Patients should review all surgical treatment information with their physician prior to undergoing treatment for Mohs surgery and reconstruction. Penn Dermatology's Mohs surgeons are available for consultation or questions at any time during the entire treatment process.
What to Expect During Mohs Surgery
During Mohs surgery, patients may experience minor discomfort when local anesthesia is injected around the skin cancer. The discomfort is similar to the biopsy that was done for their skin cancer.
After numbing the area around the skin cancer, the Mohs surgeon removes all visible portions of the skin cancer and a thin margin of normal-appearing skin. A staff member places a temporary bandage over the wound and takes the patient to a waiting area. While the patient waits, the Mohs surgeon examines the entire edge of the removed skin under the microscope in Penn Dermatology's on-site laboratory.
Patients do not feel pain while the Penn Mohs surgeon removes the skin cancer or stitches the wound. Subsequent anesthetic injections prior to any additional stages or reconstruction of the wound are often painless, since the anesthesia from the first injection is usually still effective.
If microscopic examination shows that the cancer has been completely removed, the wound is ready to be repaired. But if microscopic examination identifies extensions of the cancer that are not visible at the surface of the patient's skin, the Mohs surgeon needs to remove those precise areas where the cancer still remains.
If all of the cancer was not removed in the previous stage, the staff member brings the patient back to the operating room. During subsequent stages, the Mohs surgeon cuts out the precise areas where cancer still remains. The process of targeted cancer removal and complete microscopic margin examination continues until the Mohs surgeon finds that all of the cancer has been removed.
When all of the cancer has been removed, the Mohs surgeon discusses all the options for repairing the wound with the patient.
How Long Does Mohs Surgery Take?
The Penn Mohs surgical team cannot predict precisely how long it takes to remove the skin cancer and reconstruct the surgical wound. Times vary depending upon the nature and characteristics of the skin cancer. It is strongly recommended that patients plan to spend the entire day at Penn Dermatology and cancel any other appointments on the day of their surgery.
Waiting is the most difficult part of the process. The dermatology staff strives to keep patients informed of their progress and work efficiently so patients can return to the comfort of their homes as quickly as possible. It is recommended to bring reading materials or a companion to help pass the time.
In most cases, the Mohs surgeon repairs the final surgical wound the same day of surgery after confirming that all of the cancer has been removed. Most wounds are repaired with stitches. Patients that cannot tolerate reconstruction on the same day of surgery or whose wounds are extensive and inappropriate for reconstruction under local anesthesia are rescheduled to return for reconstructive surgery.
Scarring and Healing after Mohs Surgery
In most cases, the Mohs surgeon immediately repairs the wound with stitches. Larger wounds may require a flap by rearranging skin from near the wound, or a graft that borrows skin from another site to cover the wound. In certain cases, the surgeon may recommend letting the wound heal on its own to achieve the best appearance.
Any surgery to remove skin cancer results in a scar. However, the precision of the Mohs technique helps decrease the amount of scarring by removing all of the diseased skin while leaving behind as much healthy skin as possible. Penn Dermatology's Mohs surgeons are skilled in surgical reconstruction and repair wounds to minimize the scar as much as possible.
Most patients heal well and do not require additional treatment to their scars. However, patients with concerns about the scarring or healing process should contact Penn Dermatology to discuss other options for cosmetic improvement.
Mohs surgery is performed under local anesthesia. Patients return home with a bandage over the surgical wound. In rare cases, hospitalization may be necessary, in which case Penn Dermatology makes the hospital admission arrangements for patients.
Penn Dermatology recommends that a companion drives patients home after surgery. Postoperative swelling or bulky dressings used to cover the surgical wound may obstruct vision or restrict movements, making driving alone dangerous. Driving is prohibited if a sedative is administered during surgery for nerves or anxiety.