Frequent Asked Questions about Mohs Micrographic Surgery

1. What does Mohs stand for?
Mohs micrographic surgery was named after its founder, Dr. Frederick Mohs. The concept of Mohs surgery originated in the 1930’s but it wasn’t until the 1970’s that several key modifications were made to the procedure that allowed it to become the leading treatment for skin cancer that it is today. 
2. Why did I get skin cancer?
Although there are some genetic conditions that predispose patients to develop skin cancer, the vast majority of skin cancer is caused from overexposure to the sun’s ultraviolet rays (both Ultraviolet A and Ultraviolet B rays). We know that both intense, intermittent sun exposure (sunburns), especially prior to the age of 18, and/or a lifetime of chronic sun exposure can lead to the most common types of skin cancer: #1 Basal cell carcinoma, #2 Squamous cell carcinoma, and #3 Malignant Melanoma. This is why protecting yourself from the sun’s harmful rays is so important in your fight against skin cancer. Although using sunscreen is vitally important for children under 18, it is never too late to start using sunscreen because it can have a dramatic effect on the development of new skin cancers in the future no matter what your age. 
3. Will my Mohs surgery occur in a hospital and will I have anesthesia for this surgery?
Mohs surgery is performed as an outpatient procedure in the office surgery suites at Dermatologic Surgery of the Carolinas (DSC). The procedure is performed entirely with local anesthesia which dramatically decreases the risks of adverse events associated with general anesthesia. Dr. Lane and his staff are especially adept at making the local anesthesia portion and your entire encounter with us at DSC as comfortable as possible. For patients that would like the addition of oral medicine that will help you relax during your procedure, please mention this prior to your surgery or during your consultation. 
4. Will my skin cancer metastasize (spread to other places in the body)?

The risk of metastasis depends on the kind of skin cancer. Basal cell carcinoma accounts for approximately 80% of skin cancers diagnosed today. Along with being the most common skin cancer, it is also the most treatable. The risk of metastasis for basal cell carcinoma is very close to 0% but basal cell carcinomas can cause extensive local tissue damage so it is vitally important to treat these skin cancers as early as possible to minimize the amount of this tissue damage. 

Squamous cell carcinoma is the second most common type of skin cancer today. When considering all squamous cell carcinomas, the majority of these skin cancers do not metastasize and, like basal cell carcinomas, cause only local tissue damage. But a small minority (5% or less) of squamous cell carcinomas can metastasize, especially if they are located in high-risk areas like the ears, lips, and genitalia. Because of this fact, squamous cell carcinomas are thought to be more aggressive than basal cell carcinomas and the earlier they are treated, the better the outcome for patients.

The third common type of skin cancer is malignant melanoma. While some early, superficial melanomas (lentigo maligna) are treated with a modification of the Mohs procedure, most malignant melanomas are treated with wide local excision with the addition of other procedures depending on the depth of the skin cancer. Please see a further discussion of melanoma in Skin Cancer Info.

5. What kind of skin cancers can be treated with Mohs surgery?

 The most common type of skin cancers treated with Mohs surgery includes basal cell carcinoma and squamous cell carcinoma. Some early, superficial types of melanoma (lentigo maligna) are treated with a modification of the Mohs surgery technique. Also, some more rare types of skin cancer and some aggressive benign growths are also treated with the Mohs surgery technique.

6. Can I continue my medications prior to my surgery?

Please have a detailed list of your prescription and non-prescription medications that you take ready to give our staff when you call to make an appointment. Most prescription medicines are continued during surgery but it is important to notify us of any blood thinners you are taking prior to surgery so Dr. Lane may tailor his recommendations to your specific case. If you take coumadin or warfarin, it is important that you arrange to have a PT/INR blood test within 2 weeks prior to surgery. Please fax this result to 803-329-0688.

Some non-prescription and herbal medicines also have blood-thinning capacity. Some of these include: 

Because of this, it is important that you notify us of any other non-prescription/herbal medicines that you take and we will advise you on whether or not to continue these medications based on your specific medical situation.

7. Do I need to take antibiotics prior to my Mohs surgery?

While this is a controversial topic and constantly evolving, we typically prescribe preoperative antibiotics for patients that have been told to take antibiotics prior to dental work or other procedures. This is especially important for patients with a history of a joint replacement in the last 5 years, patients with artificial heart valves, and patients with a history of certain types of heart murmurs or history of rheumatic heart disease. It is typically not necessary for patients with pacemakers, implanted defibrillators, or implanted screws/plates to take antibiotics prior to Mohs surgery. It is very important to discuss with Dr. Lane and his staff any medical conditions you may have prior to surgery so we may tailor our treatment to your specific medical situation.

8. Will I have stitches after my surgery?

Dr. Lane will have a detailed discussion with you after the skin cancer is removed about the different options available for treatment of the wound that remains after Mohs surgery. These include letting it heal on its own (secondary intention), putting stitches in the wound, or referral to another physician for more extensive reconstruction. For the vast majority of wounds, closure with stitches offers the quickest healing time and produces the best cosmetic result but Dr. Lane will tailor treatment to each patient individually.     

9. Will I have any limitations after surgery?

It will be very important that patients do not engage in any strenuous activity for a period of time after the procedure. Any activity that raises the blood pressure or requires exertion can have a negative effect on the healing wound and predispose wounds to re-opening or poor healing. Dr. Lane will discuss with you the length of time to avoid activity based on your specific situation. 

10. How do I take care of the wound after my surgery? 
You will leave our office after your surgery with a bulky bandage that provides pressure on the wound to prevent bleeding. Our staff will review in detail with you and your family how to bandage and take care of this wound and we will also provide written instructions at the time of surgery.
 
If you should have any questions about your wound or wound care, please do not hesitate to contact our office at 803-329-0888.
11. How can I prevent future skin cancers and how do I know it when I have one?

Since skin cancers are a direct result of ultraviolet rays from sunlight, proper protection from these rays is essential for prevention of further skin cancers. Please see Skin Cancer Info for more information.

Most skin cancers (basal cell carcinoma/squamous cell carcinoma) are noticed as a new growing lesion that occasionally bleeds and never completely heals. Although this is a typical presentation of skin cancer, they can present in a variety of ways and any new lesion that continues to grow and causes any symptoms or bleeds should be evaluated by a trained professional. 

Once you have one skin cancer, you have an elevated risk of developing more skin cancers. Because of this, it will be important for you to continue to follow up with your general dermatologist for regular skin cancer screenings (typically every 6 months for 2 years after having a skin cancer).

For a further discussion of protecting yourself from the sun’s harmful ultraviolet rays and the development of skin cancer, please see the Skin Cancer Info section. Please also see the Links tab to visit national skin cancer and dermatology websites to obtain more information.