications will be checked, and any questions you have will be answered prior to surgery. 
Step 1: The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur.
Step 2: A visible portion of the tumor is surgically removed along with a narrow margin of normal skin.
Step 3: A layer of skin is removed and divided into sections. Dr. Chu then color codes each of these sections with dyes and makes reference marks on the skin to show the source of these sections. A map of the surgical site is then drawn.
Step 4: The lab processes the tissue, so Dr. Chu can microscopically examine the undersurface and edges of every section.
Step 5: If cancer cells are found under the microscope, Dr. Chu will “map” the location and returns to the patient to remove another layer of skin– but only from precisely where the cancer cell remains.
Step 6: The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Once the skin cancer is removed we will discuss the closure of the wound with you.


How long can I expect to be at the office?

It is impossible to know how many stages a skin cancer may require until clear margins are present. Each stage takes about 30-40 minutes. Usually, it takes 1-3 stages to clear most skin cancers. Please come prepared to spend several hours in our office. Generally most cases are removed & repaired by noon. 


How is the skin cancer site repaired?

After the cancer is “cleared”, we will discuss with you the best possible repair options that will allow the best cosmetic results. These may include:

  • Suturing the wound in a side to side manner in layers resulting in a linear scar.
  • To preserve function and cosmesis the use of a skin flap from adjacent skin or a graft from another site is sometimes necessary.  The donor site is taken from a less cosmetically sensitive area where the scar can be hidden.
  • In very rare circumstances where closure is impossible or inadvisable, the wound is left open to heal by secondary intention.   


What happens after surgery?

We will have you return 1-2 weeks after surgery(depending on the site). You should expect some swelling and bruising. There may be numbness around the site for up to a year after surgery. While scarring cannot be prevented, every effort will be made to minimize scarring. You will be given written wound care instructions  after surgery. You will be given contact information should any problems arise after surgery. Usually there is minimal pain for the first 2-3 days after surgery. 

Exercise and vigorous physical activity should be limited the first 2 weeks after surgery. Please discuss any concerns with the staff.


Do I need to return for a follow-up appointment after Mohs surgery?

Once you have had a skin cancer, you are at an increased risk for additional skin cancers (50% chance of developing another skin cancer). For this reason, it is very important to follow up with your dermatologist on a regular basis.