Mohs surgery, also known as Mohs micrographic surgery, is an advanced technique used to treat common skin cancers such as basal cell carcinoma, squamous cell carcinoma, and certain forms of melanoma. The procedure involves removing thin layers of skin containing cancer cells and examining each layer under a microscope. This process is repeated until only cancer-free tissue remains, ensuring complete removal while preserving as much healthy skin as possible.
What is Mohs Surgery?
Developed by Frederic Mohs, Mohs surgery is a highly precise technique used to treat skin cancer, particularly in cosmetically and functionally sensitive areas such as the face.
What sets this method apart is its use of detailed mapping and immediate microscopic examination during the procedure to ensure complete removal of cancerous cells while preserving as much healthy tissue as possible. After local anesthesia is administered, the visible cancer and a very thin layer of surrounding, normal-appearing skin are removed. This tissue is then processed as a frozen section and carefully examined under a microscope for any remaining cancer cells at the margins.
If cancer cells are still present, the process is repeated in stages until the area is fully clear, providing a high cure rate while minimizing tissue loss.
What is Mohs Surgery?
Once you arrive, a member of our staff will escort you to the surgical suite. The physician will identify and confirm the surgical site, and a medical assistant will numb the area around the cancerous tissue to ensure your comfort.
The visible cancer, along with a thin layer of surrounding tissue, is then carefully removed. The surgeon maps and codes the tissue to track its exact location before it is sent to the lab, where it is processed onto microscope slides for detailed examination. A temporary bandage is placed over the area while this analysis is completed.
During this time, you may relax in the waiting area or remain in the surgical room, depending on your preference. Preparing and examining each layer typically takes at least 45 minutes. If any cancer cells are still present, additional layers will be removed and examined in the same precise manner. This process is repeated as needed until the cancer has been completely removed.
Once clear margins are confirmed, the physician will repair the surgical site and apply a final bandage. Depending on the extent of the repair, this step may take an additional 30 to 90 minutes.
What are the advantages of Mohs Surgery?
By using detailed mapping techniques and complete microscopic control, the Mohs surgeon can precisely identify areas of cancer that are not visible to the naked eye. This allows even the smallest microscopic extensions of the tumor to be detected and removed. As a result, Mohs surgery preserves as much healthy tissue as possible while offering one of the highest cure rates for skin cancer.
Will the surgery leave a scar?
Yes—any form of treatment will result in a scar. However, because Mohs surgery is designed to remove as little healthy tissue as possible, scarring is minimized. Once the cancer has been completely removed, we will determine the most appropriate method of repair. This decision is based on selecting the safest approach while also achieving the best possible cosmetic outcome.
Will I have pain after surgery?
Most patients experience little to no discomfort following the procedure. If needed, over-the-counter pain relief such as acetaminophen is typically sufficient. We recommend avoiding aspirin or aspirin-containing products, as they may increase the risk of bleeding.
PREPARING FOR SURGERY
Medical History
Prior to your scheduled Mohs surgery, your medical history and current medications will be carefully reviewed, including a complete list of what you take and how often. On the day of your procedure, please avoid wearing makeup, perfume, or cologne to help maintain a clean surgical environment.
Medications
Continue all medications as prescribed by your physician. If you are taking prescription blood thinners—such as Coumadin, Plavix, Xarelto, or Eliquis—or if you take aspirin under a doctor’s direction, please continue these medications unless specifically instructed otherwise. Be sure to notify our office of the name of any blood thinner you are taking prior to your procedure.
You may take acetaminophen as needed for pain before surgery. Additionally, alcohol can increase the risk of bleeding, so please avoid alcoholic beverages for at least 48 hours prior to your procedure.
Transportation
Depending on the location of the skin cancer and the extent of the procedure, you may need to arrange for a companion to drive you to and from the office. You may also find it more comfortable to have someone with you during the waiting periods while the tissue is being processed and examined under the microscope.
Breakfast
On the day of surgery, you may eat breakfast as usual and are welcome to have coffee, as there are no dietary restrictions for Mohs surgery.
AFTER SURGERY
What should I expect?
Our medical assistants will review your wound care instructions with you prior to your departure. It is normal to experience swelling, redness, and bruising around the surgical site. Swelling typically lasts 48–72 hours, while bruising may persist for up to 7 days.
A pressure bandage will be applied and should remain in place for 48 hours after surgery. This initial dressing is larger and more supportive than the smaller dressing you will use in the days that follow.
If you normally wear glasses and your surgical site is near your nose or temples, your glasses may not fit comfortably due to the bandage during the first 48 hours. If your surgical site is on or around the lips or mouth, please avoid hot foods and beverages (such as hot coffee, tea, or soup) until the numbing medication has completely worn off, typically within a few hours.
Some drainage or minor bleeding after surgery is possible. If bleeding occurs, apply firm, continuous pressure to the area for 30 minutes without checking or lifting the bandage. If bleeding persists, please contact our office, the nurses’ line, Dr. Casale directly, or proceed to the nearest emergency room.
We recommend taking it easy and planning to rest and relax for the first 48 hours whenever possible. Please avoid strenuous activity, including exercise, long walks, fishing, or golfing on the day of surgery. You may gradually resume your normal exercise routine over the course of the following seven days. Excessive exertion during the first week can increase the risk of bleeding at or under the surgical site.
Taking proper care during this recovery period is an important investment in your healing and helps support the best possible surgical outcome.
Will I need to come back?
You will return for a follow-up visit after surgery so we can assess the healing site and remove sutures if necessary. Once healing is complete, you may resume routine care and regular skin examinations with your referring physician.
After having one skin cancer, your risk of developing another is increased. It is important to have regular skin examinations with your referring physician at least once a year. These visits help ensure proper follow-up of the treated area and allow for early detection of any new skin cancers.