Since Mohs micrographic surgery is performed in an outpatient setting under local anesthesia, you should have a nice hearty breakfast before coming to the office.  You are also welcome to bring some snacks and water.  Please take all of your medications as usual.  If your primary care physician has recommended taking aspirin, please continue, but if you have started taking aspirin on your own accord, please discontinue 2 weeks prior to your procedure.  Please avoid taking ibuprofen, Aleve, and fish oil for 2 weeks prior to your procedure.

The surgical site will be cleaned thoroughly with surgical soap and the skin will be numbed with a simple injection of lidocaine, just like your original biopsy.  This should be the only painful part of the whole procedure.

After the skin is numb, a curette is used to gently scrape away the cancer cells. Because skin cancer cells do form the normal strong connections with their neighbor skin cells, they are easily dislodged from the skin.  This helps Dr. Fleming to delineate the true border of the skin cancer.

A 1mm margin is drawn around the clinical border of the cancer.  The margin is extremely small in order to save as much of the normal healthy skin cells and ensure the best cosmetic outcome.

The specimen is then given to our in-house histotechnician who makes a map of the tissue and then slices the piece onto microscrope slides.  This process takes about 45 mins.  Dr. Fleming will then review all of the microscope slides and will identify any cancer cells present at the tissue margin.  If there is a positive margin, at 12:00 for example, Dr. Fleming will take an additional specimen, but only around that 12:00 margin.  The second level is processed exactly the same as the initial level.  This process continues until the cancer is removed completely with no remaining positive margins.  The typical number of levels is 1-4, but on rare occasions may be more, which is why we recommend planning on being at our office til early afternoon.

Depending on the size and location of the defect, your wound may be sutured close, may require a flap or graft, or might be left to heal on it’s own.  Occasionally, the cancer is deeper and/or wider than expected and the repair is better suited for the operating room.  If this is the case, we will arrange for one of several local plastic surgeons to repair the site.

Mohs surgeries can be long and largely boring for patients.  We recommend bringing a friend or loved one for company and to drive you home after the procedure.  You will also be given specific instructions on proper wound care and when to return to the office for wound check or suture removal.  If you have any questions or concerns after the procedure, please don’t hesitate to call the office.