• Please arrive 15 minutes early to your appointment time to check in (or 30 minutes if it is your first time visiting the office in order to complete paperwork).

• Be prepared to spend the entire day with us – we cannot predict how long the surgery will take. Most patients are here 3-6 hours, but there are times that the removal and reconstruction can take longer.

• Once you arrive and finish your paperwork:

1. The front desk staff will register you and verify your insurance information

2. A member of the nursing staff will then escort you to a procedure room and review your medical history, medications, allergies, and referring physician

3. You will then be asked to review and sign a consent form giving us permission to perform the surgery

4. The nurse will then cleanse the skin and take a photograph of your skin cancer site. This is done so that we can have a detailed record and send a letter to your referring physician.

5. You will then meet your doctor who will explain the procedure, confirm the correct site with you, and answer any questions you may have.

6. The skin will then be numbed with local anesthetic (lidocaine). There is often a burning and stinging as the medicine is injected and begins to take effect. We know that this can be most uncomfortable part of the procedure and aim to make this as painless as possible.

7. After the skin is numb, your doctor will then begin the surgery. The first step in Mohs surgery is to try to determine the extent of the tumor under the skin. This is done with specialized skin tool called a curette, or with the scalpel.

8. Once the extent of the tumor has been estimated, the doctor will remove all the visible tumor along with a very small margin of skin.

9. The nurse will then stop any bleeding using cautery and bandage will be placed.

10. You will then be shown to the waiting. There is coffee, water, juice, and snacks available. In addition, we have free wireless internet as well as television.

11. The doctor will then take the removed skin (tissue) to the lab. The specimen is carefully oriented, marked with colored dye and then processed and prepared to be looked at under the microscope by your doctor. This process takes approximately 90 minutes in most cases.

12. Once the tissue is ready, your doctor will examine it under the microscope to see if there is any cancer remaining.

12. 1. If the doctor finds that there is still cancer left, they will mark the area on a special map which corresponds to your skin. You be called back to the procedure room, where the nurse will remove the bandage and place more anesthetic in the skin. The doctor will then carefully remove additional skin only from the area(s) where the cancer is still present. This process will be repeated as many times as necessary to completely remove the cancer. About half of people require more than one pass.

12. 2. If all of the cancer has been removed, the nurse will begin preparing you for the repair as explained below.

13. Once the cancer is completely removed, the nurse will take another photograph and your doctor will decide how to best repair/replace the skin which was removed by the cancer.

14. We will ask you if you would like to look at the wound. We recommend and encourage you to look so that you can better understand the extent of the tumor and what will be necessary to repair the wound. However, you are not required to look if you don’t want to.

 Wound Closure (Repair)

When all of the cancer has been removed, your doctor will discuss all the options for repairing your wound, which is most often performed the same day, but in rare circumstances may be postponed to a later date. Options for wound repair include:

·         Doing nothing. Simply allowing the wound to heal by itself. The skin has a remarkable ability to regenerate and heal. While it may take longer, 4-8 weeks, it can lead to excellent results. This may also be the only option in certain areas where there is very limited skin like the shins.

·         Simple Side-To-Side Repair (also called primary closure or linear repair). This is where the skin is stitched back together side-to-side in straight line. This is the most common type of repair.

·         Skin Flap: this is where skin adjacent to the wound is moved  over to cover the wound

·         Skin Graft: a graft is when a piece of skin is harvested from another site (often behind the ear) and placed to cover the wound like a patch.

·         In rare circumstances, the location or size of wound may require referral to plastic surgeon or eye surgeon for repair. Your doctor will let you know if they anticipate this being the case so that arrangements can be made in advance.