Mohs surgery is a highly specialized form of skin cancer surgery. Most skin cancers extend under the skin beyond what is seen on the surface. Therefore, Mohs surgery has two stages: first all the visible tumor is removed, then while the patient waits, the tissue is processed and carefully examined under the microscope. If there is any cancer remaining, another thin margin of skin is removed, from the affected area only, and this is again examined. The whole process is repeated until all the cancer has been removed.

WHAT ARE THE ADVANTAGES OF MOHS SURGERY?

Mohs surgery has two main advantages over other skin cancer treatments. First, for most skin cancers Mohs surgery offers the highest cure rate possible, approximately 99%. Second, as Mohs surgery is guided by what is found under the microscope, it removes the least possible amount of skin while still removing all the cancer. This is especially important for lesions on areas such as the ear or face.

WHO PERFORMS MOHS SURGERY?

Training in Mohs surgery requires a one or two year fellowship after completing a dermatology residency. Dr. Massey completed his fellowship in Mohs Micrographic and Cosmetic Surgery at Columbia University in New York.

IS MOHS SURGERY PAINFUL?

No. Mohs surgery is performed with local anesthetic. This means that the area will be made totally numb, so the patient is awake but does not feel any pain.

HOW LONG DOES MOHS SURGERY TAKE?

It is impossible to know before the surgery exactly how extensive the cancer is below the surface. If the cancer is limited to what is seen clinically, then only one or two stages of Mohs surgery may be needed to eradicate the tumor. However, occasionally the cancer extends far beyond what might have been expected and so several stages are required to achieve a cure. As a result, patients may be in the office for just a couple of hours or literally the whole day. Most of this time is spent in the waiting room, talking, eating and reading, while the tissue is being processed and examined under the microscope.

HOW WILL THE WOUND BE REPAIRED?

Once all the cancer has been removed the wound will be assessed and the best reconstructive options discussed with the patient. Sometimes the wound will be left to heal without reconstruction or sutures, in other cases the best cosmetic result can be achieved with a relatively simple repair, while for others complex reconstruction utilizing flaps or grafts may be the best option. Once the most appropriate reconstructive option has been agreed upon, the patient will be scheduled for that surgery, typically the very next day. (See section on reconstructive surgery or visit www.RalphMasseyMD.com for examples of reconstructive surgery.)

IS MOHS SURGERY RIGHT FOR ME?

Mohs surgery is not indicated for every skin cancer. It is most commonly used for;

• Skin cancers on important or high-risk locations such as the face or hands.
• Tumors that have reoccurred after a previous treatment.
• Large or rapidly growing tumors.
• Patients who have a predisposition to multiple skin cancers.

Your doctor and / or Dr. Massey can discuss with you whether Mohs surgery is right for you.

PATIENT INSTRUCTIONS FOR MOHS SURGERY

1. If your medical doctor has requested that you take aspirin, please ask your doctor if you may safely discontinue the aspirin before your surgery. If you are allowed to we request that you do not take aspirin, or products containing aspirin for ten days before and two days after your surgery.

2. Similarly, if you take any blood thinners such as Coumadin or Plavix, ask your medical doctor if you can safely discontinue this for 3 days before and one day after your surgery.

3. Please avoid Motrin, Advil, Ibuprofen, or any similar medications, or any Vitamin E supplements for five days before and two days after surgery. Like aspirin, these medications may cause increased bleeding both during and after surgery.

4. You may take Tylenol for any aches or pains both before and after your surgery. Tylenol does not cause bleeding, so that its use is not restricted.

5. Please avoid alcohol for two days after your surgery.

6. It is very important that you DO NOT SMOKE for one week before and for at least two weeks
after your surgery. Smoking will severely affect normal healing.

7. Please try to refrain from any heavy chores such as cleaning the house or lifting heavy groceries, as well as strenuous exercise for one week after your surgery.

• 3% Hydrogen Peroxide.
• Cotton tipped swabs (eg. Q-tips) & Gauze pads.
• Non-stick gauze pads, such as Telfa pads.
• Polysporin or Bacitracin ointment.
• Paper tape.

8. If you have a damaged or artificial heart valve or a new artificial joint, you may require oral
antibiotics prior to your procedure. Ask your medical doctor prior to your surgery.

9. Prior to surgery, please purchase the following items in order to care for your surgical wound.
• 3% Hydrogen Peroxide
• Cotton tipped swabs (eg. Q-tips) & Gauze pads
• Non-stick gauze pads, such as Telfa pads
• Polysporin or Bacitracin ointment
• Paper tape

10. Please shower with an anti-bacterial soap (such as Hibiclens), the night before your surgery.

11. ON THE DAY OF SURGERY PLEASE…
• Do not wear any make-up or jewelry to the office.
• Wear a button-down rather than a pull-over top.
• Take all your usual medications (except Aspirin, Plavix or Coumadin if allowed to discontinue).
• Eat your normal breakfast, and bring a packed lunch and a good book.
• BE PREPARED TO SPEND THE WHOLE DAY IN THE OFFICE.

12. Our goal is to make your treatment as pleasant and stress free as possible. If you have any questions prior to your surgery, please do not hesitate to call our office.