Mohs micrographic surgery is a highly specialized, state-of-the-art procedure for removal of skin cancer. It is the most effective and advanced treatment for skin cancer today, offering cure rates of up to 99%. Mohs surgery consists of a precise technique that removes skin cancer in stages, allowing the Mohs surgeon to identify and remove the entire tumor while leaving the surrounding normal skin unharmed and intact. It is the procedure of choice for large, recurrent, or aggressive cancers, and cancers in cosmetically sensitive areas such as the face, scalp, ears, neck, shins, hands and feet. The entire procedure is done safely in the office, under local anesthesia.
Please arrive at our office 10 minutes prior to your scheduled appointment time. Nursing staff will escort you to a surgery room to review your medical history and explain the procedure.
Dr. Sheth will meet you and answer any questions you might have. She will circle the visible skin cancer with a marking pen and numb the area with a local anesthetic. Next, she’ll use a scalpel to remove the cancer and a very small amount of surrounding skin. Cautery or pressure will be used to stop any bleeding. A temporary dressing will be placed over the surgical site, and you will then be escorted to the waiting area.
The specimen is carefully oriented and marked with colored dye. Our Mohs technician will process the tissue by freezing it, cutting it in thin slices, placing it on slides, and staining it for microscopic evaluation. Dr. Sheth will carefully examine the slides under the microscope, checking the edges of each piece of skin for residual skin cancer. Completion of tissue processing and microscopic evaluation usually takes approximately 1 hour.
If residual skin cancer is found, we will bring you back to the surgery room for a second stage to remove the residual tumor – only in the specific area where it still remains. This process continues until all of the cancer cells have been removed. Most cases require 1-3 stages of Mohs for tumor clearance, but additional stages are sometimes necessary. Your surgery day may last from a few hours to the entire day.
Once the skin cancer has been completely removed, Dr. Sheth will discuss the most appropriate repair options for your surgical defect. Wound repair is usually performed on the same day as Mohs surgery. The goal of reconstruction is to give each patient an optimal cosmetic and functional result. Options for wound repair include
No. Continue all medications that have been PRESCRIBED by one of your doctors, including blood thinners (Aspirin, Coumadin [warfarin], Plavix [clopidogrel], and Xarelto). However, if you are taking Aspirin only as a preventative measure, please STOP this medication 2 weeks prior to your surgery.
If you take Coumadin, please have a routine coagulation study (PT/INR) drawn within 1 week of your surgery, and have the results FAXED to our office. (708) 390-0842.
Please bring a complete list of your medications with you on the day of your surgery.
Yes. To prevent bleeding problems, please discontinue the following medications and supplements unless ordered by your doctor, starting 14 days prior to surgery: Ibuprofen (Motrin, Advil, Aleve), Aspirin, vitamin E, fish oil, gingko biloba, multi-vitamin and all other herbal supplements. Again, if you take Aspirin because your doctor has suggested it as a preventative measure, please DISCONTINUE; if you have a history of heart problems or stroke (physician prescribed), CONTINUE the Aspirin. Tylenol does not increase bleeding and is fine to take.
The length of Mohs surgery is unpredictable because some skin cancers grow underneath the skin more than at the surface. Expect multiple brief episodes of surgery followed by long periods of waiting while we process your tissue and evaluated it under the microscope. The day usually lasts 2-4 hours, but occasionally patients spend the entire day at the office. Bring reading material, food for lunch or snacks, or a friend/family member to help you pass the time.
Injections of local anesthesia control pain during surgery. After surgery, patients normally experience only mild pain that can be controlled by Tylenol. In some instances, Dr Sheth will prescribe a stronger pain medication.
The surgical site will remain bandaged for approximately 1-2 weeks following surgery. Our staff will demonstrate how to care for your wound, give you written instructions regarding wound care, and provide Dr. Sheth’s direct contact information in case of a rare emergency. Usually you will return to our office within 1-2 weeks for bandage change or suture removal. To optimize healing, we ask that you do not plan any travel or other outings during this post-operative time.
We recommend that you avoid strenuous activities for at least 1-2 weeks after your surgery. Be aware that you may have significant swelling, redness, or bruising of the surgical site for 1-2 weeks post-surgery, especially if your cancer is on the central face (i.e. forehead, eyes, nose, lips). Icing the surgical site is an important part of the post-operative period.
Alcohol can increase bleeding and bruising; please avoid alcohol for at least 48 hours before your surgery. Stop smoking – ideally for at least a few days before and 1 week after your procedure. Smoking increases your risk of complications and infection from surgery. The best choice is to refrain entirely but even cutting back will help.