YOUR MOHS SURGERY: what to expect

Mohs surgery is the gold standard for removing certain types of skin cancer by a highly trained Mohs micrographic surgeon. It allows your surgeon to evaluate 100 percent of the tissue margin, compared with 2 to 3 percent in standard surgical excision. This precise technique also maintains as much healthy tissue as possible, thereby minimising scarring.

Your surgeon will discuss any pre-existing medical conditions and provide you with the relevant information prior to your Mohs procedure.

You surgeon will discuss your existing medications and provide relevant information prior to your Mohs procedure.  

You can usually continue taking all your regular medication including blood thinners.  If you are taking warfarin, then a blood test a few days before to check your levels are in the normal range for you is important.  Avoid any over the counter medicines / supplements as these can increase bleeding risk.

Given that Mohs surgery is a day case procedure performed under local anaesthesia, there is no need to fast.  We recommend that you have a good breakfast on the day.

Wear clothing that is comfortable and non-restrictive. Depending on the location of the Mohs surgery, you may be required to change into a gown.

If your Mohs surgery is on your face, please ensure your face is free of make up.

Given that Mohs surgery involves multiple steps ( skin cancer removal, laboratory tissue processing, microscope reading of slides and surgical reconstruction), please prepare to be in our facility for the whole day.

Although the procedure involves local anesthesia, we advise you to arrange someone to drive you home.

At Dermatology Hawke’s Bay, we welcome you to bring a family member or friend for additional support.  However, to preserve patient privacy and dignity, they will not be able to wait in the patient lounge.

Your Mohs surgery will take place in one of our two fully-equipped operating theatres on our premises at Dermatology Hawke’s Bay. We also have a purpose built laboratory on site, where your tissue processing will take place during the procedure.

Your Mohs surgery will be carried out by a Mohs micrographic surgeon (specialist dermatologist) supported by a dermatology nurse. Your Mohs micrographic surgeon will be supported in the laboratory for tissue sampling by an experienced Mohs laboratory technician.

Mohs surgery is an outpatient procedure that requires local anesthesia. That means treatment and recovery is relatively quick and easy, with return to the comfort of your own home.  

1. A local anesthesic injection will be given
2. Under magnification, the skin cancer that is visible without a microscope will be removed
3. A thin layer of surrounding skin tissue will be removed and marked for reference, along with the surgical site
4. The tissue sample will be processed by our Mohs laboratory technician and be examined under a microscope to identify sections with cancerous cells
5. Steps 3 and 4 will be repeated, if necessary, until the skin cancer is fully removed. 
6. Your surgeon will then discuss the best way to repair the surgical site —  this usually involves flap from adjacent skin or a skin graft from other areas of the body. On rare occasions, your doctor will bring in another reconstruction specialist with repair of the wound under sedation or general anaesthesia.
7. A post-op check-up will be scheduled for the removal of stitches and to ensure the wound is healing well. 

The local anaesthetic injection is generally the most uncomfortable part of the procedure. Once the area is numb, you may feel some gentle pressure as the surgeon performs the procedure.

Tissue processing time in the laboratory is variable but can take a couple of hours.  You will stay in our private patient lounge to wait whilst this takes place. Our patient lounge is equipped with comfortable armchairs,  light refreshments, TV, iPads and offers beautiful views over Havelock North Village. You may want to bring a book or magazine or connect to our free Wifi to carry on with work to pass the time.  Bring your mobile phone chargers along.

Your surgeon will discuss this with you to give you the best cosmetic and functional result.

One of the benefits of the  Mohs surgery technique is that it allows the surgeon to preserve as much healthy tissue as possible, thereby minimising scarring. Your Mohs micrographic surgeon is highly experienced and will take extreme care to ensure the smallest possible and least noticeable scar. It is important to follow your surgeon’s wound care instructions to achieve the best results post-procedure. There are helpful videos on our website to help optimise wound healing.  Also, here at Dermatology Hawke’s Bay, we offer the state of the art skin appearance treatments that can be utilised to reduce scarring even further.  

After your procedure, you will be provided with full post-op recovery instructions, including the possible warning signs of wound infection and who to call if you have any concerns. You may experience a little discomfort, such as bruising and swelling, but these symptoms usually resolve fairly quickly. You’ll likely be instructed to avoid strenuous work or exercise post-procedure and to rest. It’s important that you follow your doctor’s instructions for wound care, scar care and follow-up to achieve the best possible outcome.

It is entirely normal to feel nervous and we completely understand. The anxieties of having surgery for skin cancer are all too familiar to us.  At Dermatology Hawke’s Bay, with our highly-experienced team, be rest assured that we will do all we can to make your experience as comfortable as possible with the best possible care.

If you have any further questions around your upcoming Mohs procedure, please don’t hesitate to contact us.