Mohs micrographic surgery is a precise method for removing skin cancer. It allows us to remove cancer cells one layer at a time while sparing healthy skin. This approach offers the highest cure rate for most types of skin cancer.
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This specialized technique, developed by Dr. Frederic Mohs in the 1930s, is now the gold standard of treatment and offers the highest possible cure rate while preserving as much healthy tissue as possible.
How Mohs Surgery Works
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The cancer is removed one thin layer at a time.
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Each layer is processed and examined under a microscope while you remain in the office.
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If cancer cells remain, the exact location is identified, and another precise layer is removed.
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This process continues until no cancer cells are detected.
While removing each layer only takes a few minutes, processing and examining the tissue can take about 2 hours per stage. Multiple stages may be required. As a result, you may need to spend several hours with us to clear your tumor and repair the defect. Please do not schedule other appointments/engagements the day of your surgery.
After surgery, there will be a wound. Your surgeon (Dr. Allen or Dr. Book) will discuss the best healing option for you, which may include:
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Natural healing
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Sutures (primary closure)
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Skin graft
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Skin flap
The decision depends on the size and location of the final wound once all cancer is removed.
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Bathing/Eating: Please shower/wash hair and eat normally the morning of surgery unless otherwise directed.
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Medications:
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Continue all regularly prescribed medications unless otherwise directed.
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Avoid Aleve or Ibuprofen for 7 days prior to surgery, if able.
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Aspirin:
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If prescribed for heart disease → continue taking it.
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If for prevention only (no prior heart attack or stroke) → stop 7 days prior.
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If you take blood thinners (e.g., Coumadin, Plavix, Eliquis), continue as prescribed unless otherwise directed.
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Please notify our nurse if you have a history of excessive bleeding during past procedures.
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The procedure is performed in our office’s Mohs surgery suite.
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Your surgeon will review the procedure and then numb the area with local anesthesia (Lidocaine).
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After tissue is removed, the area is cauterized to control bleeding and covered with a bandage while slides are created in our lab and reviewed your Mohs surgeon.
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If additional stages are needed, the process will be repeated.
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Once the site is cancer-free, most wounds are repaired the same day.
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Plan to spend the entire day in our office.
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Each stage requires waiting time between tissue removal and examination.
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While waiting, you’ll sit in our Mohs lounge. The temperature can vary in our surgical suites, so consider wearing layers and bringing a sweater to ensure your comfort.
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Meals & Comfort:
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Eat a good breakfast before arrival unless otherwise directed.
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You are welcome to bring snacks or lunch.
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Coffee, drinks, and light snacks are provided.
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Bring a book, magazine, or activity to help pass the time. Please bring headphones if you plan to watch anything with audio.
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If you use an oxygen tank, please bring a backup battery/enough oxygen to last the day
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Transportation:
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You may drive yourself unless the surgical site is near the eye or sedation is needed—then a driver is required.
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You may bring one adult companion, who may stay with you or return later for pick-up.
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Patients prone to disorientation/confusion should have a companion with them at all times.
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You will receive detailed post-operative instructions before leaving.
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Swelling and bruising around the site may last 1–2 weeks.
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Depending on the location, swelling or dressings may affect glasses or vision.
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Suture removal is usually needed in 1–2 weeks, depending on your surgeon’s recommendation.
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A bandage will be required for 24 hours up to 1 week, depending on your repair type.
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Activity:
Do not lift anything weighing more than 10 lbs until sutures/staples are removed. Avoid strenuous activities, such as jogging or aerobics until your stitches are removed. Walking is encouraged, but do not walk so fast that your heart rate greatly increases, or you are breathing hard. This could cause incisional bleeding.
Pain and Discomfort:
You may alternate taking Acetaminophen (Tylenol) and Ibuprofen (Advil) for discomfort unless you had been told you should not take these medications or your physician prescribed a different medication. Icing the wound over the bandage can help relieve post-operative pain and swelling. It is recommended to apply the ice pack in a covering (washcloth, etc) for 15 minutes every two hours. If these steps do not relieve your pain, please contact our office.
For wounds closed with stitches, staples or left open to heal (NOT SKIN GRAFTS):
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Leave bandage on for 24-48 hours after the surgery (duration per provider)
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Avoid heavy lifting, exercise, bending, or straining. Sleeping with your head elevated on a couple of pillows may help with swelling/discomfort if site is on head.
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A small amount of bloody drainage is not unusual for the first few days, but it should not be saturating or bleeding through the bandage. (see Bleeding section below)
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Remove bandage in 24-48 hours. If dressing tends to stick, pour warm water over/soak dressing to soften crust
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Cleanse wound with lukewarm tap water and a mild soap. Dry with clean gauze.
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After cleaning, apply thin layer of Vaseline, cover with non-stick gauze (Telfa) and tape or band-aid.
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Continue daily cleaning and dressing change until suture removal or area has healed completely.
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Showering the wounded area is usually safe after 48 hours but be sure to replace the dressing.
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Wounds tend to heal better (faster, with less pain, and a nicer cosmetic outcome) when kept clean and covered with ointment and a bandage as opposed to leaving uncovered with scab formation.
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Swelling and bruising are expected after surgery. Occasionally the swelling and bruising (especially around the eyes) can appear later (up to 3 days after the surgery).
Bleeding:
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Do not take Aspirin or other blood thinning medications unless you have been directed to do so by a physician.
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Some minor oozing of blood from the surgical site is normal for a few days after surgery. If your wound bleeds enough that blood soaks through to the outside of your bandage, follow these guidelines:
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Apply firm, continuous pressure with a gauze pad directly over the wound for 15-20 minutes. If bleeding continues, apply continuous pressure for another 20 minutes and immediately call our office.
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Call the office if any of the following occurs:
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Wound develops green or yellow drainage
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Surrounding area becomes red and swollen
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Red streaks are seen around the wound
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Fever develops after procedure
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You experience worsening pain at the surgical site after the first 3 days have passed
If you are calling between the normal business hours of 8:00 am and 4:30 pm, please call our main number (479) 876-8550 and press extension “1” for medical and follow the prompts to reach a phone nurse. You can also try reaching the Mohs Coordinator at (479) 876-8493. Please be sure to leave a voicemail or send us a text message on our Klara messaging system if you are unable to reach us directly. Please note, the Mohs Coordinator is not at her desk to check voicemails every day so if your call is time-sensitive, please send a Klara message or leave a voicemail for our phone nurses.
If you have questions or concerns after hours, please call our on-call provider at 479-426-4373 for assistance (be sure to leave a message) and you will be called back.
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Call our office at (479) 876-8550 (8:00 am–4:30 pm)
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For direct Mohs coordinator assistance, call (479) 876-8493.
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If unavailable, please leave a voicemail and your call will be returned at the next available desk day for the Mohs coordinator
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Once your provider refers you for Mohs surgery, scheduling may take up to 2 weeks due to case review and coordination
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