Commonly asked questions
We suggest that you bring someone with you to keep you company during the procedure and to drive you home. It is recommended that you have someone to drive you home after the surgery for a variety of reasons. If surgery is to be performed on the face, especially near the eyes or nose, you will likely have swelling around your eyes making it difficult to see or the bandage may obstruct your vision and you will be unable to drive.
If a sedative is taken, you will not be able to drive. You should plan to take the day off work and possibly a couple extra days depending on the nature of your employment. We can provide you with a work excuse if needed.
We will ask that you take it easy for the two weeks following the procedure by not engaging in any strenuous activity. We also will ask that you limit your bending and heavy lifting for the two weeks following the procedure as well.
We may ask that you take an antibiotic once you arrive to prevent infection in areas that are considered high risk. If you normally take antibiotics prior to going to the dentist or before procedures, you should take your normal dose before coming to our office. Please bring an updated list of your medications and allergies with you to your appointment. If you are on a blood thinner medication, you should continue taking it normally unless a physician has instructed you otherwise. If you take Coumadin or Warfarin, please bring a copy of your most recent INR or Coumadin level.
In the 1930s, Dr. Frederic Mohs, a surgeon in Wisconsin, applied a technique for evaluating skin cancer microscopically during its removal. Early on, this technique was known as chemosurgery, but today is widely known as Mohs micrographic surgery. The Mohs technique has evolved into an efficient and extremely effective skin cancer treatment allowing the physician to remove as little tissue as possible with the highest cure rate. During the procedure, the tumor portion that can be seen is removed with a small margin. This specimen is then taken to the onsite lab while the patient waits. After it is processed, the physician examines 100% of the edges under the microscope. This allows the physician to precisely identify any remaining skin cancer. If more skin cancer is seen under the microscope, the physician can then remove more tissue only in the area where more skin cancer was identified. By examining all of the edges under the microscope, Mohs micrographic surgery offers the highest cure rate for most skin cancers.
Dr. Nicole Warner is a board-certified Dermatologist and Dermatologic Surgeon who completed an ACGME accredited fellowship in Micrographic Surgery and Dermatologic Oncology (Mohs Surgery). She completed her Medical Degree at the Pennsylvania State University College of Medicine where she also went on to complete a residency in Dermatology. She served as chief resident her final year before then going on to complete her Mohs fellowship at Geisinger Medical Center. Dr. Warner’s clinical interests include Mohs and dermatologic surgery, skin cancer management, and cosmetic dermatology.
The Mohs Micrographic Surgery Team at The Dermatology Group consists of several highly trained individuals who will be involved in your care. In addition to Dr. Warner, there are surgical assistants who are experienced in caring for patients during surgery and laboratory technicians who precisely prepare the tissue for microscopic examination.
You will arrive for your scheduled appointment in the morning and should plan to spend the whole day with us. You may wish to bring snacks or lunch and reading material. Once you are checked in, the first layer of tissue will be removed by cutting around the visible skin cancer. This is done under local anesthesia, meaning an injection of medicine into the skin which causes the area to be numb during the procedure and while you are waiting. After the first layer of tissue is taken, you will head to our waiting room with a bandage over the area to relax while the tissue goes to the lab and is then examined under the microscope. This process usually takes around an hour. If there is more skin cancer identified, you will be taken back to the procedure room and another piece of tissue will be taken. Each time tissue is taken to our lab you will have to wait while the tissue goes to the lab and is examined. If there is no more skin cancer identified, you will be brought back to the procedure room and the area where the skin cancer was removed will be repaired. Sometimes, we allow the area to heal in by itself, but usually we will use sutures (stitches) to repair the area. Occasionally we will need to do a skin flap or a skin graft. We will discuss these procedures with you prior to repair.
Most skin cancers require one to two layers for removal, but some may require many more for complete removal.
Each stage of the surgical procedure can require up to 2.5 hours, half hour for surgery and one to two hours to process the tissue for microscopic examination. Again, several layers or stages may be required and you should plan on being at the office all day. In rare instances, the patient may have to come back the next day to have the process completed.
Yes, as almost any form of treatment for skin cancer will leave a scar. However, Mohs micrographic surgery preserves as much normal tissue as possible. As a result, the defect created during surgery to remove the skin cancer is as small as possible. Each repair is designed to reconstruct the unique skin cancer defect to give the smallest and least noticeable scar possible. On occasion, a multi-specialty team of doctors may be needed to work in conjunction with the Mohs surgeon to maximize the optimal result for the patient.
A local anesthetic, usually lidocaine, is injected around the skin cancer to anesthetize the skin. A slight discomfort is experienced initially until the skin becomes numb. Once the numbness has begun, no discomfort is experienced. Anesthesia generally will keep the patient pain free for a couple hours. If additional stages of surgery are required, additional anesthetic may be injected to keep the patient pain free. After the surgery is completed, most patients experience very little discomfort. Any pain after the procedure can usually be controlled with Tylenol or acetaminophen.
