Mohs surgery is a type of surgery to treat skin cancer. It uses a special technique to remove ALL of the skin cancer but saves healthy tissue in order to limit scarring. Mohs surgery is the most effective treatment for skin cancer. It is often used to treat skin cancer that:

• May be on areas of the body where keeping appearance and function are important

• Has come back after being removed

• Has aggressive behaviors

• Covers a large area

• Grows quickly

During your surgery, a layer of tissue will be removed from your skin and checked for cancer cells using a microscope. If there are cancer cells, more layers will be removed and checked for cancer cells. This will continue until all the skin cancer has been removed and the margins are clear.

You will not get general anesthesia (medication to make you sleep) during your surgery. You will receive a local anesthetic (medication to make an area of your body numb).

Talk with your health care provider about risks associated with Mohs surgery. Possible risks may include:

• Pain or tenderness at the surgery site

• Infection

• Bleeding from the surgery site

• Scarring

• Slow or poor wound healing

• Numbness at the surgery site

• The wound splitting open where the incision (surgical cut) was made. This is only a risk if your wound is closed with sutures (stitches).

You will receive important information about how to prepare for your surgery and have time to review it and ask questions. If you are having a plastic surgeon close your wound, you will get more information.

Your health care provider will review your medications and health history.

If you develop any illness (fever, cold, sore throat or flu) or are hospitalized before your surgery, call your health care provider’s office.

Depending on how many layers of tissue need to be removed, you may be at Hoag for several hours. We recommend that you eat breakfast and bring lunch or snacks with you. We can store your food, if needed.

If you have any questions, call your health care provider’s office.

How Long Does Mohs Surgery Take?

The length of your surgery depends on how many layers of tissue are removed. Be prepared to spend 2-3 hours at Hoag. Again, we recommend that you eat breakfast and bring lunch or snacks with you. We can store your food, if needed.

During Mohs Surgery

First, you will get an injection (shot) of local anesthesia to numb the surgery site. Once the area is numb, the cancerous tissue and a thin layer of surrounding tissue will be removed. A bandage will be placed on your wound.

After your wound is bandaged, you will stay in the procedure room. You can relax and eat light snacks or your lunch while you wait.

A lab will process and examine the removed tissue. If there are cancer cells at the border (edge) of the tissue, they will need to remove another layer of tissue.

These steps will be repeated until they find no more cancer cells at the borders of the tissue.

Closing Your Wound

After all the cancer is removed, you and your doctor will discuss the best way for your wound to close and heal. Examples include:

• Allowing the wound to heal by itself.

• Suturing the wound.

• Creating a skin graft or flap to close the wound. A skin graft or flap is tissue that’s taken from one part of your body and moved to the area that must be covered.

• Having a plastic surgeon close the wound. If you need to have a plastic surgeon close your wound, this must be planned ahead of time.

Before you leave Hoag, you will get instructions about how to care for your wound at home. You will also be told when you need to come back for your follow up appointment.

You will be able to go home right after your procedure.

• You may have pain after your surgery. If you have pain, try taking extra strength acetaminophen (such as Tylenol Extra Strength).

• If you are allergic to acetaminophen or cannot take it due to a medical condition, ask your health care provider what you can take instead.

• Do not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve) unless your health care provider says it is OK. These medications can cause bleeding.

• You can also hold an ice pack over your wound to reduce pain and swelling. Hold the ice pack for 15 to 20 minutes every hour or follow the instructions your health care provider gives you.

• If you have sutures, do not lift anything heavier than 15 pounds. The sutures will be removed during a follow-up appointment.

• Do not exercise or travel on a plane for two weeks after your surgery.

Melanoma is a type of skin cancer that originates in the melanocytes, the cells that produce pigment in the skin. Melanomas can develop anywhere there is pigmented skin, even on internal organs or the eyes, but most often occur on parts of the body exposed to the sun, including the face, arms, back and legs.Though melanoma is very treatable if diagnosed early, it is considered the most dangerous type of skin cancer due to its quick growth and ability to spread to any organ inside the body. Though only about 1 percent of all diagnosed skin cancers in the U.S. are melanoma, the disease causes the majority of skin-cancer-related deaths.

At Hoag, Our Whole-Body, Patient-First Philosophy Is All About You

Helping to limit anxiety and calm fears, when patients come to us with a potentially worrisome blemish, spot or mole, our skin exams are detailed and thorough, helping patients feel confident and comfortable. Our team sees every exam as an opportunity to educate and our world-class team of specialists take the time to explain as we examine, helping patients not only understand why one mole is safe while another is potentially malignant, but also which specific factors lead to that determination.

At Hoag, we understand the power of seeing every patient as a whole person, not just a name on a chart. And it’s another great reason to trust Hoag for your dermatologic care.

The most frequent early symptom of melanoma is finding a previously-unnoticed spot on the skin, or changes to the size, shape or color of an existing mole or blemish.

In evaluating suspect spots, moles or blemishes, the CDC suggests that those deciding whether to consult their doctor should remember “A-B-C-D-E.” It stands for:

• Asymmetry: If you divide the spot in two, does it have an irregular shape that makes the two halves look different?

• Border: Is the border of the spot uneven, irregular or jagged?

• Color: Is color in the spot unevenly distributed across its surface?

• Diameter: Is the spot larger than the diameter of a standard pencil eraser?

• Evolving: Has the spot noticeably changed in color, size, shape or other characteristics over a period of weeks or months?

If the answer to one or more of these questions is yes, be safe and see your doctor.

There are a number of factors that are believed to increase your risk of developing melanoma.

Certain individuals are at higher risk for melanoma. These may include:

• Fitzpatrick skin types I, II

  • Type I – described as skin that always burns, never tans and is sensitive to UV exposure

  • Type II – described as skin that burns easily, tans minimally

• Excessive UV light exposure: excessive exposure to the sun or using indoor tanning beds

• A history of severe, blistering sunburns

• Family history of melanoma

• Personal history of non-melanotic skin cancers

However, not all melanomas are at high risk. Here are some additional, more specific, risk factors for melanoma:

• Having fair skin

• A previous diagnosis of melanoma

• Having more than 50 moles on your skin

• Diagnosis with dysplastic nevi, which are a variety of moles which tend to be larger, and of an irregular color and shape

• A weakened immune system (immunosuppression)

• Familial melanoma

• CDKN2A or CDK4 mutations

• Melanocortin 1 Receptor Genotype

• Childhood cancer survivors (previous treatment with XRT)

• Parkinson’s Disease

Ways to reduce your risk of developing melanoma may include:

• Check your skin regularly

• Avoid purposeful tanning, whether in the sun or in a tanning bed

• Avoid the sun during the middle of the day

• Wear sunscreen when outdoors, year round, as the Skin Cancer Foundation says that daily use of sunscreen of at least 15 SPF can lower your risk of developing melanoma by at least 50 percent.

• Limit your exposure to the sun while working outdoors through seeking shade, wearing clothing that covers more of your skin, applying a high-SPF sunscreen or working in the morning or late afternoon

The simplest step is to visit your dermatologist for a skin check-up once a year, or every six months if you have a family history.