Preparation for Mohs Surgery
The best preparation for Mohs surgery is a good night’s rest followed by breakfast. In almost all cases,
the surgery will be completed on an outpatient basis. Because you may be here for most of the day, it is
wise to bring along a companion, book or laptop. We provide Wi-Fi if you would like to connect to the
internet. Wear comfortable clothing in layers so that you may adjust easily to the temperature of the
room. We have coffee, tea and light snacks available, but we encourage you to also bring a light lunch.
Work/Activities
Work
It is recommended you take the day off from work and plan on spending several hours with us. There
may be swelling, redness and bruising following surgery. You will also have a pressure bandage in place
for 5-7 days. The pain after surgery is usually minimal and you should be able to return to work the next
day if you can tolerate the bulky bandage and can take it easy. If this is not the case, we are happy to
provide a doctor’s note to ensure you are able to rest.
Activities
After surgery, it is important to take it easy to decrease your risk of bleeding and infection and to
minimize scar formation. While your stitches are in you will need to refrain from exercise, heavy lifting
or other strenuous activity.
Medications
Blood Thinners
We suggest that you continue to take all of your prescribed medications up to, and including, the day of
your surgery unless directed by your physician. This includes blood thinners such as aspirin, Plavix,
Coumadin, etc. Although these medications may increase your risk of bleeding during and after your
surgery, this is a minor concern compared to the serious complications that could occur if these
prescription medications are stopped. If you are on Coumadin/Warfarin, we will need your most recent
INR results. If higher than 2.6 we may need to reschedule your surgery.
If you take aspirin (not prescribed by a physician), ibuprofen or other anti-inflammatory medication, we
suggest you discontinue these medications four days prior to surgery. Tylenol is a safe alternative if
needed. Please see our drug guide for a more complete list of blood thinners to avoid pre-operatively.
Herbal Supplements
If you take herbal supplements such as fish oil, ginko, garlic pills, ginseng, vitamin E, we recommend that
you discontinue these 1-2 weeks prior to surgery, as they can thin your blood. Please see our drug guide
for a more complete list of blood thinners to avoid pre-operatively.
Alcohol
Drinking alcohol can increase your chance of bleeding during or following your surgery. Please refrain
from drinking alcohol two days prior to your surgery.
Smoking
Tobacco interferes with wound healing. We realize it can be very difficult to stop smoking, but please try
to limit your smoking starting one week prior and two weeks after surgery for better wound healing.
What does the procedure involve?
Mohs surgery is a minor surgical procedure performed on an outpatient basis in our office. The Mohs
procedure provides a road map allowing us to trace the extent of the cancerous growth. Since the
laboratory processing is time consuming, please be prepared to spend the entire day. In many cases, less
time is required but there is no way to predict the length of your surgery.
The surgery is performed in stages. Each stage involves about 5-15 minutes of surgery to remove the
cancerous tissue plus about 45 minutes to check if any cancer remains. The number of stages required
depends on the size and the depth of the cancer. The procedure is not finished until the last laboratory
examination shows no remaining cancer cells.
Once the surgical site is located, marked and cleaned, a local anesthetic will be injected to numb the skin
cancer and surrounding area. This is usually the only part of the procedure that will cause any
discomfort. Once the area is numbed, a disc shaped piece of tissue will be removed by Dr Jenkin and the
bleeding controlled. A temporary bandage will be placed to cover the site. You can then relax in your
exam room or in our comfortable waiting room. You are allowed to eat and drink while the tissue is
being processed.
If microscopic examination reveals remaining tumor, a map is drawn indicating the precise location.
Additional anesthetic will be injected if needed, and another layer of tissue will be removed, but only
where the map indicates residual cancer. The healthy tissue is left intact, only the diseased tissue is
excised. The average tumor requires 2-4 stages for removal. Do not be discouraged if your cancer is not
removed in one stage. We are tracing the extent of the tumor very carefully and trying hard to minimize
the removal of normal tissue. Once free of skin cancer, Dr Jenkin will plan how best to close the opening
made by removing the tumor.
After Surgery
Localized discomfort is normal and usually mild enough to be managed with Tylenol. A pressure dressing
is applied to the wound in the office and is to be left in place until your suture removal to minimize
swelling and bleeding. If your surgical site is on the face, you may want to sleep with your head elevated
for the first 2 nights to help reduce swelling. Moderate bruising and swelling are common, and may take
1-2 weeks to resolve.
If bleeding occurs, lie down and apply firm pressure to the site for 15 minutes. Do not lift up or relieve
the pressure at all during that period of time. If bleeding persists, please call our office. If it is after hours
please follow voicemail instructions to have the answering service page the on call doctor. If the
dressing comes off, you may return to our office for a new bandage, or cover the sutures with Aquaphor
or Vaseline, a non-adherent dressing and tape.
Contact our office immediately if you experience any continued bleeding despite 15 minutes of constant
pressure, excessive swelling, increasing redness, increasing discomfort or drainage from the wound.
Will I have a scar?
Although every effort will be made to offer the best possible cosmetic result, you will be left with a scar.
The scar can be minimized by the proper care of your wound. We will discuss wound care in detail with
you and give you wound care information. The skin may appear red, firm or lumpy initially, but this will
normally resolve within 4-8 weeks. Occasionally, some of the deeper stitches that normally dissolve on
their own work their way to the surface; these are called ‘spitting sutures’. These will dissolve with
warm compresses or can be removed in the office.
Follow Up
Your sutures will be removed 7-10 days following your surgery. We would like to recheck the surgical
site 6 weeks after your Mohs surgery to ensure the wound has healed. A full skin exam is recommended
3 months after your surgery. Of course, any areas of your skin that change, fail to heal, or just concern
you should be brought to the attention of your dermatologist immediately.
We look forward to making your office visit as pleasant and comfortable as possible. Our staff is here
to help, so please feel free to contact the office with any questions or concerns.
Blood Thinners to Avoid Pre-Operatively
Over the Counter Medications to Avoid:
Aspirin
Aleve
Bayer
Ibuprofen
Motrin
Nyquil
Triaminicin Cold
Advil
Alka-Seltzer
Bufferin
Midol
Naproxen
Pamprin
Medicinal Plants Associated with Increased Risk of Bleeding:
Bilberry
Dong quai
Horse chestnut bark
Tonka bean seeds
Woodruff plant
Meadowsweet flower
Sweet birch bark
Wintergreen leaves
Cayenne fruit
Dan shen root
Feverfew
Ginseng
Tumeric root
Fish Oil
Chondroitin
Sweet clover plant
Sweet vernal grass leaves
Sweet-scented bedstraw plant
Vanilla leaf leaves
Black cohosh rhizome
Poplar bark
Willow bark
Bromelain
Chinese skullcap root
Garlic
Ginkgo Biloba
Onion
Reishi fruit bodies
St. John’s Wort
If you have any questions, please contact the office at (206) 267-2100.