Number 1 Skin Cancer & Pre-Cancer Care

C. Skin Cancer Treatments

Number 1 Skin Cancer & Pre-Cancer Care

A. Skin Cancer Diagnosis

B. Skin Cancer Types

C. Skin Cancer Treatment

D. Pre-Cancerous Lesions

Number 1 Medical Dermatology
(Chronic & Inflammatory Skin Diseases)
Number 3 Pigment & Lesion Disorders
Number 4 Non-Cancer Growth
Number 5 Surgical Dermatology (Non-Cancer Procedures)
Number 6 Cosmetic Dermatology
Mohs Micrographic Surgery PDF

• Mohs Micrographic Surgery

1. What Is Mohs Micrographic Surgery?

Mohs micrographic surgery is an advanced technique for removing certain types of skin cancer—most commonly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). During Mohs, the surgeon removes the cancer in thin layers, examining each layer under a microscope the same day. This staged approach allows us to remove the entire cancer while saving as much normal skin as possible.

2. Why Mohs is often recommended

  • Skin cancers on high-visibility or high-function areas (nose, eyelids, lips, ears, scalp, hands)

  • Cancers with unclear borders

  • Recurrent skin cancer (previously treated but returned)

  • Tumors with higher-risk features or locations

 

3. How Mohs Works (Step-by-Step)

  1. Numb the area with local anesthesia.

  2. Remove the visible tumor and a thin layer of surrounding tissue.

  3. Map + color-code the tissue so the exact location is tracked.

  4. Examine margins under the microscope to find any remaining cancer cells.

  5. If cancer remains, we remove tissue only where needed and repeat until the margins are clear.

  6. Once clear, we discuss the best repair option for healing and appearance.

4. What to Expect on Surgery Day

  • Plan to be here several hours (Mohs is done in stages; waiting between stages is normal).

  • You will be awake; Mohs uses local anesthesia.

  • After margins are clear, your surgeon will recommend the best repair option:

    • Stitches (linear closure)

    • Flap or graft repair

    • Healing naturally (when appropriate)

    • Coordinated reconstruction for more complex cases (when needed)

What to bring: snack, water, sweater, reading material, phone charger.

5. Pre-Op Instructions (Before Surgery)

5. a) 1–2 Weeks Before

  • Provide a full list of your medications and supplements, including aspirin, NSAIDs, blood thinners, and herbal supplements.

  • Any blood thinner prescribed by your providers, patient needs to ask the prescribers to see if it’s OK to stop the med prior to surgery, and for how long.

  • Do not stop prescription blood thinners unless the prescribing clinician approves. We will guide you based on your situation.

  • Tell us if you:

    • Need antibiotics before dental work (certain heart conditions/joint replacements)

    • Have a bleeding disorder or history of heavy bleeding

    • Have had keloids or difficult scarring

5. b) One week before
  • Stop drinking alcohol (due to blood thinning effect of alcohol)
  • stop fish oil supplement
  • avoid optional aspirin and NSAIDS: Ibuprofen (Advil®, Motrin®), Naproxen (Aleve®), Aspirin (Bayer®), etc…
5.c) The Day Before

  • Get a good night’s sleep.

5.d) The Morning Of

  • Eat breakfast (unless instructed otherwise).

  • Take your usual medications unless told differently.

  • Wear comfortable, loose clothing.

  • Avoid makeup if the site is on the face; avoid hair products if on the scalp.

6. Post-Op Instructions (After Surgery)

6. a) Bleeding (Most Important)

  • A small amount of oozing is normal.

  • If bleeding occurs: apply firm, continuous pressure for 20 minutes (do not “peek”).

  • If bleeding continues after 20 minutes of firm pressure, call the office.

6. b) Pain Control

  • Most patients do well with acetaminophen (Tylenol) as directed.

  • Avoid ibuprofen/naproxen unless your surgeon says it’s okay.

6. c) Swelling & Bruising

  • Ice pack (wrapped) 10–15 minutes on/off for the first 24–48 hours.

  • Elevate the area when possible (extra pillow for head/face sites).

6. d) Wound Care Basics

Your care instructions may vary by location and repair type. In general:

  • Keep the initial bandage in place and dry for the time you’re instructed.

  • After that, clean gently and apply ointment, then re-bandage as directed.

6. e) When to Call Us Urgently

  • Bleeding that won’t stop after 20 minutes of firm pressure

  • Rapidly increasing swelling, severe pain, or tight pressure under the skin

  • Fever, pus, worsening redness spreading outward

  • Rash/hives or trouble breathing (seek urgent care)

Frequently Asked Questions

How is Mohs different from a standard excision?

Mohs checks the margins during the procedure and removes additional tissue only where cancer remains. Standard excision usually evaluates a smaller sampling of margins after the procedure.

Often several hours because tissue processing and microscopic evaluation happen between stages.

Any surgery can scar, but Mohs is designed to remove the least healthy tissue possible. We choose a repair method to support the best cosmetic and functional result.

You’ll be numb during the procedure. Afterward, discomfort is usually mild to moderate and manageable with recommended medication.

Commonly 5–7 days on the face and 10–14 days elsewhere, depending on location and repair.

Usually light activity after a few days, but avoid strenuous activity and heavy lifting for 7–14 days (varies by site). Follow your surgeon’s instructions.

Yes. Mohs treats the current skin cancer, but regular skin exams help detect new lesions early.