Mohs Surgery Procedure

How to Prepare and What to Expect

-Do not stop any of your medications including blood thinners unless you are directed to do so by the physician who prescribed these medications.

-One week prior to the surgery avoid supplements of vitamin E, Ginkgo, Ginger, Garlic, Ginseng, and Feverfew, which can thin the blood. Three days before and after the surgery, avoid alcohol, which is a mild blood thinner.

-The day of surgery you may eat your usual breakfast.

-Please take a shower the morning of the surgery and clean the surgical site and surrounding area well with antibacterial soap and water.

-Do not wear makeup or apply lotions or creams on or around the area to be treated.

-Please wear comfortable clothing, preferably a two piece outfit.

-Due to limited waiting room space, please limit family and friends to one person.

-Patients with pacemakers or defibrillators should notify the doctor in advance of their surgery.

-If you are unable to keep your appointment please notify us within 48 hours and make sure to reschedule your appointment.

Most procedures are completed in 1 to 5 hours depending on how much needs to be done. Surgery is performed using a local anesthetic usually at a single visit. Most tumors require 1 to 4 stages for complete removal. There will be a one to two hour wait between stages during which each small layer is meticulously examined for remaining cancer cells. During this time the patient can wait comfortably with a simple bandage in place.  We recommend you bring a snack or lunch and some reading material.

Because Mohs surgery is an outpatient procedure, and uses local anesthesia, you will be able to drive yourself home or to work after your procedure.  If your cancer is near the eyelid skin, then you may prefer to have someone else drive you.

Dr. Giuffrida usually recommends not returning to work the day of the surgery and preferably the following day but exceptions can be made.

 

The Procedure

1. Dr. Giuffrida administers a local anesthetic at the site of the cancer.

2. Dr. Giuffrida removes the visible tumor with a surgical instrument. He removes a thin layer of tissue with a small margin around the tumor site and this is called the 1st stage. in which the cancer is removed in stages, one tissue layer at a time (see figure 1).

3. Dr. Giuffrida makes a map or drawing of the tissue. This is used as a guide to determine the precise location of any remaining tumor cells.

4. Dr. Giuffrida takes the tissue to his lab area which is within his office. The tissue is sliced into very thin layers and then mounted on microscope slides by a technician. These are then stained to help see the tissue better. There is typically a one to two hour wait between this period or stage in which the patient can wait comfortably with a simple bandage in place(see figure 2).

5. The entire margin of the tissue is examined with a microscope thoroughly by Dr. Giuffrida to check for evidence of remaining cancer cells.

6. If any cancer is found with the microscope, Dr. Giuffrida returns to the specific area of the tumor (Figure 3) as indicated on the map and removes another thin layer of tissue from the patient only from the area where cancer cells remain. (Figure 4).

7. The newly removed tissue is again processed in the lab and examined under the microscope by Dr. Giuffrida.

8. If microscopic analysis still shows evidence of disease, the process continues layer by layer until the cancer is completely gone. Once there is no further cancer cells seen with the microscope, the patient is evaluated to determine the best option to help the area heal. Because this systematic search reveals the complete “roots” of the skin cancer, Mohs surgery offers the highest chance of complete removal of the cancer while sparing normal tissue.

 

Recovery

After Dr.Giuffrida has determined that your skin cancer has been removed, reconstruction and healing of the treated area is also important. Together, Dr. Giuffrida and you will determine how the wound will heal best. Dr. Giuffrida is highly skilled in reconstructive surgery for repairing the wound. Usually the surgical area is reconstructed with sutures to try to achieve the best possible cosmetic and functional results. This is typically done the same day as the cancer removal. In certain cases the wound may be allowed to heal on its own. On rare occasions, Dr. Giuffrida may refer the patient to another reconstructive surgical specialist.

Most patients have only minimal pain after surgery. A normal dose of Tylenol can relieve most discomfort.

Some redness, swelling, and/or bruising is normal (especially around the eyes) and it gradually decreases in about one week. Bruising goes away in one to two weeks.

However, should you experience severe pain or sudden swelling, you should call our office immediately to notify us.

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