Skin cancer is the most common type of cancer in the U.S. In fact, one in five Americans are projected to develop skin cancer over their lifetime, according to the American Academy of Dermatology. Because your face, neck and hands are easily exposed to sun, these areas are more vulnerable to skin cancer.
Many dermatologic surgeons are trained to use a technique called Mohs micrographic surgery to remove skin cancer. With Mohs, the surgeon can remove the skin cancer with a narrow margin of normal skin and then examine the skin cancer under a microscope to see if it’s fully removed, says Dr. Jesse M. Lewin, Mohs micrographic/dermatologic surgeon and director of dermatologic surgery education at Columbia University Irving Medical Center in New York. The surgeon can remove more skin cancer if needed from the target area. Mohs is named after the surgeon, Dr. Frederic Mohs, who developed this approach in the 1930s.
Dermatologists use Mohs for skin cancers in functionally or cosmetically sensitive areas, Lewin says. These include:
— Feet and shins.
Mohs is most often used for non-melanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma. ( Melanoma is the most serious type of skin cancer.) Eighty percent of basal cell and squamous cell carcinomas are on the head or neck, the Skin Cancer Foundation reports.
Surgeons also may use Mohs for large or aggressive skin cancers that are on other parts of the body. They use it in those areas because Mohs has a success rate of up to 99% for non-melanoma cancers, Lewin says. There’s a 94% cure rate with Mohs for a skin cancer that has recurred in the same area, according to the Skin Cancer Foundation.
Prepping for Mohs Surgery
It can be scary any time that you hear you may need surgery. That’s why it can help to know what to expect before, during and after Mohs surgery.
Here are tips to help better prepare for Mohs surgery:
— Stop smoking two weeks beforehand, advises Dr. S. Brian Jiang, a clinical professor of medicine/dermatology and director of dermatologic and Mohs surgery at the University of California in San Diego. Although it’s always a good idea to quit smoking, it’s especially important before surgery, as smoking can impair wound healing. You should also avoid smoking for two weeks after surgery.
— Avoid alcohol for two days before Mohs surgery. Having alcohol in your system could raise your chances of bleeding during surgery and increase the chances of postoperative bruising, says Dr. Jennifer Lucas, a dermatologist and dermatologic surgeon with Cleveland Clinic in Cleveland, Ohio.
Occasionally, the Mohs surgeon will ask patients to take a dose of antibiotics before Mohs surgery if they have artificial heart valves or joints, Lewin says. Presurgical antibiotics can help cut down the risk for infection.
[Read: Ways to Prevent Skin Cancer.]
What to Expect During Mohs Surgery
Mohs surgery usually takes place in an outpatient clinic and may be done at the surgeon’s office.
Before surgery starts, you’ll receive an injection of a local anesthetic so you won’t feel any pain during the procedure. You may feel a pinch or burn when you receive the anesthetic, Lucas says. During the surgery, you may feel some pressure in the surgical area but not pain.
The Mohs surgeon will then remove skin cancer tissue, leaving behind a small (1 to 2 mm) rim of normal skin, Lucas says. Next, while you’re waiting for 30 minutes to an hour with a surgical bandage over the area, the physician and technicians will freeze the skin cancer tissue and turn it into microscope slides. Looking at it this way, the Mohs surgeon can see if the skin cancer is completely removed or not. There’s a 50% chance of complete removal with each layer removed, Lucas says.
If more surgery is needed, your dermatologist will repeat this procedure until all of the cancer is gone. Each stage takes about an hour, notes Dr. Brooke Grant Jeffy, a dermatologist with Spectrum Dermatology in Phoenix.
Once all of the skin cancer is gone, the surgeon will repair and reconstruct the area. Most Mohs surgeons can repair wounds that are present from skin cancer removal, Jiang says. Sometimes, the Mohs surgeon will work with a reconstructive surgeon to handle the wound depending on its size, location or if you’re prone to keloid scars. You should only feel pressure, not pain, during any wound repair.
If it’s a large wound from skin cancer, the Mohs surgeon or reconstructive surgeon will have to use a skin graft from another part of your body (such as behind the ear) to help cover up the wound.
Questions to Ask Your Surgeon
What medications should I avoid before surgery?
The surgical team may want you to avoid aspirin or nonsteroidal anti-inflammatory medications like ibuprofen or naproxen for two weeks because they can worsen bleeding, Jiang says. They also may want you to avoid supplements like Ginkgo biloba, ginseng or vitamin C as they can interfere with blood pressure or blood clotting, he adds.
How long will I have to use a surgical bandage?
If you’ve had surgery on your face, you’ll likely want to know in advance how long you have to wear a bandage, as that affects your appearance. Typically, patients need to wear bandages for one to two weeks and may experience bruising around the surgical area for two to four weeks, says Jeffy.
Do I need someone to drive me home?
Consider asking someone to give you a ride home if you’re feeling anxious about the procedure or you’re having skin cancer removed near the eye. Otherwise, it’s fine if you drive home yourself.
Can I eat before?
Unlike some other types of surgery, there’s usually no restriction on what you can eat before having Mohs surgery, Lewin says. Your surgeon will let you know if you need to fast for some reason.
How long will it take?
Wear comfortable clothing and bring something to help pass the time. That’s because Mohs surgery can take a couple of hours. After the surgeon removes your skin cancer, you’ll need to wait while it’s examined. Sometimes, they will need to perform surgery a couple of times before all of the skin cancer is removed. Between each time, there’s a waiting period. Because of the waiting time, you also may want to have some snacks, Jiang says.
What to Expect After Mohs Surgery
You can expect to leave surgery with a surgical bandage on your face. Most patients have sutures as well. If the sutures are on your face, the office staff will instruct you on how to do daily dressing changes until the top layer of sutures are removed, Lewin says. Each surgeon will have their recommended wound care and scar minimizing techniques, which could include massage and silicone gel, Jeffy says.
Here are some other tips to help manage your surgical wound after Mohs surgery:
— Expect some mild pain for two days. You may have some mild soreness and swelling initially and can usually use acetaminophen or ice packs for it. Occasionally, a person having Mohs may need prescription pain medication, Jeffy says. Some Mohs surgeons will steer you away from ibuprofen or aspirin as they are blood thinners, Lucas says. You can also ask your Mohs surgeon about the use of topical or oral arnica to help with any bruising, Jeffy advises.
— Sleep on two pillows during your recovery if the surgery was on your head or neck. This can help decrease swelling around the wound, Jiang says.
— Watch out for signs of infection. The risk for an infection after Mohs surgery is only 2%. You may want to perform your wound care outside of the bathroom to lower your infection risk. That’s because bacteria commonly are more prominent in bathrooms, Lucas says.
— Don’t be shocked if there’s a temporary loss of sensation. This can happen in the wound and in the skin around the wound due to damage of the skin’s small nerve fibers, Jeffy says. It’s common and usually temporary.
— Avoid strenuous exercise or activity for about a week during your recovery. It could irritate the wound.
— Be patient with recovery. There may be a surgical scar, and it can take a full year to mature to its final appearance, Lucas says. However, the surgical area should look much better by six weeks after Mohs surgery. Talk to your Mohs surgeon if you have any concerns about how the surgical scar looks.
— Maintain a sun-protective regimen. Use sunscreen with an SPF of at least 30 year-round. Wear protective clothing in the sun. See your dermatologist as often as recommended for skin checks. For those who’ve had previous skin cancer, that’s usually twice a year.
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