What To Expect On The Day Of Surgery
After you arrive in the office, one of our nurses will greet you and take you to the treatment room where the Mohs procedure will be performed. They will take your blood pressure and ask about your medications and allergies.
Your surgeon will be in to greet you before the start of the procedure and answer any last-minute questions. The site of the skin cancer will be marked and your confirmation of the site as correct will be documented. Please let us know if there is anything we can do to make you feel more comfortable (i.e. change the chair position, etc.).
First, your surgeon will use a small needle to inject a local anesthetic (Lidocaine) to numb the skin. This feels like a bee sting and lasts only a few seconds. This is the only part of the procedure that is uncomfortable. The numbing medication lasts a few hours, however, if additional injections are needed later, these are usually painless or much less painful.
After the area is numb, your surgeon will remove a thin layer of skin affected by cancer. This is called Stage I and represents the first layer of skin that is mapped, divided, and color-coded. After Stage I is removed, an electric needle is used to stop any bleeding. The wound is bandaged with gauze and you will return to the waiting room or stay in the procedure room. While you are waiting, ask for a cup of coffee, cappuccino, or a latte, read a book or magazine, surf the internet, or chat with other patients. Over the next hour or so, your surgeon and the histotechnicians are busy processing the tissue and examining the stained tissue sections with the microscope. Please be patient since this technique requires meticulous care.
If the microscopic examination reveals that there is still skin cancer behind, your surgeon will repeat the procedure as soon as possible. This second layer is called Stage II. Because Stage I was divided, numbered, and color-coded, your surgeon can determine exactly where residual skin cancer is left behind. Stage II will consist of a layer of skin that corresponds to the map created from Stage I. Therefore, additional tissue is removed only from those areas still affected by skin cancer. The average number of removals required is a little under two stages. Fortunately, the Mohs procedure can be completed typically in less than a half-day and is on an outpatient basis.
Once your surgeon is confident that the skin cancer has been completely removed, he/she will discuss the options to repair the wound. Most often the wound can be closed in a linear fashion with stitches. This turns the circular hole in the skin into a fine straight line (scar). In other cases, a more complex procedure known as a flap or graft may be required to provide the best possible cosmetic result. This decision will depend on the wound size, depth, and location. If the wound is stitched up, the stitches are removed typically one week later, though this may vary from patient to patient.