Mohs Micrographic and Reconstructive Surgery

Mohs Surgery is a highly specialized procedure for skin cancer treatment. The surgery removes the skin cancer in stages, one layer at a time, until the cancer is completely removed. Once a tissue layer is removed, it is processed onto microscope slides. Using a technique specific to Mohs Surgery, fellowship-trained dermatologic surgeons Drs. Michael Hadley and Chad Tingey carefully examine the tissue. Any microscopic roots of the cancer can then be identified if they are present. If more cancer is present, the procedure is repeated.

Why Do I Need Mohs Surgery?

Mohs surgery provides patients with the highest cure rate even with the most complicated skin cancers. One of the most common reasons patients are referred for Mohs surgery is that other forms of treatment have failed. If this is your case, it does not mean that you are cancer-prone or have a hopeless case. The methods that have been used to treat you in the past simply did not destroy all of your skin cancer cells. In previously unsuccessfully treated cancers, other therapies have only a 50 to 70% chance for success. The success rate is much higher with Mohs surgery – often 97 to 99%, even if other forms of treatment have failed.

Before Surgery

You will receive a reminder call from our office a few days before your surgery. Try to get a good night’s sleep the night before surgery. Eat a light meal prior to surgery unless otherwise directed. If you are taking any medications prescribed by your doctor, take them as usual unless you are directed otherwise. We ask that you do not take any herbal supplements one week before coming in.

The Day of Surgery

The surgery is usually performed on an outpatient basis in our office, so you should be able to go home later that day. While it isn't possible to predict the exact timeframe each procedure takes from one patient to the next, you should plan for about a half a day, much of which you will spend in the waiting room. During this time, your removed tissue will be processed in our laboratory and examined by your surgeon under the microscope in our Mohs laboratory.

When you arrive for surgery, the surgical assistant will take you to your surgery suite and prepare the area of skin for surgery. Local anesthesia will then be administered around the area of the tumor as you will be awake during the entire procedure. Once the area is anesthetized, the Mohs surgeon will then remove the cancerous area(s). Your wound will then be covered with a bandage and the tissue will be sent to the laboratory for examination. It will take approximately 45 minutes for the tissue to be microscopically examined.

Once the skin cancer has been entirely removed, the Mohs surgeon will determine on the best method for repairing the wound(s) created by the surgery. The optimal method for you is determined by the size of the tumor, depth of roots, and location. Drs. Michael Hadley and Chad Tingey are well trained in all methods to repair wounds, including the use of flaps or grafts as needed. In most cases this is done on the same day.
We make every effort to obtain the optimal cosmetic results for you, in some cases, by working in conjunction with other surgical specialists in the field of cosmetic and cutaneous surgery. Plan to be in our office between 2-4 hours for the procedure.

After Surgery

A follow-up appointment will be required approximately 7 to 14 days after your surgery. At this time, you will have the stitches removed and a checkup by your surgeon. Follow up is extremely important, not only for your recovery to be monitored but also to spot any possible cancer recurrence. You may experience a sensation of tightness as the wound heals, but this is normal. You will feel this less and less as time progresses. In some cases, skin cancers involve nerves and it may be one or two years before your sensation returns to normal in that area. Any form of skin cancer surgery will leave a scar; however, the Mohs procedure tends to minimize this as much as possible. Mohs surgery preserves as much healthy skin as possible, maximizing options for repairing the wound.