What Types of Skin Cancer are Treated with Mohs Surgery?
The most common types of skin cancer treated with Mohs surgery are:
These are the two most common types of skin cancer in America. Other more rare types of skin cancer are also often treated with Mohs surgery. Some early, superficial types of melanoma are treated with a modification of the Mohs surgery technique.
What Makes Mohs Different from Other Types of Surgery?
Mohs surgery is a specialized technique for removing skin cancer. The tissue is processed so that 100% of the skin edges (margins) are evaluated and therefore smaller margins can be taken. This means that Mohs surgery has the smallest wound possible which minimizes the scar. Additionally, the margins are evaluated right there while you wait, so if some skin cancer remains, it can be removed right away. Once the procedure is complete you will know that the margins have been checked for cancer and are clear.
Mohs surgery is not necessary for all skin cancers. It is generally used to treat higher risk tumors or tumors in more cosmetically sensitive areas.
What Should I Expect on the Day of the Surgery?
- Make sure to eat breakfast and take your medications as usual, unless otherwise directed.
- Surgery is performed in our office at 3508 South Lamar.
- You will meet with Mohs surgeon Dr. Jennifer Ranario who will go over your planned procedure with you and numb the area with small injections.
- Once the skin cancer is removed, we have a comfortable separate Mohs waiting room for you to have some coffee or read a magazine while the tissue is processed and examined. It may take up to one and a half hours for your tissue to be processed.
- If any cancer remains, you will return to the procedure room for more tissue to be removed in the appropriate area.
- Once all edges are clear of cancer, Dr. Ranario will close up the area or confirm your appointment later that day or the next with a plastic surgeon to do so.
Most reconstructions in our office are performed on the same day as your Mohs surgery.
It is difficult to predict how long your surgery day will be as it will depend on how many times tissue is taken to completely remove the skin cancer and the amount of surgery that is required for the closure. Most surgeries take half a day, but sometimes it can take the better part of a day. It may be best to the leave the rest of your day unscheduled, so you can allow yourself time to recover.
Should I Request a Plastic Surgeon for My Mohs Reconstruction?
Most likely, Dr. Ranario will perform the closure. However, occasionally the wound from Mohs surgery may involve a critical structure or be quite large or complex. In those cases, she will involve the expertise of another surgical specialist (for example, a plastic surgeon or an ear, nose, & throat doctor).
At your surgery planning appointment, Dr. Ranario will discuss whether another surgical specialist might be needed and she will coordinate your care with that office.
What is the Cost of Mohs Surgery?
The average cost of Mohs surgery depends on the size of the tumor, the number of tissue layers to be removed, and subsequent wound management.
Mohs surgery is considered a medically necessary procedure and typically is covered by Medicare and most insurance plans. Some surgical charges apply to insurance deductibles, so out-of-pocket costs may vary from patient to patient. Our office will work with your insurance company to obtain approval and estimated benefits prior to your procedure.
If you are uninsured, you may qualify for a cash discount. Please let us know if cost is a barrier for you to get the care recommended by your doctor.
What is the Recovery and Healing Process After Mohs Surgery?
Your wound will require daily care during the weeks following surgery. Typically patients will have sutures which are removed a week or two after surgery, but full healing of the wound takes several weeks and sometimes even months. You should plan on wearing a bandage and refraining from any strenuous activity for several days. If you surgery is on a site where there is a lot of movement (back, neck, legs, arms), you may be asked to avoid strenuous activity for 2 weeks. You will be given detailed instructions on your post-procedure care. It is very important that you follow these instructions to ensure proper healing.
Most patients experience minimal discomfort or pain. It is normal to experience a feeling of tightness and pulling to the surgical site as healing occurs. Skin cancer sometimes involves nerves and it make take months before sensations return to normal. Sometimes numbness may be permanent.
Any type of surgery will leave a scar. However, Mohs micrographic surgery aims to minimize scarring by preserving as much healthy tissue as possible. You should be aware that it will take several months for your scar to mature. Redness can take a year to fade, and any lumpiness can take several months to resolve.
What Type of Anesthesia Will I Have? Can I Drive Myself Home After Surgery?
Dr. Ranario will use a local anesthetic to numb the area of cancerous skin. This will be done with a localized injection similar to the one you had when your biopsy was done.
It is reasonable to have someone with you to take you home after your surgery. If you have been given a sedative or if your surgery is near the eye, hands, or feet, you will not be able to drive.
Most patients have someone accompany them on the day of the surgery. We have a very comfortable waiting room just for our Mohs patients equipped with drinks, snacks, free Wi-Fi, etc.
Can I Continue My Medications Prior to Surgery?
Please provide Dr. Ranario with a detailed list of:
- ALL prescriptions
- Non-prescription medications that you take including all supplements
- Herbal medications as well
Most prescription medications can be continued prior to surgery, but it is extremely important to let Dr. Ranario know if you are on any type of blood thinner such as Coumadin or Warfarin. You will be advised as to which medications and supplements may need to be discontinued prior to surgery.
Do I Need to Take Antibiotics Prior to Mohs Surgery?
You may be prescribed a pre-operative antibiotic. It is important that you discuss ALL medical conditions with Dr. Ranario prior to surgery so that a specific treatment can be prescribed for your individual medical situation.
What Should I Wear on the Day of the Surgery?
- You should wear loose comfortable clothing that you can get in and out of easily. For example, it may be best to wear a button down shirt.
- Often you will need to change into a gown for surgery.
- Surgical rooms can be chilly (so we have blankets available), but you may want to bring something with a little warmth.
- You should avoid wearing jewelry the day of your surgery.