You have skin cancer.

With more skin cancer cases diagnosed every year than all other cancers combined, there’s a good chance that you might hear these four words someday. An estimated one in every five Americans will develop skin cancer in their lifetime, such as basal cell carcinoma, squamous cell carcinoma, or melanoma.

Here’s another significant number to note. If you have basal cell carcinoma or squamous cell carcinoma for the first time and your dermatologist recommends Mohs surgery for treatment, the procedure has an over 99% cure rate. Do you have recurrent skin cancer? Mohs surgery still has an approximately 95-96% cure rate.

Even with these promising cure rates, the prospect of having Mohs surgery and going through recovery may cause some apprehension – but it doesn’t have to. The TopLine MD Alliance Network Mohs surgeons who perform this procedure are trained to make the least aesthetic impact while completely removing cancer cells and plan a course of action for your healing.

Keep reading to learn all about Mohs surgery and recovery, including a realistic timeline of the healing process and what you will likely experience. We’ll also explain the various stages of recovery and what to do (and what not to do) to get the best possible results.

What is Mohs surgery?

Mohs surgery is a precise, outpatient procedure used to remove high-risk skin cancer and preserve healthy tissue with minimal scarring. Mohs surgery is most useful for skin cancer that:

  • Has a high risk of returning
  • Has returned after previous treatment
  • Is located in an area where you want to preserve as much healthy tissue as possible (such as your nose, mouth, eyes, ears, hands, feet, and genitals)
  • Has ill-defined borders
  • Is large or fast-growing

Your TopLine MD Alliance Network dermatologist will thoroughly examine your skin, perform a biopsy to confirm your skin cancer diagnosis, and review the details with a Mohs surgeon to determine if Mohs surgery is the most appropriate treatment option for you. Your overall health, medical history, and immune status are also taken into consideration.

What happens during Mohs surgery?

Mohs surgery is a layer-by-layer removal of skin that contains cancer cells. The removal is done in stages during one procedure, with a waiting period between each stage. Here are the usual steps:

Preparing for surgery

You may be asked to stop taking certain medications before surgery, especially if you take any that thin your blood.

On the day of surgery, wear casual clothes that are comfortable. Depending on where your skin cancer is located, you may have to wear a hospital gown instead. The Mohs surgeon will examine and mark the area where the skin cancer is located and position you for the best access, which may be sitting up or lying down.

A surgical drape is placed over the area before starting. (If your skin cancer is on your face, you may not be able to see what is happening, but the Mohs surgeon will talk you through the procedure.) The Mohs surgeon then numbs the area completely with local anesthesia. You will be awake for the entire procedure.

Top layer removal

Using a scalpel, the Mohs surgeon removes the first thin layer of visible cancerous tissue, sparing as much healthy tissue as possible.

Microscopic examination

While you wait, the Mohs surgeon cuts the tissue into sections, color codes them with dyes, and draws a map of the surgical site. A lab technician then freezes the divided tissue and cuts it into very thin horizontal slices.

Using a microscope, the Mohs surgeon carefully examines every slice of tissue – and if any cancer cells remain, marks their location on the map. The Mohs surgeon will then inform you if you need another layer of tissue removed.

Additional layer removal

The Mohs surgeon injects more anesthesia (if needed) and removes another layer of skin precisely where the cancer cells remain, based on the map. Then, while you wait, the microscopic examination begins again. This process is repeated as many times as necessary until there are no more cancer cells.

Closing the wound

Once the area is clear of all cancer cells, the wound may be left open to heal or the Mohs surgeon may close it with stitches, depending on the wound’s size and location.

In some cases, the wound may need reconstruction with a skin graft or skin flap (the transfer of healthy tissue from elsewhere on your body). If so, the Mohs surgeon may coordinate your wound repair with a plastic surgeon or another specialist.

How long does Mohs surgery take?

We recommend clearing your schedule for the entire day, since there’s no way to know ahead of time how long your Mohs surgery will take. If you need multiple rounds of layer removal, the procedure could take several hours. For most people, Mohs surgery takes four hours or less.

What happens after Mohs surgery?

It’s very important to follow the Mohs surgeon’s instructions for pain management, wound care, scar care, and follow-up visits to achieve the best possible outcome.

Pain management

Most patients report mild to moderate pain after Mohs surgery. The pain should gradually go away in a few days and can usually be managed with over-the-counter pain relievers. If the wound is large (over 3 square centimeters), you may experience pain for longer.

Wound care

After the procedure, you will likely have a bandage on your wound. Leave it untouched for the first 24-48 hours, or as directed by the Mohs surgeon.

After the initial healing, remove the bandage for wound care two times a day or as directed. Clean the wound with 3% hydrogen peroxide or mild soap and cover it with petroleum jelly before reapplying the bandage to avoid sticking. Keeping the wound moist also helps reduce scarring.

You can typically resume showering 24-48 hours after the procedure, but avoid baths or swimming for at least two weeks. You may also apply ice or cold packs to reduce any swelling or bruising, as long as you do not put the ice directly on your skin.

To prevent reopening the wound, avoid any strenuous exercise, heavy lifting, or bending over for at least a week.

Scar care

Once the bandage is no longer needed, apply a broad-spectrum sunscreen with an SPF of 30 or higher to your scar daily. Wear a wide-brimmed hat for extra protection, as sun exposure can worsen scarring.

Ask your TopLine MD Alliance Network dermatologist about other treatments that can improve the appearance of scars, such as dermabrasion, laser treatments, and more. Over-the-counter scar creams and gels that contain silicone may also be effective.

Follow-up visits

Be sure to follow the Mohs surgeon’s recommendations for all follow-up visits. Your first follow-up visit is usually for stitches removal 1-2 weeks after the procedure. The surgeon will continue to check the progress of the wound during subsequent visits.

Your dermatologist will also continue to check for any signs of new skin cancer during regular skin exams.

What are the possible complications of Mohs surgery?

The risks associated with Mohs surgery are very low, especially when you consider the extremely high cure rates associated with the procedure. Your Mohs surgeon can explain these risks in more detail, which may include:

  • Scarring
  • Poor wound healing
  • Larger wound size than expected
  • Excessive bleeding
  • Infection

When to seek help during Mohs surgery recovery

Questions about the procedure or the healing process are always welcome. You should also contact your Mohs surgeon if you have:

Excessive bleeding

It’s normal to have minor bleeding or oozing from the wound, especially in the first few hours after surgery. But active or excessive bleeding requires immediate action – apply continuous, firm pressure with a second bandage for 20 minutes. If the bleeding soaks the bandage or does not stop, seek emergency medical care or call your Mohs surgeon immediately.

Lasting pain

Again, you can expect to have some mild to moderate pain after Mohs surgery. The pain doesn’t go away after a few days, isn’t manageable with over-the-counter pain relievers, or improves and then gets worse, let your Mohs surgeon know.

Signs of infection

If the wound becomes infected, it can lengthen your recovery time and affect how your scar heals. Contact your Mohs surgeon ASAP if:

  • You develop a fever
  • The wound has a thick, yellowish discharge or foul odor
  • The skin around the wound is bright red, swollen, or hot to the touch

Find a TopLine MD Alliance Network provider today

Mohs surgery may be an ideal solution for skin cancer that is found early enough. Want to learn more? The next step is yours.

The TopLine MD Alliance was created by physicians who came together to make healthcare experiences better for patients. We help patients navigate the healthcare system, connecting them with top-of-the-line healthcare providers, practices, diagnostic centers, and imaging centers we trust.

The TopLine MD Alliance brings together high-quality care and exceptional service while ensuring that you are always satisfied with your choice of medical providers. Our specialties include dermatology, primary care, family medicine, internal medicine, pediatrics, and many more.

To get started, find a provider near you today.