Mohs surgery is a surgical procedure that allows for the complete removal of skin cancer while sparing normal adjacent skin. This technique allows the skin cancer to be removed under microscopic control, thereby greatly improving the cure rate as well as minimizing the size of the final surgical wound. It achieves the highest cure rate (99%) for some types of skin cancers. By creating the smallest possible wound, the cosmetic outcome is much better than standard excisional surgery.

The American College of Mohs Surgery has published an informative video about Mohs surgery and its effectiveness as a treatment for skin cancer.

Mohs surgery is an outpatient procedure performed under local anesthesia (injections with numbing medication). After the area is numb, a layer of skin surrounding the cancer is removed. The removed tissue is processed in our laboratory and examined by the Mohs surgeon. Your doctor can determine with high precision whether any cancer remains and where it is. If there is still skin cancer left, you will return to the surgical suite for more surgery. These steps are repeated until the area is clear of cancer.

In most circumstances, your doctor will close the wound on the same day. The decision on how to repair the wound cannot be determined until the tumor has been completely removed.

Mohs surgery can be a lengthy process since it is impossible to know how large a cancer is until it is completely removed. Most patients are finished in 4-5 hours. However, on rare occasions the procedure can take an entire day. When you are ready to go home, wound care instructions will be provided.

Do:

• Bathe or shower with soap (preferably antibacterial) the night before or morning of your appointment.
• Eat breakfast the morning of your surgery. As a courtesy to our patients, complimentary light snacks and beverages are available in the clinic upon request. If time permits, you may also leave to get food and come back.
• Wear comfortable, loose fitting clothes. Consider bringing a light jacket, sweater, or blanket since the waiting room may be chilly.
• Take all of your regular medications on time. Bring your medications with you if you need to take them during the day.
• Bring something to pass the time. Free Wi-Fi is available.
• Arrive on time with completed paperwork, insurance information, and picture ID.

DO NOT:

• Do not wear makeup or earrings if the skin cancer is on your face.
• Do not smoke several weeks before your surgery since smoking causes poor wound healing.
• Do not drink alcohol for several days before your surgery since alcohol will increase bleeding.

It is NOT NECESSARY to stop the following medications:

• Anticoagulants or "blood thinners" such as Coumadin (warfarin), Plavix (clopidogrel), Xarelto (rivaroxaban), Pradaxa (dabigatran), Lovenox (enoxaparin), etc.
• Aspirin that has been prescribed to you by a doctor AND you have heart disease, coronary artery disease, stents, a history of heart attack, stroke or TIA. If you do not have any of these conditions, then call your doctor and ask if you can stop aspirin.

7 days before surgery:

• STOP taking Ibuprofen, Naproxen, or other non-steroidal anti-inflammatory agents (NSAIDS). Instead, Tylenol can be taken for pain but do NOT take more than 3000mg per day.
• STOP taking Aspirin and aspirin-related products if they are NOT prescribed by a doctor or if your doctor gave you permission to stop.
• STOP taking fish oil, vitamin E, flax seed oil and herbal supplements. Certain herbal supplements increase bleeding.

Contact our clinic to arrange for preoperative antibiotics if you have the following conditions:

Anxiety

Mohs surgery is well-tolerated by most patients. However, if you feel anxious about your surgery, please notify the staff when you arrive. If deemed necessary by our physician, an anti-anxiety pill can be given to you in the office. As a precaution, you will need to have someone drive you home.

Due to limited seating in our lobby, we kindly ask that no more than 2 people accompany you on the day of your surgery. Only 1 support person will be allowed in the surgery suite.

As a courtesy to our patients, we will file your insurance claims on your behalf. Any copays, deductibles, and coinsurance is due on the day of your surgery. If you are unable to take care of the full amount when payment is due, payment options are available to those who qualify. Our intent is to provide quality care and services to all patients regardless of their financial situation.

If you need to reschedule, we ask that you do so at least 2 business days in advance of your appointment. If you do not show up for your surgery or cancel with less than 24 hours notice (not including weekends), we do allow you to reschedule your surgery one time before requiring a $100 rescheduling fee for a future appointment. We understand that unforeseen circumstances arise and appreciate you letting us know as soon as possible.