Mohs Micrographic Surgery
Generally, surgery is considered the “standard of care” for most skin cancers. There are different types of surgeries, but Mohs Surgery has the highest cure rate. Mohs means that the SAME doctor that removes the skin will examine it under a microscope. Mohs means that 100% of the outer margin will be evaluated microscopically. Mohs takes time, so plan to be at the office all day; IMPORTANT, repairs are done later the same day. For more information about Mohs read below AND go to this website: https://www.mohscollege.org/for-patients/about-mohs-surgery
The surgery is performed in a medical office, not an OR/surgery center. Briefly, the technique is performed as follows:
- A local anesthetic is injected to numb the area to be treated. The visible tumor is then surgically removed.
- In the area under and around this, a thin layer of tissue is removed and cut into small pieces, each of which is color coded. This and succeeding layers of tissue are taken to find and remove the roots of the tumor.
- To remember exactly where each piece of tissue came from, the doctor draws a map corresponding exactly to the wound he has created. The tissue is then brought into an adjoining lab where the technician makes horizontal frozen section slides.
- These slides, when seen under the microscope, allow the doctor to examine the entire base and periphery of the tissue that was removed from the patient. If any remaining tumor is seen, through use of the color coded edges, the doctor is able to mark its exact location on the map.
- The patient would then be brought back into the operating room where the doctor would remove a second thin layer of tissue under and around the remaining tumor, examining that in the manner previously described.
- The process continues until the entire tumor has been removed. There will be down time between stages and repairs, so bring something to do or read as well as snacks and lunch (though restaurants are nearby).
Once a tumor-free layer of tissue has been reached, the Mohs surgery is complete. The number of stages or layers that must be taken from any individual varies and depends upon the size and depth of the tumor. On average, most patients require 1-2 stages/passes to remove all their cancer.
Once the surgery is complete, the doctor and patient will review repair options. Usually, repairs are done the same day as the Mohs surgery. The website above gives more information about this as well.
Preparation For Surgery
Part of the office medical team will contact you before your surgery to review your medical history and the procedure. Before this, reference the Mohs College website and read the information below to be prepared. Also, use our patient portal to input and update important medical information into your records.
Take all your usual medications. Importantly, if you suffer from high blood pressure, it must be under good control prior to surgery. Please have it checked and continue your medications the day of surgery.
For aches and pains, we ask that you do not take aspirin or other anti-inflammatory drugs (such as Motrin, ibuprofen, Aleve, etc…), for seven days before your scheduled surgery. You may take Tylenol (acetaminophen) for pain as needed. You should continue to take aspirin or other blood thinners if prescribed or recommended by your doctor. If you take warfarin/coumadin, try to check your INR within a week of surgery and notify us ASAP if your INR is >3. If you have questions regarding taking any of your medications before surgery, our nurses will be happy to answer them.
Many over the counter supplements, vitamins, and herbals can affect bleeding. Please stop these 10 days pre-op.
To avoid infection, it is important to wash your body thoroughly the night before surgery.
Specifically:
- If your cancer is on your head, wash your face with standard antibacterial soap AND your hair with soap or shampoo and then avoid putting anything else on your face or hair (like make-up or conditioner).
- If your cancer is on your neck or body, please buy soap with 2-4% chlorhexidine (common brand name Hibiclens) from your local pharmacy, and then gently lather your body for 3 minutes before rinsing; AVOID applying this on your face since it can be damaging to the eyes and ears.
*If having surgery on your face, please do not wear any cosmetics*
Day of Surgery
On the day of surgery, please arrive at Dr. Witheiler’s office at your scheduled time. It is important that you bring with you your medications or a detailed list of all medications that you take, including non-prescription drugs. You should eat breakfast, and take your usual daily medications that morning. Surgery will then begin and, as described above, will continue on a layer by layer basis until the entire tumor has been removed. While it depends on your cancer size, location and repair type, it is advised to have someone be able to drive you home following the completion of surgery. Although you may be finished earlier, please plan on spending the entire day with us.
Most follow up visits are within 1 week of the scheduled surgery date; please be sure you are available for this.
Always remember to bring your primary and secondary insurance cards and any required billing forms. Billing representatives are available Monday through Friday at our office to answer questions. We are pleased to have you as our patient and to be able to offer you this highly effective surgical technique. If you have any questions, please feel free to call before or after your surgery.
Post Operative Wound Care
Specific wound care instructions will be given to you after surgery; however, in most situations, you will need to have the following on hand. All are available at the drugstore:
For Pain
Post-operative pain is usually minimal. If you are given a prescription for pain, follow the instructions on the prescription. If you are NOT given a prescription your pain can be controlled by taking acetaminophen (Tylenol) with or without ibuprofen (Motrin/Advil).
Instructions for OTC pain relief: acetaminophen (extra strength Tylenol) 500mg, two tablets every 6 hours (or every 8 hours if you are over 60) usually relieves any pain you may have. If needed, you can take ibuprofen (Motrin/Advil) 200mg, two tablets, every 6 hours; try to take these between your acetaminophen doses so you always have pain control.
Wound Dressing
- Telfa non-stick pads or similar material
- Gauze
- Paper tape (easiest on most peoples’ skin)
- Ointment - Vaseline or other plain white petroleum jelly; Polysporin, bacitracin or Aquaphor ointments may also be used
- Scissors which have been cleaned with soap and water or alcohol
- Pre-made wound care kits are available to purchase in our office for $20
For Swelling or Bruising
An ice pack is useful in controlling swelling and bruising after surgery you can make an ice pack using Ziploc bags and ice cubes.
Overnight Accommodations
Holiday Inn Market Center
4500 Harry Hines Boulevard
Dallas, Texas 75219
Phone: (214) 219-3333
Candlewood Suites
7930 North Stemmons Freeway
Dallas, Texas 75247
Phone: (214) 631-3333
