How Long Does Mohs Surgery Take?
Mohs surgery continues until the entire cancer is cured. This is a meticulous process and can take time. You may be in the clinic for 2-4 hours or more depending on how many stages are required. Please eat breakfast before your surgery, bring lunch, and layers of clothing in case you get cold.
Am I Awake?
Mohs surgery is performed under local anesthesia while you are awake. General anesthesia is not required for Mohs. In-between stages you will have a temporary bandage on, and you can read, watch TV or your phone/tablet, and go to the bathroom. Guest wifi networks are available while you wait.
How Do I Prepare for Surgery?
Medications
- Take all of your medications as prescribed unless told otherwise by our office. We do NOT routinely stop blood thinners before Mohs surgery. Please do NOT stop these medications on your own without speaking to your doctor.
- Please let us know if you take any of the following blood thinning products (but do not stop any of these medications unless instructed to do so): aspirin, Coumadin (Warfarin), Plavix (Clopidogrel).
- We recommend that you stop all supplements 7 days before Mohs surgery. This includes Vitamin E, fish oil, etc. You can resume these supplements after your surgery.
- If you take aspirin on your own for heart health, but not at your doctor's specific recommendation, we suggest that you stop 7 days prior to Mohs as it can cause increased bleeding. You may resume this after Mohs. If your doctor has recommended that you take aspirin, because you have a history of heart problems, please do NOT stop aspirin prior to Mohs.
- Please stop OTC NSAID pain relievers (i.e. ibuprofen (Advil, Motrin) or Naproxen (Naprosyn, Aleve)) seven days prior to your surgery as they can increase bleeding. If you take any of these medications by prescription, please discuss this with your prescribing doctor first.
- You may take Acetaminophen (Tylenol) for pain during this period. Tylenol does NOT cause bleeding and is safe to take.
Alcohol
Three days prior to surgery, we ask that you avoid drinking alcohol as it may increase your risk of bleeding.
Breakfast, Companions, Makeup, and Books
- Eat your normal breakfast. It is NOT recommended that you fast prior to surgery. Pack a lunch to eat between stages of Mohs.
- It is helpful, but not required, that you have someone with you to keep you company between stages.
- You will have a bulky bandage after surgery. It is recommended, but not required, that you have someone else drive you home.
- On the day of surgery, please do not apply any makeup, sunscreen, perfume/cologne, or moisturizers to your skin.
- Because you will be with us for several hours, you may want to bring along a light snack and reading material, your tablet, or another quiet activity as there is waiting time between stages.
Will I Have a Scar?
There is always a scar after any surgery. Our Mohs surgeons have special training in techniques to hide scars in the natural contours of your face and to preserve the shape and function of sensitive areas such as the nose and lips. Scars improve over months as scar tissue remodels, so it is important to give the scar time to "mature." Silicone gel/strips can help scars fade after Mohs - please inquire about these products at our office.
What Can I Expect After Surgery?
Discomfort
- After the anesthetic wears off, there may be some soreness or aching. This usually improves within 24 hours.
- We do not routinely prescribe narcotics (opioids) after Mohs surgery. Studies have found that OTC pain relievers are just as effective for discomfort after Mohs surgery compared with Rx opioids.
- Rest, icing the area, and Tylenol are usually sufficient to relieve any discomfort.
- You may wish to start taking Tylenol after surgery even if you have no pain, to not allow discomfort to appear suddenly. Please follow the labels for prescribing doses.
- While NSAIDs like ibuprofen are not recommended before surgery because they promote bleeding, if you're having a lot of pain, you can take ibuprofen (along with Tylenol) 4-6 hours after your surgery.
Activities
- We recommend that you limit your activities for 7-14 days after the surgery to prevent the wound from opening up.
- Quick, jerky movements (i.e. golf swing, weight lifting, aerobic activity) should be strictly avoided after surgery for 7 days or more.
- Strenuous exercise after surgery can elevate your blood pressure and lead to bleeding and should be avoided.
- Remember that, even though you didn't go to sleep, you still had surgery and you should practice common-sense activity restrictions.
- At work, try not to lift anything over 5-10 pounds for 14 days. We can write you a note if you need it.
What Is Normal?
It is normal to have some redness and swelling around the area. You may also have some loss of sensation and nerve dysfunction. This generally improves over the first few weeks. Bruising may occur as well and can take one to two weeks to resolve.
- Bleeding after surgery
- Slight bleeding under the pressure dressing is normal and you may notice dried blood on your bandage when you remove it. More extensive bleeding is only rarely a problem after surgery.
- If more extensive bleeding occurs, apply moderate pressure continuously with clean gauze or washcloth for 20 to 30 minutes. Most bleeding will stop with pressure. Don't worry if you see some bleeding - this will not affect your health and it may take a few hours to stop.
- If there is still significant bleeding, please head to an emergency room and call our office on-call service.
- Infections are rare after Mohs surgery. This will appear as increasing pain, deep redness, significant warmth, pus/drainage, and/or redness several days after your surgery. If this occurs, please call our office immediately.
