How Long Does the Surgery Take?
You arrive for a morning or afternoon session and will generally be in the clinic for two to four hours depending on how many stages are required.
Am I Awake?
Mohs surgery is performed under local anesthesia while you are awake. In between stages you will have a temporary bandage on, and you can sit up, talk, read and go the bathroom.
How Do I Prepare for Surgery?
Take all of your medications as prescribed unless specifically instructed otherwise by a physician.
Please let us know if you take any of the following blood thinning products (but do not stop any of these medications unless instructed to do so): aspirin, coumadin (warfarin), plavix (clopidegrel), vitamin E, fish oil.
If you take ibuprofen (Advil, Motrin) or naproxen (naprosyn, Aleve) on an as-needed basis, please stop these medications seven days prior to your surgery. If you take any of these medications by prescription, please discuss this with your prescribing doctor first. You may take acetaminophen (Tylenol) for pain during this period.
Three days prior to surgery, we ask that you avoid drinking alcohol as it may increase your risk of bleeding.
Breakfast, Companions, Makeup and Books
Eat your normal breakfast (unless specifically instructed otherwise by a physician). It is helpful to have someone with you to keep you company between stages. Also, you will have a bulky bandage on afterwards, and it is preferable to have someone else drive you home.
On the day of surgery, please do not apply any makeup or moisturizers. Because you will be with us for several hours, you and your companion may want to bring along a light snack and reading material or another quiet activity as there is waiting time between stages.
Will I Have a Scar?
There is always a scar after surgery. Your Mohs surgeon makes all efforts to hide the scar in the natural contours of your face and to preserve the shape and function of sensitive areas such as the nose and lips. Scars improve over weeks to months as scar tissue remodels, so it is important to give the scar time to "mature." Sometimes a second procedure may be needed to modify or smooth the scar. We will work with you to give you the most invisible scar possible. Our goal is for both you and your Mohs surgeon to be happy with your result.
What Can I Expect After Surgery?
After the anesthetic wears off, there may be some soreness or aching. This usually improves within 24 hours and usually there is surprisingly little pain. Rest, icing the area and Tylenol are usually sufficient to relieve any discomfort. Occasionally, stronger pain medication may be prescribed. Please avoid ibuprofen (Advil, Motrin, Aleve) as it may increase the risk of bleeding.
In general, we recommend that you limit your activities for two to seven days after the surgery. Your surgery team will give you specific recommendations depending on how your wound was repaired. Activities such as bending, heavy lifting and strenuous exercise should be avoided as they can elevate your blood pressure and lead to bleeding, swelling or opening up of stitches. Please defer airplane travel for at least one to two weeks after your surgery as the rigors of travel may adversely affect healing.
Alcohol should be avoided for three days following surgery as it dilates the blood vessels and could lead to bleeding problems in the wound.
What Is Normal?
It is normal to have some redness and swelling around the area. This generally improves over the first week. Bruising may occur as well and can take one to two weeks to resolve.
What Are the Risks After Surgery?
Bleeding. Slight bleeding under the pressure dressing is normal and you may notice dried blood on your bandage when you remove it. More extensive bleeding is only rarely a problem after surgery. If this occurs, you should apply moderate pressure continuously with a clean gauze or washcloth for 20 to 30 minutes. If there is still active bleeding, please call the clinic or page the covering dermatologist who will instruct you further. Things that increase your risk of bleeding include aspirin, other blood thinners, strenuous activity and bleeding disorders.
Infection is a risk after Mohs surgery but is uncommon. Infections usually appear several days after surgery with increased redness, tenderness, swelling and drainage. If you notice any of these symptoms, please call our office. We will generally have you come to clinic to be checked and prescribe a topical or oral antibiotic if needed.
Allergic Reaction. Allergies to the local anesthetic, lidocaine, are extremely rare. Local allergic reactions to bacitracin ointment are more common, resulting in an itchy rash. In most cases we recommend sterile Vaseline for your wound ointment instead of bacitracin to avoid such reactions. Occasionally people will develop itchy topical reactions from the irritation of the bandage or adhesive tape.
Recurrence of Tumor. With Mohs surgery, the risk of recurrence is one to three percent for tumors being treated for the first time. If the tumor has previously been treated by another method and now is being treated with Mohs surgery, the risk of recurrence is slightly higher.
Numbness or Tingling. Even after the scar heals, there may be numbness or tingling over the area. Often the numbness improves over months as small nerves regrow into the area. Sometimes, especially with a skin graft, some degree of numbness can be permanent.