Why does one need an examination before Mohs surgery?

The surgeon must be sure that Mohs surgery is indeed the best treatment for you. The examination also gives surgeon and patient a chance to meet each other, an opportunity for you to ask any questions and discuss expectations. The surgeon will check for anything liable to interfere with or prevent the surgery, explain exactly what is going to happen and you will be able to agree to the surgery with full knowledge of what to expect. At the end of this session, surgeon and patient will fix a mutually suitable time for the surgery. 

Will the surgery leave a scar?

Yes. Every type of surgery leaves a scar. However, Mohs surgery leaves the smallest possible scar relative to other methods while removing all of the cancerous tissue. The surgeon uses special plastic surgery techniques to obtain optimal results.

What will the scar look like?

In the early months after surgery, the scar will be reddish but will get lighter as time goes on. It will also gradually improve over the first year. Exposure to sun can cause the scar to adopt a different shade to your normal skin and so we recommend limited exposure to sunlight during the first year.

Scars may stay red, hard and raised for a long time after surgery. This largely depends on the individual patient’s recovery protocol.

How should I prepare for the operation?

1. Prepare an envelope the night before containing the necessary medical documents: referral letter, payment guarantee, results of lab tests you were asked to perform before the operation.

2. We recommend resting well the night before your surgery and eating a good breakfast.

3. There is no need to fast on the day of the operation.

4. If you are taking prescription drugs, you should continue to do so unless told otherwise.

5. On the morning of the surgery, it is good to wash your hair and face well (we advise no wetting of the affected area for three days after the surgery.) 

6. It is preferable not to put on make-up on the morning of the operation and to wear clothes you don’t mind getting blood-stained.

7. We recommend coming with someone (one person please) who can stay with you and help you home after the surgery. It can be a very tiring day.

8. The average stay in the clinic is 4-5 hours. So to pass the time, bring something to read or to listen to.

 What happens on the day itself? 

A number of patients are operated on simultaneously. How long you’ll wait for your surgery depends on the surgeon’s planning schedule and the time you arrive.

Since the operation is performed using local anesthetic, music is played in the operating theater for your enjoyment. You may even be able to choose your favorite songs. You can also bring your own music.

After every stage, you will go back to the waiting room, bandaged, to wait for the surgeon’s instructions. As you first leave the operating theater, put pressure on your bandage to prevent bleeding. If the bleeding starts anyway, tell the nurse in the waiting room.

Your waiting time depends on how much work they have in the laboratory, the various stages other patients are in and the severity of your illness. The procedure may take a whole day. You are advised to eat and drink normally throughout the day.

Should I expect pain?

Most patients do not report significant pain.  The anesthetic is injected into the skin around the tumor. The injection itself may cause you some discomfort or pain but for 30-60 seconds at most. As the surgery progresses we will try and prevent further pain by adding more anesthetic before the area ‘awakens’ from the previous dosage.

If you do feel discomfort or pain after the surgery, it can usually be calmed by taking Acamol/Optalgin/Nurofen. 

What are the expected complications?

There may be bleeding during the operation, which may need the intervention of an electric needle to stop it. In this case, a special sticker will be placed on your right arm which serves to close the electric circuit and prevent electrocution. If you have a pacemaker you should tell the surgeon so as not to stop it working during the treatment.

A few hours after surgery you may notice some bleeding. This usually comes from the disappearance of adrenalin injected with the anesthetic. It is important to distinguish between a bloody secretion coloring the bandage red and bleeding that soaks the bandage with blood flowing outside it. Bloody secretions are common to all surgery. It is nothing to worry about and needs no intervention. However, when you are bleeding, the external bandage should be changed and you or someone else should put uninterrupted pressure on the wound for 15-20 minutes.

If the bleeding does not stop, repeat the pressure and if that still doesn’t work, contact your surgeon or the hospital (your discharge letter should have the relevant contact numbers.)

Sometimes, you may see bruises under your eyes, mostly on the side operated on but sometimes under both eyes if the surgery was focused more in the center of your face. This side effect is caused by the tissue under the eye being absorbent and therefore absorbing the blood remaining in the tissue or slight bleeding after surgery. This is perfectly normal, nothing to worry about and should disappear within 7-10 days.

Nerve damage during the operation can cause disorder in your sensations around the affected area, and in rare cases even weaken the muscles in the area. In most of the cases in which the tumor is very close to a significant nerve, the surgeon will explain the ramifications of continuing the surgery in light of the expected damage to the nerve and receive the patient’s approval to continue. Smaller nerves may also be damaged but they are responsible for small areas and any damage will not cause any significant disruption in functioning or feeling. In most cases, sensations around the affected area will return to normal after a few months.

The local anesthetic itself may cause side effects, if the patient is allergic to the specific anesthetic. The mixture also contains adrenalin, which helps the veins contract in the affected area and prevent the anesthetic spreading as well as reducing bleeding from the tissue. Although it is a very low concentration, some patients may react with increased heartbeats and a sense of anxiety. These symptoms are normal and pass quickly.

In rare cases there may be an infection in the surgical wound. This may need drainage or antibiotic treatment. Symptoms are pain, localized or widespread heat, redness around the wound or swelling. In cases in which the length of the operation, the circumstances, the size or location of the wound are likely to increase the risk of infection, the surgeon will instruct the patient to take preventative antibiotics immediately after surgery. Of course, if an infection arises during your antibiotic course, inform the surgeon immediately.

In even rarer cases, healing can be very slow, delayed or abnormal. In these situations, contact your surgeon. In most cases, the solution is straightforward and the final result will be very good.

Some of the above complications may be accompanied by localized pain or discomfort. If your pain does not go away, does not respond to drugs or becomes more acute, contact your surgeon. He or she will either prescribe stronger drugs or call you in for a check-up.

It is important to know that no treatment can promise 100% cure for skin cancer and there is a very low rate of tumor relapse after Mohs surgery.