12 Must-Ask Questions Before Mohs Surgery

Don't Go Under the Knife Without These Answers

Undergoing Mohs surgery for skin cancer can feel overwhelming, but being well-informed can put your mind at ease. Asking your dermatologist the right questions before the procedure ensures you know exactly what to expect. 

In this article, we'll discuss 12 essential questions to ask before having Mohs surgery, covering everything from the basics to recovery and prevention.

1. What is Mohs surgery and how is it different from other skin cancer treatments?

Mohs surgery is the gold standard treatment for many basal cell and squamous cell carcinomas. The procedure is done in stages, examining 100% of tumor margins microscopically to ensure complete removal. This spares the greatest amount of healthy tissue for optimal cosmetic results. Mohs is an outpatient procedure performed under local anesthesia in a single visit.

2. Is Mohs surgery the best option for my specific type of skin cancer?

Mohs surgery is commonly used for basal cell and squamous cell carcinomas, and some melanomas. It's ideal for tumors on cosmetically sensitive areas like the face. Mohs is also used for large, aggressive, or recurrent tumors. Cure rates are up to 99% for first-treatment cancers and 94% for recurrent cancers.

Questions About the Mohs Surgeon

3. What makes you qualified to perform my Mohs surgery?

Look for a fellowship-trained Mohs surgeon who is highly experienced in the technique. Ask how many Mohs surgeries they have performed and confirm they are members of the American College of Mohs Surgery. Extensive specialized training is important for this delicate procedure.

4. How many stages of Mohs surgery do you anticipate for my tumor?

The number of stages depends on your tumor's size, location, and type. Most Mohs surgeries involve 1-3 stages. Your surgeon will examine 100% of the tumor margins during each stage microscopically. The process continues layer by layer until all samples are cancer-free.

Questions About the Mohs Surgery Procedure

5. What happens during each step of the Mohs procedure?

First, the area is numbed with local anesthesia. The visible tumor is removed with a thin margin of surrounding healthy tissue. A temporary bandage is placed while the removed tissue is color-coded, mapped, and examined microscopically to check 100% of the margins. 

If any cancer remains, your Mohs surgeon precisely removes another layer from only the cancerous area. The process repeats until the margins are clear.

6. How long does Mohs surgery usually take?

Plan to spend several hours at your appointment since Mohs is done in stages. Removing and analyzing each layer takes around 1-2 hours. The actual surgical time is shorter, usually totaling under an hour. Most of the time is spent waiting between stages for the microscopic analysis to be completed. Bring a book or activity to help pass the time.

7. What type of anesthesia is used and what are the side effects?

Local anesthesia is injected to numb the treatment area. Side effects are minimal, most commonly including temporary swelling and bruising at the injection site. There's much less risk compared to general anesthesia. You'll be alert and awake during the procedure and can drive yourself home afterwards.

Questions About Mohs Surgery Recovery & Follow-Up

8. What happens after the final stage when all margins are clear?

Once your Mohs surgeon determines all the cancer has been removed, they'll discuss repair options. The wound may be left open to heal, closed side-to-side, or closed with a skin flap or graft. 

This decision is based on the best anticipated healing and cosmetic result. Larger wounds typically take 4-6 weeks to heal. Additional reconstructive procedures may happen the same day or be scheduled later.

9. How do I care for the wound after Mohs surgery?

Your Mohs surgeon will provide detailed wound care instructions tailored to your specific repair type. In general:

• Keep the wound dressed and dry for 1-2 days
• Then gently clean the area daily with soap and water
• Apply a thin layer of petroleum jelly or antibiotic ointment to keep the wound moist
• Avoid strenuous activity, alcohol, smoking, aspirin, and ibuprofen for about a week

Close follow-up with your surgeon is key as the wound heals. Don't hesitate to ask questions if you're unsure about any of the aftercare steps.

10. What are the potential side effects and complications of Mohs surgery?

Most patients heal from Mohs surgery without problems. Temporary pain, swelling, bruising, bleeding, and scarring commonly occur and resolve with proper wound care. 

Rarely, poor wound healing, infection, or skin numbness can develop. Skin grafts and flaps sometimes fail to "take", requiring further repair. While Mohs offers extremely high cure rates, recurrence of the skin cancer is still possible and warrants ongoing monitoring.

11. How often do I need follow-up after Mohs surgery to check for recurrence?

Skin cancer follow-up is a lifelong process after Mohs surgery:

• Visits are usually scheduled around 1 week and 3 months post-op to check healing
• Skin exams every 3-6 months for the first few years to monitor for recurrence
• After 3-5 years, at least annual full-body skin exams for life
• Monthly self skin-checks at home are also important to catch any recurrence early

Your Mohs surgeon or dermatologist may recommend more frequent visits based on your specific risk factors. Following this surveillance schedule improves the likelihood of detecting a recurrence at its earliest, most treatable stage.

Questions About Skin Cancer Prevention

12. What can I do to minimize the risk of developing another skin cancer?

Since you've had one skin cancer, you have an increased risk of developing another in the future. Protect your skin from UV damage to reduce that risk:

• Avoid direct sun exposure, especially between 10am-4pm
• Wear SPF 30+ broad-spectrum sunscreen daily and reapply every 2 hours
• Cover up with UPF clothing, a wide-brimmed hat, and UV-blocking sunglasses
• Never use tanning beds and avoid sunburns
• See your dermatologist annually for a full-body professional skin exam
• Perform a thorough self skin-check every month and report any concerns

Adopting these prevention strategies can help you avoid a second round of Mohs surgery down the line. If you do notice a suspicious spot, promptly having it checked can make treatment easier. Establish a strong ongoing partnership with your dermatologist so you have support in keeping your skin healthy.

Moving Forward With Mohs Surgery

Having Mohs surgery may feel scary or overwhelming, but knowledge is power. By getting answers to these essential questions, you'll understand exactly what to expect before, during, and after the procedure.

Mohs surgery is the gold standard for treating many skin cancers after all, offering an extremely high cure rate and optimal cosmetic results. Take comfort knowing you're in skilled, experienced hands with your Mohs surgeon.

Use this information to feel confident and prepared going into your Mohs surgery appointment. Don't hesitate to discuss any other concerns with your doctor so you can put your mind at ease. Here's to becoming skin cancer free!