Mohs Surgery FAQ
It is very important for Dr. Tull to evaluate your skin cancer in person to be able to determine when the best timing for your procedure is. Some skin cancers are more aggressive and need to be treated as soon as possible. Others benefit from allowing the biopsy site time to fully heal to minimize the inflammation that can make clearing cancer cells more difficult and creating larger defects. We also need to make sure your blood pressure is healthy, make sure we have any special equipment ready if needed, and in some cases have time to consult a reconstructive surgeon. Even if you have been treated by Dr. Tull and her team in the past it is very important to have your pre-operative consultation.
When Dr. Tull and her team evaluate your skin cancer at the consultation they will determine if there will likely be a functional deficit. For example, if your skin cancer involves the tear duct or crosses the eyelashes you will likely be sent to a special eye plastic surgeon to repair the defect.
Often when a skin cancer is biopsied the area will heal and look normal again. In higher risk, cosmetically sensitive, and functional areas it is important to make sure that the lesion is gone with clear margins. If there are any cancer cells still left after the biopsy the scar could actually seal them in and cause the roots to grow down and take longer to show up again.
Only about half of Dr. Tull’s patients will need stitches. This is because she is specially trained to be able to take paper-thin tissue layers in cancers that are superficial enough. This happens when the skin cancers have been caught early and when the biopsy sites have had enough time to heal.
No. Mohs surgery is performed under local anesthesia, just like your original biopsy. Once the area has been numbed, we will keep the area “boosted” in any subsequent stages or repairs. Typically the numbing effect will last 2-3 hours.
Mohs is a highly specialized procedure that requires technical precision to be able to clear skin cancers with microscopic accuracy. Because it is difficult to predict how many “layers” it will take to clear your skin cancer and because the in-house laboratory work takes time, most patients end up spending the better part of their day with us.
Because Mohs surgery is performed so safely under local anesthesia, we are limited in how much anesthesia a patient can safely have within a given amount of time. We cannot start more than one lesion at a time in case one or both would require multiple stages and/or surgical repair. Even if a patient were to come first thing in the morning, clear after one Mohs stage, and not need stitches, they would have to “line up” again for their second lesion which would be much later in the day.
There is no way to treat a skin cancer and not have some physical evidence that something was there, even with chemotherapy creams and radiation. What most people are asking is will they have a noticeable scar. This depends on 3 factors: 1) the skill of the surgeon, 2) adherence to the post-surgical wound care regimen, and 3) the physical attributes of both the cancer (size, location, aggressiveness) and the patient (age, bleeding/infection risk, smoking status).
The only restriction will be to prevent bleeding in the high risk 36-48 hour window post surgery. This will minimize swelling, bruising, and risk for infection. Anything that increases your blood pressure in this window such as aerobic exercise or “cardio” will increase this risk. This is also why we ask you to keep our first pressure bandage intact and dry until the second morning after your procedure. Light exercise, lifting, and regular daily activity are allowed as long as they do not elevate your blood pressure.