The length of time required to complete a Mohs surgery case is variable, and is based on the involvement of the tumor and the complexity of the surgical reconstruction. As a general rule, each stage of Mohs will require approximately one hour for tissue processing to be completed. If the tumor persists at the margins, an additional stage will be performed, which will add an additional hour to the procedure. Additional stages, if necessary, are performed until all of the cancer has been removed. The surgical reconstruction will then take an hour or more to complete.
Given the highly variable time requirements to complete the Mohs procedure, we ask that all patients anticipate being in the office all day and plan their schedules accordingly. Much of the day involves waiting in the office’s reception area or the examination room while the tissue samples are being processed.
As the Mohs procedure is performed under local anesthesia, patients are encouraged to have a normal breakfast on the morning of their procedure. Patients are asked to avoid caffeine on the day of their surgery, however, as caffeine, in combination with the epinephrine that is typically used in the local anesthetic, may result in over-stimulation.
Many patients drive themselves to their Mohs surgery appointment. As the procedure is performed using local anesthesia, there is no contraindication for driving post-operatively. However, patients who receive oral pain medications or anti-anxiety medications during the procedure are required to have a driver. In addition, patients with cancers around the eyes or nose may have swelling post-operatively, which may partially obstruct one’s vision and necessitate a driver.
The Mohs procedure is performed using local anesthesia. Prior to administrating the local anesthesia, which is injected with a small needle, a topical anesthetic is often used to minimize the discomfort of the injection. Additional local anesthetic is administered throughout the day, if necessary, to minimize discomfort. Oral medications are also sometimes used to control pain and minimize anxiety, if necessary.
A successful surgical outcome relies on the skill of the surgeon, appropriate post-operative care by the patient, and the ability of the body to heal.
The Mohs procedure minimizes the removal of healthy skin, resulting in the smallest possible surgical defect. This helps to decrease the risk of scarring. Dr. Bortz will choose the most appropriate reconstruction option to achieve the best possible aesthetic outcome. Post-operative wound care instructions are provided, which patients must follow closely to promote healing.
The majority of patients heal with an imperceptible scar. Some wounds, however, may take several months to completely settle. A small percentage of patients will require a touch-up surgery or laser procedure to achieve the highest possible aesthetic outcome.
There is typically some degree of bruising and swelling after the Mohs procedure, particularly for surgeries around the eyes or lips. These changes are most pronounced during the first one to two days and may take up to a week or more to resolve. A larger bandage is typically required for the first one to two days, at which time a smaller bandage is placed. Many patients return to work the day after the procedure, if they are comfortable going to work with a larger bandage and some degree of bruising and swelling.
Sutures on the face and neck are removed between days 5 and 7 post-operatively. Sutures on the scalp, torso, and extremities are removed between 12 and 14 days post-operatively.