Regarding Mohs Micrographic Surgery

Will it hurt?

When we start the procedure, you will be given local anesthesia with a very small needle.  Although everyone’s tolerance for pain is different, patients that undergo Mohs surgery find the procedure remarkably painless.  We pride ourselves on being particularly gentle.  When you go home, you will be given a prescription for a pain medication.  Most patients report that they did not need it. 

Will there be a scar?

Yes.  It is impossible to undergo surgery without having a scar.  Nevertheless, it is our commitment that you will be completely satisfied with the cosmetic outcome.  This means that, in some instances, it may take extra post-operative corrective procedures to attain the desired goal.  We are committed to that process.  

What will the scar look like?

Everybody heals at a different rate, and the scar will look different over time.  Initially, it will be red and bumpy, but eventually, the scar will be a barely visible “hair-thin” white line.  We typically camouflage the scar in the lines of facial expression or in your natural skin folds.

Will I need plastic surgery?

We perform the reconstructive surgery on site.  Once your cancer has been successfully removed, our Doctor‘s expertise lies in the reconstructive component of the surgery.  If the cancer involves the inside of the eye or if the reconstruction requires you to be put to sleep, our doctor works closely with other specialists with whom we will coordinate your care.

Can I go back to work after the procedure?

We recommend that you go home and take it easy.  Although the surgery takes place in an ambulatory setting with the use of local anesthesia, we have found that patients often feel “drained” or “wiped out” after the procedure.  Furthermore, any activity that puts strain on your surgical site or causes your blood pressure to elevate is contraindicated and would compromise the way you heal.

When can I exercise?

The resting period that we recommend after your surgery depends on where your cancer is located.  Typically, we recommend that you do not exert yourself for 1 week if your cancer is on your head or neck area.  This restriction is increased to 2 weeks when your cancer is on the trunk and extremities.  Our doctor may recommend even longer restrictions for certain types of exercise.   Make sure you ask us about the specific exercise you intend on doing.

Will my insurance cover this procedure?

Absolutely!  This is a medically necessary procedure.

Can I drive home?

Unless you have had surgery near the eye or on your hands, it is reasonable to expect that you can safely drive home.  Of course, it is always comforting to have someone give you a ride.

Can you do multiple surgeries at the same time?

We do not perform multiple surgeries on the same day.  In general, the chances of getting an infection increase when multiple surgeries are done at the same time. 

What if I did not have this treated?

If you have been diagnosed with a skin cancer, it is important that you understand what would happen if this tumor was left untreated.  There are 3 types of cancers that we deal with most commonly:  Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma. An untreated Basal Cell Carcinoma is a cancer that would continue to grow at a relatively slow rate.  Even if it seems to you that the biopsy took it all away, it has little extensions under the skin and it would grow in that direction.  Eventually, it would become larger, would bleed, and would be painful, and disfiguring.  In rare cases, in could grow down a nerve and lead to death.  Basal Cell Carcinomas do not spread to other parts of the body (metastasize).  Unlike a Basal Cell Carcinoma, an untreated Squamous Cell Carcinoma can metastasize.  The same holds true for a Melanoma, and it can do so rapidly. 

 Can I postpone the surgery?

We do not recommend doing so.  Your doctor has sent you here for us to remove your cancer and it should be addressed as soon as possible.  It is important that you keep your appointment and not reschedule so as not to delay your treatment.  When we schedule your procedure, we reserve a 3 hour space.  It is very difficult for us to find another one in short notice.  Delaying surgery would allow your cancer to grow larger, making the reconstruction and your recovery more complicated.  In the case of Squamous Cell Carcinomas and Melanoma, it may even lead to spreading of the cancer.

Do I need to stop my medications?

In general, we do not recommend that you stop any medications that were prescribed by a doctor without checking with that doctor.  Over the counter medications containing aspirin, ibuprofen, or vitamins should be discontinued. 

Can I die from this?

Squamous Cell Carcinomas and Melanomas can spread to other parts of the body and lead to death under certain circumstances.  It is very rare to die from a Basal Cell Carcinoma.  The concern with Basal Cell Carcinoma is that it is disfiguring and can lead to loss of function of nearby structures such as the eye, or lips.

Can I eat before the surgery?

We recommend that you have a light meal before your surgery.  You may be with us for several hours, and, although we can provide you with crackers and juices, we want you to be as comfortable as possible.  You may even want to bring a light snack with you, which you may eat in the waiting room.

Will I be put to sleep?

No.  All our surgeries are done under local anesthesia.  This is one of the reasons why our procedures are so safe.

Can someone be in the surgery room with me?

Although we want you to feel as secure as possible while undergoing surgery, we reserve the right to determine who can be in the surgical suite based on our need for space or the complexity of the case.

How long will it take?

It is all dependent on the size and the site of your cancer.  It is impossible to determine how long you will be with us until we have seen you.  Even then, the cancer may be bigger under the surface and we would not know until we have started the procedure and the doctor looked at your cancer under the microscope.  Because of these uncertainties, we ask you to plan to be with us for at least 3 hours, although it may take much less time.

What causes skin cancer?

People have skin cancer for multiple reasons.  The two main reasons are sun exposure and genetics.  Damaging sun exposure likely took place before you were 18 years old.  Although it is very important that you protect yourself now from the sun so that you do not continue to get skin cancers, your current skin cancer is due to excessive sun exposure 20 years or so back.  Also, your genetic background determines how likely you are to be affected by the sun damage.  If you have light colored eyes, blond or red hair, and fair skin, you are more likely to have skin cancer.   If you or any of your family members have had skin cancer, you are also at higher risks of developing skin cancer.  For more detailed information, please visit aad.org or skincancerfoundation.org (or place links).

Do I need to have the doctor look at the site before I have surgery?

Yes.  The doctor will examine the site and determine whether Mohs surgery is the right treatment for you before you undergo surgery.  Because some of our patients are quite elderly or live far away, we often schedule your consultation visit on the same day as the procedure. 

Will I have sutures? Will I have to come back and have the sutures removed?

You can expect to have sutures under a pressure bandage when you leave us.  We typically use two layers of sutures, both of which dissolve.  This means that you do not need to come back for your stitches to be removed, but you will have a follow up appointment with the doctor to make sure you are healing well.  In some cases, we cannot use dissolvable sutures and you would have to come back one to two weeks after the procedure to get them removed.