Understanding Mohs Surgery: Step by Step
Receiving a skin cancer diagnosis is understandably stressful, and learning that your dermatologist recommends Mohs micrographic surgery can raise many questions. At Clarus Dermatology, we want our patients to feel fully informed and confident about their treatment. This guide walks you through every stage of Mohs surgery — from preparation to recovery — so you know exactly what to expect.
What Is Mohs Surgery?
Mohs micrographic surgery is a precise surgical technique used to treat common skin cancers, including basal cell carcinoma and squamous cell carcinoma. Named after Dr. Frederic Mohs, who developed the technique, Mohs surgery involves removing thin layers of cancerous tissue one at a time and examining each layer under a microscope immediately during the procedure.
This layer-by-layer approach allows the surgeon to verify that all cancer cells have been removed while preserving as much healthy tissue as possible. Mohs surgery achieves cure rates of up to 99% for primary skin cancers, making it the gold standard treatment for skin cancers in cosmetically and functionally important areas.
Dr. Neil A. Shah, a fellowship-trained Mohs surgeon at Clarus Dermatology, performs this procedure at our New Brighton and Maple Grove locations, bringing extensive experience and meticulous technique to each case.
Before Your Mohs Surgery: How to Prepare
Consultation and Planning
Before your surgery date, you will have a consultation with your dermatologist or Mohs surgeon to review your biopsy results, discuss the procedure in detail, and answer any questions. This is the time to share your complete medical history, including any medications you take — particularly blood thinners, aspirin, or anti-inflammatory drugs.
Medication Considerations
Your surgeon may ask you to stop certain medications before the procedure to reduce bleeding risk. Never discontinue prescription medications without first consulting the prescribing physician. Common adjustments include pausing aspirin, ibuprofen, fish oil supplements, and vitamin E for one to two weeks before surgery.
Day-of Preparation
On the day of surgery, wear comfortable, loose-fitting clothing. Eat a normal breakfast, as the procedure is performed under local anesthesia and you will be awake throughout. Bring a book, phone, or tablet, as there may be waiting periods between stages. Many patients also find it helpful to bring a companion for support and to drive them home.
During the Procedure: What Happens in Each Stage
Stage 1: Anesthesia and First Layer Removal
Your Mohs surgeon will mark the visible tumor and inject a local anesthetic to numb the area completely. Once the area is numb, the surgeon removes a thin layer of tissue along with a small margin of surrounding skin. This initial removal typically takes only a few minutes. A temporary bandage is applied, and you will be escorted to a comfortable waiting area.
Stage 2: Microscopic Examination
The removed tissue is processed, color-coded, mapped, and examined under a microscope by the Mohs surgeon right in the office lab. This examination allows the surgeon to identify the precise location of any remaining cancer cells. The processing and review of each layer typically takes 30 to 60 minutes.
Stage 3: Additional Layers (If Needed)
If cancer cells are still present at any margin, the surgeon removes another targeted layer only from the area where cancer was detected. This process repeats until no cancer cells remain. Most Mohs procedures require one to three stages, though some complex cases may require more.
Stage 4: Wound Closure
Once the site is confirmed cancer-free, the surgeon discusses closure options. Depending on the wound’s size and location, options may include allowing the wound to heal naturally (secondary intention), closing with stitches (primary closure), or using a local flap or skin graft for larger wounds.
After Mohs Surgery: Recovery and Healing
The First 24 to 48 Hours
Mild discomfort, swelling, and bruising around the surgical site are normal. Over-the-counter pain relievers such as acetaminophen are usually sufficient to manage any pain. Apply ice packs wrapped in a cloth for 10 to 15 minutes at a time to reduce swelling. Avoid strenuous activity for at least 48 hours.
Wound Care
Your surgeon will provide detailed wound care instructions. Generally, this involves keeping the bandage clean and dry for the first 24 hours, then gently cleaning the wound daily with mild soap and water, applying a thin layer of petroleum jelly, and covering with a fresh bandage. Continue this routine until the wound has fully healed.
Stitches and Follow-Up
If stitches were placed, you will return to the office in five to fourteen days for removal, depending on the location. Your surgeon will assess healing and discuss any need for follow-up skin checks. Regular dermatologic monitoring after Mohs surgery is essential, as patients who have had one skin cancer are at increased risk for developing another.
Why Choose Mohs Surgery at Clarus Dermatology?
Dr. Neil A. Shah and the team at Clarus Dermatology offer Mohs micrographic surgery with the highest standards of precision and patient care. With fellowship training and extensive surgical experience, Dr. Shah is dedicated to achieving complete cancer removal while preserving healthy tissue and optimizing cosmetic outcomes.
If you have been diagnosed with skin cancer and would like to learn more about Mohs surgery in New Brighton or Mohs surgery in Maple Grove, we are here to guide you through every step. Call (612) 213-2370 or use the scheduler to book a consultation today.
This content is for informational purposes only and does not constitute medical advice. Surgical outcomes vary by individual. Please consult with your dermatologist to determine the most appropriate treatment plan for your specific diagnosis.
