Mohs Surgery for Skin Cancer

• Expect to wear a bandage for at least two days and up to seven days after surgery. You won’t be able to get the bandage wet for the first two days. On the day of your surgery, your care team will provide you with the exact details of your bandage and wound care.
• If the surgical site is near your eye, we may need to cover your eye with a bandage after surgery. In this case, for your safety, you should not drive. Please arrange to have a ride home. 
• You may experience bruising and swelling around your wound for several days after surgery.  
  Reduce your physical activities — including exercise — for one to two weeks following surgery. Again, your care team will discuss the exact details with you on the day of your surgery. Restrictions will depend on the site of your surgery.
• You may need to return to our office in one to three weeks to have your stitches removed.
• Rarely, your team may need to postpone your surgery due to medical issues that they find during your preoperative evaluation on the day of surgery. To avoid this possibility, you can have a consultation visit with us before you schedule the surgery. Please call us if you would like to schedule a consultation.
• The duration of surgery is hard to predict. You should expect to be at our office for several hours and possibly for the entire day.
• Do not schedule any trips or vacations in which you will be away from the Boston area until at least one week after your surgery. Complications are rare, but much easier to handle if you are available to come into our surgical suite. 

Except for rare circumstances, we perform Mohs surgery on an outpatient basis. This means that you’ll go home shortly after surgery. After checking in at our front desk, a member of the surgical team will bring you into one of our surgical suites.

We will review your medical history, allergies and medications. You will sign a consent form that allows us to perform the procedure. With your help, a member of the surgical team will identify your surgical site, and you will confirm that location is correct.

The surgical team uses local anesthesia to numb all feeling in the area around the skin cancer. Once the area is numb, the doctor removes as much of the skin cancer as possible by scraping it with a special instrument.

Then, the doctor removes a thin layer of skin at the site. The team marks, freezes and stains this layer so that the doctor can examine it under a microscope. This process takes about one to two hours. Larger specimens will take even longer to process.

In the meantime, a member of your care team will place a pressure bandage over your surgical wound. You can choose to wait in our main reception area or in the procedure room. During this time, you may read your book, watch TV or take a walk, perhaps to the coffee shop downstairs.

If you exit our reception area, please leave your cell phone number (and make sure your cell phone has good reception) so that we may contact you when it is time to proceed with your surgery.

If the doctor finds skin cancer at the edges of the specimen, the surgeon will repeat the process of removing another layer of skin, preparing it for the microscope and examining it. The surgical team will repeat these steps, called stages, until we no longer detect any skin cancer in the samples under microscopic examination.

Depending on the extent of your skin cancer, there may be several stages of your surgery. Since we cannot determine ahead of time how many stages you need, you should assume that you will spend most of the day with us. Rarely, it may take more than one day to remove a tumor.

• Don’t take any vitamin E, fish oil, over-the-counter supplements, herbal remedies or homeopathic medications one week before the procedure. Tylenol is OK to take.
• If you take blood thinners, continue to take them as usual. If you take Coumadin, continue to take it. The lab will check your international normalized ratio (INR), which measures blood clotting, within one week of your procedure and forward the results to our office. 
• Don’t drink alcohol for three days prior to surgery and two days after surgery. Alcohol can thin your blood.
• If you have an artificial heart valve, joint replacement, organ transplant or heart murmur, please call our office to let us know. You may need to take an antibiotic before your surgery. 
• If you have any other implanted electrical device (such as a vagal nerve stimulator or bladder stimulator), please call our office. You may need to switch this off before surgery.
• If you need to take antibiotics before surgical procedures for any other reason, please contact us or your primary care doctor for a prescription.
• Smoking can slow down wound healing. Please do not smoke. If you cannot stop completely, cut back as much as you can.
• If you’ve been prescribed Ativan (lorazepam) or Valium (diazepam), do not take it until after you sign your consent form or the procedure will be cancelled.

If your surgical site is on your leg, please wash your entire leg with antibacterial soap to reduce the risk of infection after surgery. We recommend Hibiclens, which you can find at most drug stores.

You also should:

• Get a good night’s rest.
• Take all of your medications and have breakfast or lunch before you arrive, unless your care team instructs you otherwise.
• Since you may be with us for much of the day, bring reading materials or a tablet/smartphone with earphones to help pass the time while waiting. Please pack a snack or lunch and a water bottle.
• We have free wireless internet access available in our reception area and throughout most of the hospital. Feel free to bring your laptop or other internet capable device.
• We perform all Mohs surgeries under local anesthesia. This means that we numb only the affected area, and you’ll be awake for the procedure. Most people are able to care for themselves after the procedure. However, if your case is lengthy or if the surgical area is around your eyes, you may need a ride home.

As with any kind of procedure, there are risks with surgery. Although these complications are rare, you should know about them. In general, the benefits of surgery are believed to outweigh the risks. 
Mohs surgery risks include:

• Post-operative bleeding: Some bleeding during the procedure is expected, but rarely occurs after surgery. If this should happen, applying pressure usually controls the bleeding.
• Infection: Infection rarely occurs. If it does, your doctor can prescribe antibiotics to treat it.
• Nerve damage: Most scars are numb because the treatment cut the sensory nerves. This may last for several months or longer. Very rarely, the tumor may infiltrate a nerve or come close to the nerve so that tumor removal results in nerve damage.
• Allergic reactions: Allergic reactions can occur due to the local anesthesia or bandaging material.
• Pain: There is usually minimal discomfort after the procedure. If you have discomfort at the site, Tylenol should help. If your procedure occurs on the forehead or scalp, you may develop a headache for one or two days following surgery.
• Scarring: A scar will always result from the procedure. It usually matures over several months and looks better over time. Our doctors are highly trained to minimize the appearance of scarring and to hide it within natural skin lines and wrinkles when possible.
• Recurrence: Rarely, some people will have tumors recur even after the doctor has successfully performed Mohs surgery. In most cases, your doctor will recommend Mohs surgery to treat recurrences.