Removal of the skin cancer in “layers” allows normal, healthy skin to be preserved, keeping the defect or “hole” as small as possible while simultaneously ensuring the removal of all cancer cells. Mohs surgery is unique in that 100% of the margins are checked, meaning the entire peripheral and deep edges of the tissue are looked at under the microscope. (When tissue is sent off to a standard lab, the way the tissue is processed means only about 1% of the margins are checked.) This gives Mohs surgery the highest cure rate of any skin cancer treatment, up to 99% for skin cancers that have never been treated and up to 95% for recurrent skin cancers.

The length of the surgery often depends on the extent of the skin cancer and how many “layers” of tissue need to be removed and then processed in the lab. Expect to be with us for 3 to 6 hours, but sometimes it may take longer so we ask that you come prepared to spend the day. Much of the time will be spent waiting for the tissue to be processed in the lab, usually 1-2 hours per layer. Bring snacks, reading material, and anything else that will help keep you comfortable while you are with us. If you bring a driver with you who stays for the duration of your visit, you will likely be able to spend the waiting time with them.

During the time that your tissue is being processed in the lab, please be aware that the Mohs surgeon is performing surgery on other patients. Occasionally, patients with complicated tumors or large reconstructions may require additional time. We appreciate your patience and want to respect your time while also providing each and every patient the best possible care.

Many, but not all, wounds require stitches for optimal healing. Our goal is to give you the best functional and cosmetic result possible. Oftentimes, the skin on both sides of the wound can be pulled together and closed with a line of stitches. However, some wounds heal best on their own, while others require more complicated reconstructions such as rearranging nearby skin (called a “flap”) or patching on skin taken from another area of the body (called a “graft”). Rarely, there are some flaps or grafts that may require multiple stages of surgery and will be completed over a series of appointments. Your Mohs surgeon will recommend the best option for you once the skin cancer has been entirely removed.

Unfortunately, there is no such thing as a “scarless” surgery. However, fellowship-trained Mohs surgeons spend a significant portion of their training performing reconstructive surgery and our goal is to make your scar as undetectable as possible. The size of the scar often depends on the size of the skin cancer. If the two sides of the wound are pulled together and closed with a line of stitches (linear repair), the line is often longer than patients expect. In general, the line must be 3 to 4 times longer than the width of the wound in order to make the scar lie flat or match the normal contours of the surrounding skin. 

Initially, the scar will be raised, red, and feel lumpy. There is also normal swelling and bruising that can last a few weeks. Over the following months, the scar will start to fade and flatten. The area surrounding the scar will be numb at first, then may feel itchy or tingly as nerves start to regrow. Full sensation usually returns within 6-12 months. Scars take 1-2 years to fully mature and reach their final appearance, so patience is key. 

No, Mohs surgery is performed under local anesthesia (numbing medicine is injected into the skin). Because the surgery may take several hours, this avoids the risks associated with prolonged general anesthesia.

Surgery anywhere on the face can lead to temporary swelling around the eyes, making it difficult to see. Additionally, a large bulky bandage will be placed over the surgical site for the first 2 days, which can sometimes interfere with field of vision or make it difficult for glasses to rest properly. Out of concern for your safety, we ask that you bring a driver with you or make arrangements for someone to pick you up. Many patients also enjoy having a companion with them during the waiting portions of the day and appreciate an extra set of ears to help process information. (If your surgical site is below the neck and arranging a driver will be excessively difficult for you, please call our office to discuss your specific situation.)

Please stop taking all vitamins and herbal supplements 10 days prior to surgery, as many of these unnecessarily thin the blood. If you take aspirin, ibuprofen, naproxen, celecoxib, diclofenac, or other NSAID medications that HAVE NOT been prescribed or recommended by your doctor, please stop taking these 10 days prior to surgery as these also thin the blood.

No, continue to take any blood thinners or aspirin that have been prescribed by your doctor. Studies have demonstrated that the risks of stopping these medications (e.g. stroke, heart attack, blood clot) outweigh the risks of continuing them during Mohs surgery (e.g. minor bleeding, bruising, hematoma). If there are any special circumstances where these need to be stopped, we will notify you. Please note that if take warfarin (Coumadin or Jantoven), you will need to have an INR checked 3 days prior to your procedure. Please fax these results to our office at 970-964-4038. If your INR is higher than 3.5, we will need to reschedule your surgery.

Yes, you will need to avoid vigorous activity and exercise for 1 week after surgery (walking is okay). Increases in heart rate and blood pressure may cause increased bleeding. After 1 week, you may gradually resume your normal activities. If your wound is stitched, you will need to avoid swimming for 1-2 weeks after surgery as well as avoid lifting anything heavier than 10 pounds for 10 days after surgery. Heavy lifting may cause stitches to pop open. If your job requires heavy lifting or physical exertion, you will need to make arrangements to be off. Your Mohs surgeon will give you specific instructions after the surgery and can complete any necessary paperwork for you.

Most people are surprised that they have less pain than they expected after the surgery. Typically, the first 24 hours are the most uncomfortable. We recommend you have extra strength Tylenol available and will provide additional recommendations after your surgery.

Skin cancer is most commonly due to ultraviolet exposure from the sun, although additional factors such as genetics and immune system health can play a role. Sun exposure adds up and cancers may develop years or decades afterwards. While it is true that most people who have had one skin cancer end up developing more over their lifetime, you can reduce your risk by wearing sunscreen (broad-spectrum, SPF 30 or higher) or sun protective clothing and minimizing sun exposure. It is important to follow up with a dermatologist for regular skin checks to monitor for new skin cancers.

There are many different types of skin cancer. Basal cell carcinoma is the most common and least aggressive type of skin cancer. It almost never spreads (metastasizes) to other parts of the body. However, like all skin cancers, it remains in the skin and continues to grow unless it is completely removed, so it can destroy large areas of normal tissue if left untreated for long periods of time. Squamous cell carcinoma is the second most common type of skin cancer, and rarely metastasizes unless it is large or advanced. Melanoma is the third most common type of skin cancer and has a higher risk of metastasizing but is completely curable if it is diagnosed and removed early. Not all Mohs surgery laboratories are equipped to treat melanoma though, as it requires special laboratory stains.

Yes, the biopsy is intended to only sample the tumor and provide a diagnosis, it is not a definitive procedure to get rid of all the skin cancer cells. Even though the top portion of the skin may look well-healed after the biopsy, skin cancer left under the surface will continue to grow and can cause local tissue destruction. By using the Mohs surgery technique to check 100% of the margins around the tumor, we ensure that all skin cancer cells are removed. 

There are strict criteria that determine whether a skin cancer is appropriate for Mohs surgery and sometimes insurance companies will refuse to cover the procedure if it is not deemed “appropriate.” Mohs surgery is usually reserved for skin cancers on cosmetically-sensitive areas (like the face), areas with very tight skin (like the shin), functionally important areas (like the hand), or tumors that may be more aggressive. Oftentimes, small, less aggressive skin cancers on the body are easily treated with other means such as simply cutting them out (excision) and sending the tissue to a standard laboratory, or by scraping the area (curettage). Some superficial skin cancers may be treated using a chemotherapy cream. Occasionally, very large tumors may not be amenable to surgery and are better treated with radiation or chemotherapy mediations. Your doctor will help determine the best treatment approach for you by taking factors such as the type of skin cancer, location, and your overall health into consideration.