MOHS Procedure for Skin Cancer

What is the Mohs Procedure?

A Mohs procedure is an advanced way to remove skin cancer and heal the remaining wound.

Mohs micrographic surgery involves removing a skin cancer one layer at a time and examining these layers under a microscope immediately after they are removed. This allows for a close examination of each layer of skin to detect cancer cells. It also allows a minimal amount of tissue to be removed while ensuring complete removal of all the cancer cells in the area of the wound being treated.

The Mohs procedure is a two-step process – one to remove the skin cancer and the other to heal the wound. It is a lengthy procedure and treatment may take place over multiple days. It may also require more than one doctor visit at different locations. The initial procedure is performed on an outpatient basis in your Dean Clinic – Dermatology Office.

Preparation for the Procedure

Here are some instructions on how to prepare for a Mohs procedure:

• Stop the use of aspirin or aspirin-containing compounds (Anacin, Bufferin, Ascriptin, etc.) for two weeks prior to your visit.
• If your doctor has prescribed the use of aspirin or a blood thinner such as Coumadin (Warfarin), or Plavix for an important condition such as heart disease, strokes, or clotting, DO NOT stop taking these medications without first consulting your doctor.
• Stop non-steroidal anti-inflammatory agents for pain (Advil, Nuprin, Motrin, ibuprofen, etc.) seven days prior to surgery.
• Stop Vitamin E and all herbal supplements at least two weeks before surgery, including but not limited to garlic, ginger, ginseng, feverfew, fish oils, flax seed, dong quai root, tumeric, hawthorne, ma huang, St. John’s Wort, bilberry, and gingko biloba.
• Continue all other medications, including blood pressure medications and diuretics.
• The night before surgery, or the morning of surgery, please use an antibacterial soap to wash the affected area to reduce the chance of infection.
• Eat a good breakfast prior to your visit.
• Wear comfortable clothing.
• Come prepared with an activity to occupy your time during the process.

Steps to a Mohs Procedure

• The affected area is injected with a local anesthetic (numbing agent).
• A layer of tissue is removed and inspected under a microscope.  
• The dermatologist will repeat the removal of tissue and the inspection of it multiple times, if needed, until no more cancer cells are detected in the area being treated.
• This process may take course over multiple hours. Plan to spend most of your morning in Dermatology.

Wound Repair

Some wound repairs may be scheduled for a later date, and/or may require travel to another clinic. Wound repair options include the following:

• Some wounds are left open to heal over time.
• Some wounds will be closed with sutures (stitches) by a dermatologist.
• Some patients will be referred to a facial reconstructive surgeon for wound repair in the Ear, Nose and Throat, Oculoplastic or the Plastic & Reconstructive Surgery Departments. If your wound repair is completed in one of these departments, it is recommended to have someone drive you home.
• Some wounds are repaired at an outpatient surgery center.

After a Mohs Procedure

• Pain after the procedure is generally mild and usually controlled with Tylenol.
• You will receive written instruction on wound care from your doctor.
• Activity restrictions may be necessary after your procedure per the surgeon’s instructions.
• If stitches are placed, a follow up appointment will be necessary for their removal.

Please note that any surgery will result in a scar. Most scars will diminish over a year’s time. They will flatten out and lose their redness.