What Drug is Used to Numb the Pain When You Have Mohs Surgery?

Anesthesia Options for Mohs Surgery

The anesthetic commonly utilized to provide numbness during Mohs surgery is lidocaine. The surgeon administers lidocaine via injection surrounding the tumor site, blocking pain signals in the nerves to keep the area anesthetized throughout the procedure.

Mohs surgery can make patients uneasy about pain, but there are highly effective numbing techniques used throughout the procedure. Patients remain comfortable while the surgeon removes layers of skin tissue to eliminate cancer cells.

But what exactly is the medical magic that keeps the area around the tumor completely numb during the Mohs process? How is this anesthesia administered to block any pain and discomfort for hours at a time?

In this article, we will explain the sedation process for Mohs surgery. We’ll explore the powerful local anesthetic that keeps the area fully numb, how it’s delivered, and other ways your medical team manages pain before, during, and after the procedure.

By understanding the meticulous sedation process, you can feel at ease knowing Mohs surgery doesn’t have to hurt. You’ll be relaxed and pain-free as the doctor sculpts away imperfections until only healthy, beautiful skin remains.

Schedule a consultation with our experienced team at Dermatology and Skin Health to determine if Mohs surgery is the best treatment option for your skin cancer.

What is Mohs Surgery?

Mohs surgery, developed by Dr. Frederic Mohs in the 1930s, is a precise surgical technique used to treat skin cancer. The primary goal is to remove all cancerous cells while preserving as much healthy tissue as possible. 

This is achieved through a layer-by-layer excision of skin, with each layer examined microscopically for cancer cells until clear margins are confirmed.

Mohs surgery is most commonly used for:

• Basal Cell Carcinoma (BCC): The most prevalent type of skin cancer.
• Squamous Cell Carcinoma (SCC): The second most common type.

Additionally, it is effective for treating some rare skin cancers, such as:

• Dermatofibrosarcoma protuberans
• Microcystic adnexal carcinoma
• Sebaceous carcinoma
• Extramammary Paget disease

It is typically used when the skin cancer is high-risk, in a cosmetically or functionally sensitive area, or has recurred after previous treatment.

The goal of Mohs is to remove all cancerous cells while preserving healthy tissue. This is achieved by progressively removing thin layers of tissue and immediately examining them under a microscope.

Once the margins are clear, the surgical defect is repaired using one of various reconstructive techniques like simple closure, skin grafts, or flaps.

Why is Mohs Surgery Used?

There are several advantages to Mohs surgery:

High Cure Rate

Mohs surgery is known for its high cure rates, with studies indicating 5-year cure rates of 97% or higher for basal cell carcinoma (BCC) and 95% or higher for squamous cell carcinoma (SCC).

Tissue Sparing

The technique involves removing cancerous tissue layer by layer while examining each layer microscopically. This method allows for the preservation of healthy tissue, minimizing unnecessary removal and reducing potential scarring.

Accuracy

Mohs surgery's approach enables precise mapping and removal of tumors, including small or deep extensions that might not be visible during standard excision. This thorough examination helps ensure complete cancer removal.

Versatility

It is particularly beneficial for cancers located in sensitive areas such as around the eyes, nose, lips, and ears, where maintaining healthy tissue is crucial for both function and appearance.

Cost-Effectiveness

While some studies suggest that Mohs surgery can be more expensive initially due to the specialized nature of the procedure, it can be cost-effective in the long run. The high cure rate reduces the likelihood of recurrence and the need for additional treatments or surgeries.

Minimizes Scarring

By removing only the necessary cancerous tissue and preserving as much surrounding healthy skin as possible, Mohs surgery typically results in smaller wounds and less noticeable scars compared to other surgical methods.

Does Mohs Surgery Hurt?

With proper anesthesia, most patients do not feel pain during the procedure after the initial injections. They may feel some minor pressure or tugging as tissue is removed.

Here are some factors that influence pain levels during Mohs surgery:

Site of Surgery	More sensitive areas like the nose, lips, or fingernails may experience more discomfort than thicker-skinned areas before lidocaine takes effect.
Size of Tumor	Larger tumors or those that extend deeper require more injections and tissue removal, which may increase pain.
Individual Pain Tolerance	Some patients have a higher threshold for pain than others.
Anxiety Level	Anxiety may increase focus on pain; relaxation techniques can help mitigate this effect.
Skill of Surgeon	An experienced Mohs surgeon will use ample anesthesia and remove tissue precisely and efficiently.

Let Dermatology and Skin Health's compassionate surgeons expertly manage discomfort before, during, and after your Mohs procedure. Contact us today

Numbing Medications Used During Mohs Surgery

To maximize patient comfort throughout this process, a local anesthetic is used to numb the surgical site and surrounding tissues.

The most common anesthetic used is lidocaine. Some brand names for lidocaine include Xylocaine or Lidoderm.

Lidocaine belongs to the amide family of local anesthetics. It prevents nerves from transmitting pain signals by blocking sodium channels in nerve fibers.

Lidocaine provides rapid onset of anesthesia, generally within 2-5 minutes after injection. Anesthesia lasts approximately 1-2 hours, which is suitable for most Mohs cases.

Lidocaine is preferred for Mohs surgery because it:

• Provides excellent pain control during and immediately after the procedure.
• Has a rapid onset and medium duration of action.
• Results in minimal irritation or burning when injected.
• Has a wide safety margin, making lidocaine allergy very rare.
• Is readily available as a generic, lowering costs.

How is Anesthesia Administered?

For Mohs surgery, lidocaine is administered locally via injection around the tumor site. This is referred to as local infiltration or a "nerve block".

Using a very fine needle, the surgeon injects the lidocaine solution into the dermis, just under the surface of the skin. This blocks pain sensation to the epidermis, dermis, and upper parts of the subcutaneous tissue.

Injecting lidocaine creates a ring of numbness around the surgical site, allowing the surgeon to remove layers of tissue without causing pain. Additional anesthesia can be administered as needed during the procedure.

For larger tumors or those on the scalp or other sensitive areas, the initial injection may cause some minor temporary discomfort. But within a few minutes, the lidocaine will take effect and the area will become fully numb.

The Mohs Surgery Procedure

Now that we've covered anesthesia, let's take a step-by-step look at what happens during a Mohs procedure:

Step 1 - Removal of Visible Tumor

After inspecting and marking the surgical site, our Mohs surgeon will use a scalpel or curette to scrape away the visible tumor above the skin. Bleeding is controlled with an electrocautery device.

You may feel some tugging or pressure during removal of the visible growth, but the area should be completely numb.

Step 2 - Removal of Additional Tissue Layer

Our surgeon takes an additional 1-2mm margin of tissue around the initial tumor site using a scalpel. This layer is thicker for large tumors. You should only feel movement or pressure as the scalpel slices through the anesthetized tissue. Let us know if you feel any significant pain.

Step 3 - Mapping and Freezing the Tissue

The layer of tissue removed is then divided into sections, color coded for orientation, mapped on a diagram, and frozen onto slides using a cryostat machine. You won't feel anything during the processing of the tissue sample. This gives the lidocaine additional time to remain in effect.

Step 4 - Microscopic Analysis

The frozen tissue sections are stained, then checked under a microscope by the Mohs surgeon or pathologist to look for any remaining cancer cells. You simply relax in the waiting room or recovery area while the tissue analysis is performed.

Step 5 - Additional Layer Removal if Needed

If cancer cells are still seen under the microscope, our surgeon uses the map to precisely remove another thin layer of tissue only from the involved area. The process then repeats from Step 3 until the margins are clear. Most cases take 1-2 layers, but it can require 3 or more for larger tumors.

Step 6 - Wound Closure

Once cancer cells are completely removed, our surgeon will close the surgical defect. This may involve stitches, a skin flap or skin graft to facilitate optimal healing and cosmetic outcome.

You will likely feel some tugging and pressure as the tissue is sutured together. Additional local anesthetic can be injected to maintain numbness during closure if needed.

Dermatology and Skin Health's board-certified surgeons will walk you through each phase of Mohs surgery to deliver clear margins and preserve healthy tissue. Start your journey with us

Recovery and Aftercare after Mohs Surgery

After Mohs surgery, the anesthetic will take some time to completely wear off. Here's what to expect:

How Long Does the Numbing Last?

Lidocaine provides approximately 1-2 hours of anesthesia. However, residual effects often linger longer, with complete sensation taking 3-6 hours to return.

You may notice tingling, numbness, tightness, or a "fat lip" feeling around the surgery site as the anesthesia gradually dissipates.

Don't worry, this is very normal! Be careful not to bite or chew the numb area until complete feeling returns to prevent injury.

Potential Side Effects of the Anesthetic

Normal side effects from lidocaine include:

• Residual numbness at the injection site
• Lightheadedness or dizziness
• Bruising or redness where injected
• Nausea or vomiting in some patients

These effects are temporary and not dangerous. But let our surgeon know if they become severe.

Allergic reaction to lidocaine is exceedingly rare but may cause hives, breathing issues, or anaphylaxis. Seek immediate help if this unlikely scenario occurs.

Conclusion

Mohs surgery may sound frightening, but with proper anesthesia patients can get through the procedure with minimal discomfort.

The most common local anesthetic used is lidocaine, which provides rapid and medium-term numbness when injected around the tumor site. This allows removal of cancerous tissue while sparing healthy skin.

Being awake for Mohs surgery is understandably anxiety provoking, but you can rest assured the anesthetic will keep you pain-free while our skilled surgeon removes the cancerous tissue. 

[Schedule an appointment with Dermatology and Skin Health to discuss anesthesia and pain management for your upcoming Mohs surgery.]