and placing towels around the operative site. Your provider will then carefully debulk an obvious remaining tumor and remove a layer of tissue. Any bleeding will be controlled using a cautery or bipolar forceps and the surgical assistant will bandage your surgical site. Your provider will take the layer of tissue to the laboratory where it is mapped by orienting it with nicks and tissue dye in preparation for processing. Your provider's histotechnician will then process the outer margin of tissue, making microscope slides of this true margin. These slides are stained with hematoxylin and eosin or special stains so that your provider can carefully examine the microscope slides for any remaining cancer at the margin. This processing takes approximately one hour and is repeated when the microscope slides show residual cancer at any margin. Typically patients are in our office for 3-4 hours, but longer cases do occur when tumors are very large or have ill-defined margins. You will spend a significant time in the “Mohs waiting room” during your appointment while tissue is processing. It is a good idea to bring something to read or work on for the day of surgery. To make your stay more comfortable, we have a television and wireless Internet access . You are welcome to bring a friend or family member to your surgery appointment to accompany you while you wait in the Mohs waiting room, but please limit the number of people accompanying you to one person due to the limited space in our waiting room. If you have several family members or friends at your appointment, we may ask you to wait in a designated area within our building at the Hulston Cancer Center. What to Expect After Surgery Once your skin cancer has been completely removed, your provider will discuss repair options with you. Repair options are individualized, but options include sewing the skin together (simple closure or skin flap), taking skin from another similar-looking area (skin graft) or actually allowing the wound to heal by itself (granulation). Your provider will discuss options with you and decide on the best repair. For special wounds, other surgical specialists can be involved in the repair of your Mohs wound. Typically sutures are removed 7 days after surgery on the face, and up to 14 days on certain areas. Mild to moderate post-operative pain usually lasts less than 24 hours and can be controlled using Tylenol (acetaminophen). Bruising and swelling are common following surgery and usually last for 5-7 days. Applying ice during the first 24-hours after surgery reduces bruising, swelling and pain. As the surgery site heals, it is normal for the area to feel like it is tightening. The risk of significant postoperative bleeding is very low. Our staff will place a pressure dressing on the wound after surgery, which should stay in place for 48 hours. A small number of patients have some postoperative bleeding as the epinephrine (adrenaline) in the anesthetic wears off, which usually occurs 1-2 hours after surgery. Applying direct pressure over the dressing for 20 minutes can usually stop this. For any bleeding that is not controlled after 20 minutes of direct pressure, notify us immediately. Numbness is also common at the surgical site because skin cancers are often found around nerves that carry sensation. This can sometimes become permanent, but most initial numbness improves over 4-6 months. When skin layers are realigned correctly, sensory nerves slowly grow across the scar minimizing numbness. This healing process often makes patients feel like their scars are sensitive or itchy . This is normal and can be expected. Occasionally, a patient’s tumor is large and reconstruction may be easier for the patient if they are put to sleep by an anesthesiologist. In these cases, your provider will discuss your case with a trusted surgeon for your reconstruction. Most of the time, your provider will repair your wound on the same day as your Mohs surgery. After any surgical procedures you will be left with a scar . Every effort will be made to offer the best possible cosmetic result. The scar will often be longer than what you may have anticipated because cancer “roots” beneath the surface extend beyond what is visible before surgery. The scar may also need to be lengthened to better fit the contours of the skin. Scars can take a few months or longer to heal completely. The scar can be minimized by the proper care of your wound. Your provider will individualize wound care after your surgery, but you should plan on applying ointment to your wound twice daily for 2 weeks and applying a bandage twice daily for 1 week. Keeping the area moist after surgery and being disciplined to not let air get to the suture
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