Overview
Mohs micrographic surgery is a precise, step-wise technique for removing common skin cancers—primarily basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)—while conserving as much healthy tissue as possible. Cancer is removed in stages, and each stage is examined under the microscope in real time. The process repeats until the margins are clear, maximizing cure while minimizing the size of the wound and the eventual scar.
Cure rates with Mohs are among the highest of any skin cancer treatment. Studies show cure rates of up to 99 percent for primary BCC and up to 97 percent for primary SCC. Mohs is considered the gold-standard approach for many cancers on the head and neck, around the eyes, nose, lips, and ears, the hands and feet, genital sites, previously treated (recurrent) cancers, and tumors with aggressive histology.
Is Mohs Right For Me?
Mohs is typically recommended for:
- Critical sites: Cancers in cosmetically or functionally important areas such as eyelids, nose, lips, ears, fingers, toes, and genitalia.
- Recurrent tumors: Skin cancers that have returned after prior treatment.
- Aggressive tumors: Tumors with aggressive growth patterns or poorly defined borders.
- Large cancers: Tumors on scar-prone or sun-damaged skin where precision is crucial.
What To Expect on the Day of Surgery
- Duration: Plan to spend two to four hours in our office, depending on how many stages are needed and the type of repair.
- Meals: Eat normally; fasting is not required.
- Clothing: Wear loose-fitting clothing. If your surgery is above the shoulders, a button-front shirt is best.
- Driving: Most patients may drive themselves home unless they have taken sedating medications.
- Comfort: Bring snacks and drinks for waiting periods between stages.
- Anesthesia: Mohs surgery is performed with local anesthesia; you will be awake and comfortable.
How Mohs Works
- Stage removal: The visible cancer and a thin rim of surrounding tissue are removed.
- Microscopic review: The tissue is processed immediately and examined under the microscope.
- Targeted re-excision: Only the areas with remaining cancer are re-excised.
- Repetition: The process continues until all margins are clear.
- Reconstruction: Wounds are repaired using one of several methods—secondary intention healing, linear or layered closure, local tissue flaps, or skin grafts. For complex sites such as eyelids, subspecialist repair may occasionally be required.
Reconstruction- Natural healing: Some wounds are best left to heal on their own.
- Linear or layered closure: Wounds are closed with stitches when possible.
- Local tissue flaps: Adjacent skin is repositioned to cover the wound while preserving function and appearance.
- Skin grafts: Skin from another site is used to cover the defect if local tissue is insufficient.
- No smoking: Absolutely avoid smoking for at least two weeks after surgery to maximize healing and ensure flap or graft survival.
Pre-Surgery Instructions- Medications: Continue all prescribed medications, including blood thinners, unless instructed otherwise by your primary doctor or cardiologist.
- Supplements and aspirin: If not medically necessary, stop one week before surgery.
- Smoking: Do not smoke for two weeks after surgery to allow best healing.
- Scheduling: Anticipate two to four hours in the office and allow for reduced activity for several days afterward.
Post-Operative Care- Pressure dressing: You will leave with a firm dressing to reduce bleeding and swelling. Keep it clean and dry until your team instructs otherwise.
- Wound care: Clean gently with soap and water once permitted, apply petroleum jelly, and use a non-stick dressing.
- Bleeding: If active bleeding occurs, apply firm, steady pressure with clean gauze for 15–20 minutes without checking. Call us if it continues, or go to the ER if severe.
- Pain control: Most patients manage well with acetaminophen. Avoid NSAIDs if advised.
- Swelling: Use ice packs wrapped in cloth for 10–15 minutes per hour while awake on the first day.
- Activity: Avoid heavy lifting, strenuous exercise, and bending over for 48–72 hours, longer if flap or graft repairs are performed.
- Suture removal: Typically scheduled 5–14 days post-op depending on site and repair type.
- Infection watch: Call immediately if you notice spreading redness, escalating pain, swelling, pus, fever, or chills.
Location
Mohs surgery is offered at Dermatology Solutions in Decatur, serving Wise County and surrounding communities including Boyd, Rhome, Paradise, Bridgeport, Alvord, Chico, and Bowie. Please bring your insurance card and a current list of medications and supplements.
Frequently Asked Questions
How long does Mohs surgery take?
Most visits last two to four hours depending on the number of stages and whether flaps or grafts are required.
Will I have stitches?
In many cases, yes. Depending on the wound and location, repairs may involve stitches, a flap, or a graft. Some wounds heal best without closure.>
Do I need to stop my blood thinners?
No. Continue all prescribed blood thinners unless directed otherwise by your primary doctor or cardiologist.
Should I stop supplements or aspirin?
Yes, if not prescribed. Stop one week before surgery.
Can I eat before surgery?
Yes. Eat your normal meals.
Can I drive myself home?
Yes, unless you take sedating medications
Will it hurt?
The surgery is done under local anesthesia. You may feel pressure but not pain during the procedure. Mild soreness afterward is expected and easily managed.
What are the risks?
Risks include bleeding, bruising, swelling, infection, scar, numbness or tingling, delayed healing, and rare nerve injury. Smoking increases these risks and threatens flap or graft success.>
What are the cure rates?
Mohs provides the highest cure rates—up to 99 percent for BCC and up to 97 percent for SCC.
When can I return to work or exercise?
Desk work is usually possible the next day. Strenuous activity should be avoided for 48–72 hours, longer for complex repairs.
