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Mohs Surgery

Frequently asked questions about Mohs Skin Cancer Surgery.

What is Mohs Surgery?

Mohs surgery is a specific type of skin cancer removal procedure named after Dr. Frederick Mohs.  With this technique, specially-trained dermatologists remove skin cancers one layer at a time, ensuring all of the cancer has been completely removed prior to reconstruction. 

Who performs Mohs Surgery at Belle Meade Dermatology?

Dr. T. Wayne Day is a Fellow of the American Society of Mohs Surgery.  Dr. Jerry “Jay” Smith completed a fellowship in Mohs Surgery and Cutaneous Oncology and is a Fellow of the American College of Mohs Surgery. Dr. Smith’s practice focuses solely on Mohs surgery.

What are the advantages of Mohs Surgery?

Mohs surgery offers the highest cure rates for skin cancer, which for most primary skin cancers is 99%.  In contrast, the alternative methods available to treat high-risk skin cancers have cure rates of only approximately 50-90%.

The reason that Mohs surgery is so effective is because it is the only technique that allows for evaluation of 100% of the surgical margin and allows the surgeon to detect any “roots” of cancer that were left behind.  In addition, it is very safe since it is performed in the office under local anesthesia.

Who needs Mohs Surgery?

Mohs surgery is used for skin cancers which are higher risk of forming subclinical extensions or “roots” which are invisible to the eye.  Mohs surgery is indicated in the treatment of skin cancers:

  • located on or in close proximity to the nose, eyelids, lips, ears, scalp, hands, feet, or genitalia
  • that are recurrent (skin cancer that has come back after being treated before)
  • that have an aggressive pattern on the biopsy
  • that are large
  • that are rapidly growing
  • that cannot be clearly defined (it is difficult to see where the skin cancer starts or stops)
  • that occur in immunocompromised patients (transplants patients, etc.)
What to expect that day

Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite where the surgeon will numb the area around the skin cancer. Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the surgeon and taken to the adjoining laboratory where the technician processes the microscope slides. You will have a temporary dressing placed over the wound and will be free to return to the waiting room.

The surgical procedure usually takes only 10-15 minutes. However, it takes a minimum of 1-2 hours in the laboratory to process and examine the tissue. You will be asked to wait in the waiting room while the laboratory work is being done. If remaining cancer is found, you will be brought back to the surgical suite and a second thin layer will be taken from that area. This will also be taken to the laboratory for processing while you wait. Although there is no way to tell before surgery how many stages will be needed, most cancers are removed in three stages or less.

How long does Mohs Surgery take?

It is impossible to predict how many stages of Mohs surgery a patient will need.  Each stage can take 1-2 hours to process in the lab with the reconstruction requiring an additional hour or more.  For that reason, you should plan on being in our office for the entire day.

  • Please feel free to bring snack or pack a lunch
  • You may also bring a light sweater as surgical rooms can often be cool
  • Bring materials to pass the time such as a book or magazines
Will I need stitches after Mohs Surgery or will there be a scar?

Any form of skin cancer treatment will leave a scar. However, because micro-graphic surgery removes as little normal tissue as possible, scarring is minimized. After the cancer is removed, we may choose to: (1) let the wound heal by itself, (2) close the wound with stitches or (3) reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result.

How do I prepare for Mohs Surgery?
  • Do not discontinue taking aspirin, Coumadin, Plavix, or other blood thinners unless specifically instructed by your doctor.
  • Avoid alcohol for 48 hours before and after surgery; alcohol can cause excessive bleeding
  • Prepare to be in the office for the entire day; as mentioned, bring something to pass the time.
  • You may be instructed to have someone drive you home from the surgery, but in most cases, you can drive yourself home. The waiting area is limited, so please try and bring no more than one person with you.  Please, no young children if possible.
  • Get a good night’s rest prior to the surgery. Unless otherwise instructed, you are free to eat and drink as usual the day of surgery.
What should I expect after Mohs Surgery?
  • Stitches will often need to be removed in 7-14 days depending on the surgical site
  • Bruising, swelling, and mild to moderate discomfort are common for the first couple of days after surgery
  • You must rest to heal properly. No exercise or heavy lifting for atleast one to two weeks after surgery
  • Depending on your job, you may need to take time off from work
  • The staff will provide detailed, written, instructions on how to care for the wound