What to Expect During Mohs Surgery

Mohs Micrographic Surgery is a procedure performed on tissue-sparing areas such as the head, neck, hands, feet, and lower leg region for the treatment of skin cancer such as Basal Cell Carcinoma and Squamous Cell Carcinoma.

On the day of your surgery we will get you set up in your own exam room and then our surgeon, Dr. James Quertermous, will identify the correct site based on photos and your pathology report. Once the site is confirmed, the medical assistant will inject numbing to the area. This part can be a little uncomfortable but very important, we want the patient comfortable during the surgery.

Once the patient is prepped and numbed, Dr. Quertermous will take the first stage, a small portion of tissue, then bring it to the dermatopathology lab. In the dermatopathology lab, our histotechs will make a slide from the patient’s specimen for Dr. Quertermous to look at under the microscope to determine if all cancer cells have been completely removed.

During stages, patients can wait in their assigned exam room. Free Wi-Fi is provided for laptops, phones and/or iPads. Patients may bring someone to wait with them - outside of when they are having the surgery. Once the patient’s pathology slides are read, Dr. Quertermous will advise if the margins are clear or not. If there are still residual skin cancer cells, the staging process repeats, and more skin tissue is taken. This process allows for the highest cure rate while sparing healthy tissue and leaving the smallest possible defect and scar.

If the margins are clear and there are no residual skin cancer cells, the patient will be started on their post-op care which may include: Placing sutures to close the wound (primary closure), letting the wound heal on its own (healing by secondary intention), shifting skin from an adjacent area (skin flap) to cover the wound, or using a skin graft from another part of the body, such as behind the ear, to cover the wound. If the surgical area is extensive or complex, the wound will be bandaged with a pressure dressing and we will coordinate with a plastic surgeon for reconstructive repair.

A follow-up visit may be required to monitor your recovery to make sure your wound is healing properly or to have the sutures removed. Based on what type of skin cancer, we may recommend more frequent full body skin checks in order to properly monitor the possible development of new lesions.

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