Arriving and Getting Ready
When you arrive, a staff member will check you in and review your consent forms with you. Consent forms explain the procedure, its benefits, and its possible risks. Your surgeon or a nurse will answer any questions before you sign. You will be brought to a comfortable procedure room. Your surgeon will look at the area to be treated and use a special pen to mark the outer edges of the tumor. A drape (sterile cloth) may be placed around the area to keep it clean.
Helpful Tips
- Wear comfortable, loose clothing that gives easy access to the surgical area.
- Eat a normal breakfast or lunch beforehand. Skipping meals is not required for local anesthesia.
- Bring something to read, listen to, or watch during waiting periods between stages.
- Bring a trusted friend or family member to drive you home and keep you company.
- Tell your doctor about all medications you take, especially blood thinners.
Numbing the Area (Local Anesthesia)
Before any tissue is removed, your surgeon will inject a numbing medicine called local anesthesia (such as lidocaine) into the skin around the tumor. This feels very similar to the shot you get at the dentist. A brief sting or burning feeling for 10–20 seconds, followed by complete numbness. Most patients say this is the most uncomfortable part of the entire day, and it passes quickly. If you need more anesthesia during the procedure for later stages, the additional injections are nearly painless because the area is already numb.
Helpful Tips
- Deep breathing or squeezing your hands can help you get through the brief sting of the first injection.
- Tell your surgeon right away if you feel any pain during the procedure. More numbing medicine can be added.
- Feeling pressure or tugging is normal and expected, even when fully numb.
Important
- Do not drive after receiving sedation if it was used. Local anesthesia alone does not impair driving, but confirm with your doctor.
Removing the First Layer (Stage 1)
Once the area is completely numb, your surgeon removes a thin, saucer-shaped layer of tissue that includes the visible tumor plus a small margin (border) of normal-looking skin. This layer is called the Mohs layer or stage. The wound is then covered with a temporary pressure bandage to control any minor bleeding. You will not feel any pain during this step. Only mild pressure or movement.
Waiting While the Lab Works
After the tissue layer is removed, it goes to the in-office lab for processing. A lab technician carefully maps, color-codes, and freezes the tissue, then cuts it into very thin slices and mounts them on glass slides. Your surgeon then looks at every edge of the tissue under a microscope to see if any cancer cells remain. This process typically takes 20 to 45 minutes per stage. You will wait comfortably. In a waiting area or the procedure room. With your temporary bandage in place. This waiting time is normal and expected, so plan for it.
Helpful Tips
- Use the waiting time to rest, read, listen to music, or chat with your companion.
- Snacks and drinks are usually available. Ask the staff.
- The waiting time is not a sign that something went wrong; it is built into the procedure.
Microscopic Examination and More Stages
When the microscope examination is complete, your surgeon will come back with results. If the edges are clear (no cancer cells seen), you move on to repair. If cancer cells are still present at one area of the edge, only that specific area needs to be removed in the next stage. Healthy tissue in clear areas is left completely alone. This is the key advantage of Mohs surgery: it removes only what needs to come out, saving as much normal skin as possible. On average, most patients need 1 to 3 stages. After each additional stage, the process repeats. Numb, remove, bandage, wait, examine. Until all edges are clear.
Helpful Tips
- Each additional stage only targets the area where cancer was still found, not the whole wound.
- Needing more than one stage does not mean something went wrong. It means the surgery is working as designed.
Closing the Wound: Repair Options
Once all cancer is removed and the margins are clear, your surgeon will discuss how to repair the wound. The right repair depends on the size and location of the wound, the depth of tissue removed, and your overall health. Most repairs are performed the same day, right after the final stage.
Direct Closure (Linear Repair)
If the wound is small enough and the surrounding skin has enough flexibility, the edges are simply pulled together and stitched closed in a straight line. This is the most straightforward repair and usually heals with a thin, flat scar. Most small-to-medium wounds on the trunk and limbs are closed this way.
Skin Flap
A skin flap uses nearby skin that is still attached to its blood supply. The surgeon moves a section of adjacent skin over to cover the wound, then stitches it into place. Flaps are often used on the face, where the skin has a good blood supply and matching skin is nearby. Flap repairs heal well and tend to produce natural-looking results.
Skin Graft
A skin graft takes a thin piece of skin from another part of your body (called the donor site. Often the upper arm, behind the ear, or the collar area) and places it over the wound. The graft is stitched in place and covered with a special dressing. Grafts are used when there is not enough nearby skin to use for a flap, or when the wound is on a curved surface. The donor site will also heal on its own within a few weeks.
Healing by Secondary Intention (Granulation)
Sometimes the best option is to let the wound heal on its own, without stitches. This is called healing by secondary intention or granulation healing. New skin slowly grows in from the edges of the wound over several weeks. This approach is often chosen for wounds in certain locations. Like the inner corner of the eye or curved areas of the nose or ear. Where natural healing produces an excellent cosmetic result. Your surgeon will teach you how to care for the wound at home during this healing period.
Going Home
After the repair is complete, your surgeon or a nurse will dress the wound and give you detailed written instructions for home care. You will be told what to expect in the first 24–48 hours, how to clean the wound, and when to come back to have stitches removed (if applicable). Most patients go home the same day and feel well enough to do light activities. Your surgical area will remain numb for a few hours after the procedure. Plan to rest for the remainder of the day and avoid strenuous activity.
Helpful Tips
- Have your written home-care instructions in hand before you leave. Read them the same evening.
- Stock up on supplies before surgery day: petroleum jelly (Vaseline or Aquaphor), non-stick gauze pads, and paper tape.
- Keep the phone number of your doctor's office handy in case you have questions at home.
Important
- Do not remove or disturb the first pressure bandage until instructed. Usually 24–48 hours after surgery.
- Call your doctor right away if you have heavy bleeding that does not stop with firm pressure, signs of infection, or severe pain.