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Mohs Micrographic Surgery

Mohs micrographic surgery is a precise surgical technique used to treat skin cancer. The procedure is done in stages, all in one visit, while the patient waits between each stage. During Mohs surgery patients are awake and alert. The surgery is performed using local anesthetic. After removing a layer of tissue, the surgeon examines it under a microscope in the on-site lab. If any cancer cells remain, the surgeon knows the exact area to precisely remove another layer of tissue.  The surgeon repeats this process until no cancer cells remain. In this way the skin cancer is removed entirely while doing minimal damage to surrounding healthy tissue. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery. This minimizes scarring, increases the chance of a cure and reduces the need for additional treatments or additional surgery.

Mohs surgery technique was developed by Frederic E. Mohs, MD, in the late 1930s. Mohs surgery is the gold standard for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), including those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for BCCs or SCCs that are large, aggressive or growing rapidly or have recurred after previous treatment.

Frequently Asked Questions:

What happens on the day of surgery?

The surgery takes place in the Teton Dermatology clinic. On the day of the surgery, your surgeon will first examine and confirm the area to be treated. You’ll then be prepped for surgery. This includes giving you an injection of anesthetic. This injection only numbs the area that will be operated on, so you won’t feel any discomfort during the procedure and you’ll be awake during the surgery.

Once the anesthetic takes effect, the surgery can begin. The surgeon starts by first cutting out the visible skin cancer and a thin layer of surrounding skin. The area is  then bandaged so that you can wait comfortably. While you wait, the Mohs surgeon looks at the removed skin under a microscope. The surgeon is looking for cancer cells. If cancer cells are found, you’ll need another layer of skin removed.

This process of removing a thin layer of skin and looking at it under a microscope continues until the surgeon no longer sees cancer cells.

Once cancer cells are no longer seen, your surgeon will decide how to treat your wound. Some wounds heal nicely without stitches, but most will need to be repaired with stitches.

How do I prepare for my surgery?

  • Let our clinic know what medications or supplements you may be taking, including any blood-thinning medications. Some supplements may affect your chances of bleeding after surgery, so make sure you let us know about those, too. Continue taking any prescription medications as instructed unless we advise you otherwise.
  • Wear comfortable clothing in layers that can be easily adjusted if you are too warm or too cold.
  • Bring something to help pass the time. Between your stages of Mohs surgery expect to wait about an hour, possibly longer, in a waiting room. It may help to bring a book or magazine to pass the time. You’ll be able to use the restroom or have a snack, if you need to, but you won’t be able to leave the surgeon’s office until the procedure is complete.
  • Clear your schedule for the day. It is not possible to predict how long your Mohs surgery will take. For most people, the procedure takes less than four hours. However, you should plan as though surgery will take all day, since there’s a very small chance it could take that long.

What can I expect after the procedure?

After all of the cancer has been removed, you and your surgeon can decide on how to repair the wound. Depending on the extent of the operation, this might include:

  • Letting the wound heal on its own (healing by second intention)
  • Using stitches to close the wound (primary closure)
  • Shifting skin from an adjacent area (skin flap) to cover the wound
  • Using a skin graft from another part of the body, such as behind the ear, to cover the wound
  • In rare cases, the surgical area may be too extensive or complex to close immediately and your surgeon may temporarily close your wound and refer you to another surgeon for reconstructive surgery to repair the wound.

What are the advantages of Mohs surgery?

Having any type of surgery can be scary. One advantage of Mohs surgery is that you know your results right away, and you usually don’t leave your appointment until all of the skin cancer has been removed. If your dermatologist recommends Mohs, you can take comfort in knowing a few facts:

  • Mohs has a high cure rate.
  • Your surgeon will remove the least amount of skin needed to treat the cancer.
  • Mohs surgery aids in preserving healthy tissue and thereby leaves you with the smallest possible scar. Mohs surgeons are highly trained in cosmetic facial reconstruction.


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Questions? Call Teton Dermatology at 307-734-1800