How to prepare for Mohs surgery

What happens during the procedure?

At Roswell Park, Mohs surgery is a team approach. In addition to your surgeon, a specialty-trained nurse practitioner or medical assistant, and a histotechnologist will assist during the procedure. While the specifics of your surgery may be different depending on the size and type of skin lesion you have, there are some common things you can expect to happen during your procedure:

  • Local anesthetic is injected to numb the area.
  • The area of the cancer is removed so that the entire undersurface and skin edges can be examined microscopically.
  • Tissue is dyed, and a map is drawn so that the tumor found can be located on the patient. Tissue is processed onto microscopic slides.
  • The surgeon examines the slides under the microscope. If cancer cells are found, they are marked on the map to guide the surgeon in removing additional tissue.
  • Layers of tissue will be removed until no cancer cells are found.

Before the procedure

If any medications need to be discontinued, you will be given instructions before your surgery date. Otherwise, it is important that you continue to take all your medications like you normally do. If you need to take medications during the day, bring them with you.

Additional instructions:

  • Do not drink alcohol for 24 hours before surgery.
  • Get a good night sleep.
  • Shower and wash hair and face on the day of the surgery.
  • Eat a normal breakfast. Bring a lunch or snack.
  • Wear clothing that buttons in the front.
  • Do not wear jewelry or makeup if surgery is to be performed on the face.
  • Bring a friend or relative to keep you company and to assist you in getting home. A good book or magazine would also be helpful. Wifi is available in the waiting room.

The day of surgery

Shortly after you arrive, you will be taken to a treatment room where the doctor will review the risks and benefits of Mohs surgery with you and ask you to sign an informed consent form.

The area of the skin cancer will be cleaned, and a local anesthetic will be injected. The doctor will remove a thin layer of skin surrounding the cancer. Any bleeding will be stopped with an electric machine called a cautery, and a bandage will be applied. This initial process takes about 30 minutes. Following this, you will be able to relax while the tissue is processed. Preparing the tissue for microscopic examination and evaluation of the slides by the Mohs surgeon can take up to 90 minutes.

If microscopic examination reveals that tissue still contains cancer cells, the procedure is repeated in the areas where tumor cells were found. The goal is to remove all of the skin cancer and preserve the greatest amount of healthy tissue. Skin cancers can grow deeply and develop roots that extend beyond the area you can see. As a result, the size of the surgical incision depends on the extent of the tumor. Two or three surgical layers are common, but you may require more. These are performed on the same day.