Mohs Surgery

Mohs surgery is a minimally invasive procedure to treat skin cancer. It involves removing cancerous tissue while protecting your healthy tissue.

After removing the cancerous growth, your Mohs surgeon examines it under a microscope looking for any remaining cancer cells. They then repeat the process until there are no cancerous cells left.

With Mohs surgery, you can go home on the day of your procedure with no additional treatment and feel confident that your cancer is gone.

Advantages of Mohs Surgery

• It has the highest cure rate of any procedure to treat skin cancer.
• It minimizes the risk of the cancer returning, because your Mohs surgeon verifies that all cancer cells have been removed.
• It is an outpatient procedure, often completed in a single visit.
• It includes restoring the area with a focus on maximizing cosmetic outcome.
• It removes minimal healthy tissue, which means your wound and scar tends to be as small as possible.

Why Is Mohs Surgery Done?

Mohs surgery can treat many forms of skin cancer, but it’s most often used to treat basal cell carcinoma and squamous cell carcinoma — the two most common types of skin cancer.

Mohs surgery may also be right for you if any of these situations are true about your skin cancer:

• It’s in an area — such as the face, scalp, neck or the hands — where it's important to preserve more healthy tissue for functional or cosmetic reasons.
• It has been treated previously and has recurred.
• It's growing rapidly.
• It's large.
• It has indistinct (not sharply defined) borders.
• It has formed in an area that underwent radiation treatment in the past.

Risks of Mohs Surgery

Although the risks are low for Mohs surgery (usually less than 1%), the following complications can happen:

• Bleeding
• Bruising
• Infection
• Numbness or nerve damage to the skin surrounding the wound (nerve damage may last for several months or in some cases may be permanent)
• Postoperative pain, such as tenderness
• Scarring
• Swelling

If you have any questions or concerns about the potential risks, talk to your Mohs surgeon before your procedure.

Preparing for Mohs Surgery

To prepare for Mohs surgery, keep the following tips in mind:

• Leave the day open. Plan to spend on average three to four hours in our clinic on the day of your procedure. Although the amount of time may vary, it’s best to clear your schedule so you don’t feel rushed.
• Ask your doctor about your medications and supplements. Before your surgery, talk to your Mohs surgeon about the medications and supplements you take regularly. Typically, you don’t need to stop taking prescription blood thinners, but your surgeon may ask you to stop taking certain over-the-counter medications and supplements. These may include ibuprofen (Motrin and Advil), as well as supplements like vitamin E and fish oil, which can increase your risk of bleeding during the procedure.
• Avoid alcohol. Limiting your alcohol intake for about a week before your procedure can also help minimize your risk of bleeding.
• Wear comfortable clothes. Wear warm, loose-fitting clothing to make sure you’re as comfortable as possible.
• Avoid makeup. If your skin cancer is on your head or neck, avoid wearing makeup on the day of the procedure, so the removal site is clean.
• Take a shower or bath beforehand. Take a bath or shower, wash your hair and clean the general surgical area before your procedure to reduce the risk of infection.
• Eat something before the surgery. It’s usually OK to eat something before your procedure but be sure to check with your surgeon.
• Be prepared to wait. Depending on how many rounds it takes to remove your cancer, you may be waiting in our clinic for a few hours. Bring something to read to help pass the time.

What to Expect During Mohs Surgery

When you arrive for your procedure, we will review the procedure and we'll ask you to sign consent forms. Your Mohs surgeon will then gently clean and numb the area of your skin cancer using local anesthesia before removing the affected skin. It usually takes around 5 to 10 minutes to remove the skin, depending on the size of your skin cancer.

We’ll then bandage the area, and you will have around 45 minutes to an hour to relax. Meanwhile, we will process your tissue onsite and your surgeon will do a microscopic examination.

When examining the tissue, your surgeon verifies that all cancer cells have been removed. If it looks clear, your surgeon will return to your room to close your wound. If any cancer remains, your surgeon will mark its location and repeat the process until all cancer cells are gone.

Once all cancer cells have been removed, your surgeon will discuss the best healing approach, whether it's natural healing or stitches. If you receive stitches, it will take about 20 to 30 minutes for your surgeon to stitch up your wound post-procedure. For complex wounds, your Mohs surgeon may suggest a staged closure. If necessary, they will partner with skilled head and neck plastic surgeons for post-Mohs surgery reconstruction.

What to Expect After Mohs Surgery

In most cases, you will follow up with your surgeon post-Mohs surgery in one to two weeks to remove sutures and ensure the site is healing properly.

It’s also important that you connect with your general dermatologist every six months after a recent diagnosis of skin cancer.

Here are other important ways to help your wound heal:

• Keep your bandage on for two days.
• Keep your bandage dry for two days (this includes not showering, and not washing the affected area).
• Avoid makeup if your wound is located on your head or neck.
• Avoid lifting items over 10 pounds or bending at the waist.
• Avoid strenuous exercise for one to two weeks post-procedure.

How Skin Cancer Is Diagnosed

If you notice any skin changes — like a new concerning mole or growth — make an appointment with a dermatologist at Rush. If your insurance requires it, you may need to first get a referral from a primary care provider.

To confirm your suspected diagnosis, your dermatologist will recommend a biopsy. During a biopsy, your dermatologist will numb the skin, take a small sample of the lesion and send that to the pathology lab to be analyzed.

In most cases, a biopsy does not completely remove the cancer. Your dermatologist will recommend the appropriate treatment, such as Mohs surgery, if applicable.

Rush Excellence in Mohs Surgery

• One of the nation's top cancer centers:  U.S. News & World Report  has ranked Rush University Medical Center among the top 50 hospitals in the country for cancer care.
• Special training and experience:  RUSH dermatologists have special training and experience in performing Mohs surgery, ensuring you receive the highest quality care with the best possible outcome.
• The gold standard in treating skin cancer: Mohs surgery stands out as the most effective treatment for skin cancer with its high cure rate. During Mohs surgery, your surgeon will examine 100% of your skin cancer margins, leading to an impressive 99% cure rate for basal cell carcinoma and 97% to 98% for squamous cell carcinoma. This means you can leave your procedure knowing your cancer is a thing of the past.
• Expert team in skin cancer: When you have Mohs surgery, you will have access to a team of experts from different specialties. This can include a Mohs surgeon, radiation oncologist, medical oncologist and other specialists, who meet regularly to ensure the best plan to treat your skin cancer.
• A team equipped for complex cases:  If your skin cancer is complicated or in a delicate area, you may need surgeons with special expertise. Rush's plastic surgeons and head and neck surgeons have expertise in skin cancer removal procedures that preserve your appearance and ability. They'll work closely with you and your care team as needed.