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Common Questions About Mohs Surgery

Mohs surgery was developed in the 1930's by Dr. Frederick Mohs and a vital part of his innovation was the development of a color-coding technique used to map and orient the excised tissue. Although the procedure has been refined over the last several decades, the heart of Mohs is this mapping process.

Simply put, the Mohs procedure is the removal of a skin cancer in stages. During the first stage, the surgeon removes only the visible tumor in order to minimize the loss of normal tissue. The area is numbed with local anesthetic and stings or burns intermittently for a minute or two. Patients may feel some pressure while the surgeon removes the tumor which only take a few minutes. A gauze bandage is placed on the wound and patients and their guests are escorted to a private waiting room with a TV, refreshments and snacks.

While patients are waiting, the surgeon prepares the tissue for an examination by a histotechnolgist, who determines if any of the tumor remains and its exact location. The process can take an hour or more. If some of the tumor remains, the surgeon removes more tissue from the identified, and the process continues until the removed tissue is free of tumor cells.

By treating the tumor in this way, the microscopic roots are made visible and can be removed in a conservative manner, preserving as much normal tissue as possible. The surgeon then determines the best options for repairing the wound. Dr. Whalen has extensive experience and training in complex reconstructive techniques.

Common Questions

 

How long does the procedure take?

Due to the time involved in the processing of the tissue and the possibility that more than one stage of removal may be required, the procedure can take two to four hours. Since much of the time will be spent in the patient lounge, it’s suggested patients bring something to read or an activity to pass the time. Surgery takes place in the early morning or early afternoon.

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How effective is the procedure and why is it better than any other treatment?

Treatment of basal cell and squamous cell carcinomas with the Mohs technique is 97 to 99 percent effective, even on cancers that have previously been treated unsuccessfully. The examination of the tumor is more thorough and tissue loss is significantly less than other procedures.

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Will I have a scar?

Any type of surgical treatment will leave a scar; however the Mohs procedure minimizes this.

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Will I be medicated for the procedure?

Only local anesthetic is needed for the Mohs procedure.

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Do I need to bring anyone with me?

It’s not required, but it’s a good idea to have someone who can to drive you home should it become necessary.

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Why must I have a consultation?

The consultation is important because it allows the doctor to examine your skin cancer, review your medical history, explain the procedure, and determine if Mohs surgery is the best treatment for you.

If a biopsy has not been taken, it can be done at the consultation. This is a simple five-minute procedure. Because all skin cancers are not alike, the course of treatment is determined by the type of skin cancer. Photographs are taken of the cancer and will be part of your medical record.

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How should I prepare for Mohs surgery?

Try to get a good night's sleep. Fasting isn’t necessary, but don’t drink alcoholic beverages for 48-hours before surgery. At the consultation, the surgeon will advise the patient what medications, if any, should be temporarily stopped prior to surgery. In general, they include Ibuprofen and vitamin E supplements for one week, aspirin and Plavix for two weeks and Coumadin for three to five.

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What happens after the skin cancer is removed?

Once the tumor is completely excised, the surgeon will evaluate the wound and discuss repair options that include stitches, letting natural healing, or a skin flap or graft.

With stitches or a graft, the wound will heal in one to two weeks and over a period of months continuing cosmetic improvement will be seen. If the wound is allowed to heal naturally, the tissue will grow back slowly in four to six weeks.

Regardless of the choice of repair, the wound should not be allowed to dry up and scab. Daily application of antibacterial ointment is required. Patients will receive complete wound care instructions from the surgeon.

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Will it hurt after the surgery?

It’s rare that patients complain of pain after the procedure – occasionally, a headache or mild discomfort. In most cases, Tylenol or an ice pack lessens the discomfort. Aspirin or ibuprofen should be avoided.

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What about bleeding after the surgery?

Bleeding is rare after Mohs surgery but if it happens, lie down and place steady, firm pressure over the bandage for 20 to 30 minutes. Do not remove the bandage to see if it’s still bleeding. If the bleeding persists contact the dermatology office or go to the nearest hospital emergency room.

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What else can I expect afterwards?

All wounds develop a small halo of redness. This is normal inflammation. Occasionally, a red, bumpy rash with severe itching may develop. This usually indicates an allergic reaction to either the tape or the antibacterial ointment. If this happens, contact the dermatology office immediately.

Patients who’ve had surgery around the eyes can expect mild to moderate swelling and occasional bruising. Using of ice packs 24 to 48 hours after surgery for no more than 15 minutes each hour, may reduce swelling.

After the wound has healed, patients may experience redness and tightness which will gradually diminish. Sometimes, nerves in the surgical area are affected, resulting in numbness. Sensation may take a year or more to return , but rarely is it permanent.

The Mohs surgeon follows the patient until the wound is healed. Patients are then discharged back to their general dermatologist for follow up.

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Since I've had skin cancer, how often should I have my skin examined?

Skin cancer patients have a 50 percent chance of developing it again. To catch new skin tumors in the early and most treatable stages, an annual full-skin exam with the dermatologist is advised.

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Hours: Monday to Friday, 8 a.m. to 4:30 p.m.
Phone: 860-679-7546
Fax for Dr. Whalen: 860-679-2915
Fax for Dr. Makkar: 860-679-8418

  
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