Overview

What Is Mohs Surgery for Melanoma?

What Is Mohs Surgery for Melanoma?

Mohs surgery is a way for surgeons to remove cancerous layers of skin from your face, ears, hands, and feet. Mohs surgery is a state-of-the-art procedure that carefully removes cancerous melanoma skin cells layer by layer.

Most skin cancer surgeries remove both cancerous cells and healthy cells at the same time. But Mohs surgery uses a precise technique that lets surgeons avoid removing healthy skin.

Surgeons carefully remove (or excise) small, thin pieces of tissue from your skin. After a layer of tissue is removed, your surgeon will then examine this layer under a microscope within a few minutes or hours. If your surgeon finds cancerous cells inside your skin layer, she will keep removing layers of your skin until she can’t find any more cancerous tumor cells.

The goal of Mohs surgery is to remove all malignant (cancerous) cells and as little normal tissue as possible. Mohs surgery is performed under local anesthesia on an outpatient basis, which means you won’t need to stay in the hospital overnight after your surgery.

Advantages of Mohs Micrographic Surgery

The advantages of having Mohs surgery are:

  • it offers the best potential chance to cure skin cancer—up to 99 percent;
  • it maximizes your chances that your skin will work and look the way it should after surgery because surgeons remove the least amount of tissue possible; and
  • it has fewer anesthesia risks because it uses a local anesthesia instead of a general anesthesia.

When Is Mohs Surgery Performed?

The types of cancer tumors most likely to be treated by Mohs micrographic surgery are:

  • Tumors in cosmetically sensitive or functionally critical areas, such as the skin around your eyes, nose, lips, scalp, fingers, toes, or genitals.
  • Tumors that are large, aggressive, or growing quickly.
  • Tumors that are recurrent (keep coming back).
  • Tumors that have edges that aren’t defined very well.

Dermatologists also use Mohs surgery to treat recurring tumors—or tumors that keep coming back.

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What to Expect Before, During, & After Mohs Surgery

Before Surgery

A nurse or medical assistant will call you before your procedure to review your medical history and give you information about your surgery. You can keep taking your prescription medications before your surgery.

Checklist:

Bring a list of prescription medications (including creams, inhalers, eye drops, and over-the-counter supplements) to your pre-surgery appointment.

  • Make plans for a family member or friend to drive you home after your surgery. You may not need someone to drive you home, but it’s always a good idea to be prepared.

Day of Surgery

  • Please take a shower or bath before your surgery because your doctor may ask you not to shower or bathe after your surgery. 
  • Please do not wear makeup or lotion.
  • Eat breakfast and take all your medications unless your doctor tells you otherwise.

If you plan on bringing a cell phone, please be courteous and turn it off while you’re in the waiting room and while the doctor is in your appointment room with you. You can make phone calls while you’re waiting for your surgeon to process your tissue.

Checklist:

  • Bring something to keep yourself busy! We can’t predict how long your surgery will take. You will spend most of your visit waiting. We recommend that patients bring books, CDs, tablets, or notebooks to keep themselves busy.
  • Bring a snack and drink with you. Plan on being in our clinic for at least half of the day or more.

After Surgery

You will probably have a large dressing (bandage) on the area of your skin where you had surgery. Your doctor or nurse will give you instructions on how to care for your wound and change your bandage.

You may also want to consider taking the day off from work after your surgery. You might not feel up to working depending on how your surgery went. If you do choose to back to work the next day, you will need to keep your bandage on your skin while you’re at work. You can’t take your bandage off.

  • Please limit exercise and physical activity for at least 48 hours after your surgery. Be sure not to bend, lift, or stoop. Be sure to avoid activities that increase your heart rate or blood pressure.
  • Don’t drive while you’re on pain medication.
  • Consider taking the day off work the day after your surgery.

Your doctor may prescribe pain medication after your surgery. Please be aware you should not drive or go to work while you’re on this medication.

Your Mohs surgeon will schedule a follow up appointment one or two weeks after your surgery. During this follow up appointment, your surgeon will give you additional instructions for how to help take care of your skin where you had surgery.

Checklist:

  • Ask your doctor or nurse for instructions on how to care for your wound and change your dressing (bandages).
  • Schedule a follow-up appointment.

Side Effects

After Mohs surgery, you may have swelling and bruising around where the cancerous skin was removed, especially near your eye. This part of your skin may stay numb up to several months after your surgery.

You may also have sensations of tingling, shooting, or sharp discomfort around the area where you had the surgery as your skin heals.

Any surgery to remove skin cancer will leave a scar. However, Mohs surgery uses precise techniques, and these techniques help reduce how noticeable your scar will be. Your surgeon may suggestion additional procedures, such as laser therapy, to improve the appearance of any scars.