Frequently Asked Questions
What does "Mohs" stand for?
Dr. Frederic Mohs developed this technique about 60 years ago. The procedure has been modified and refined over the years. Practitioners of the technique have kept Dr. Mohs’ name in respect for his contribution. Mohs surgery has other names including Mohs chemosurgery, Mohs microscopically controlled surgery, and Mohs micrographic surgery.
Are there different types of skin cancer?
Yes. The most common type of skin cancer is basal cell carcinoma. Often these skin cancers are very subtle, and appear like a small pimple that will not heal and often bleed. The second most common skin cancer is squamous cell carcinoma. This type usually appears as a thickened scaly plaque or nodule. The third most common type is melanoma, which behaves differently that either basal cell carcinoma or squamous cell carcinoma. Melanoma most commonly appears as an abnormal mole.
Are skin cancers life-threatening?
Fortunately, the two most common types of skin cancer, basal cell carcinoma and squamous cell carcinoma, are rarely life threatening. As a general rule, basal cell carcinoma does not spread to the glands or other parts of the body. Compared to basal cell carcinoma, squamous cell carcinoma has an increased risk to spread to other parts of the body. Fortunately, distant spread is uncommon when the cancer is treated early. However, both types of tumors will continue to grow locally and destroy normal tissue. The third most common type of skin cancer, melanoma, can be life threatening if treated late. Basal cell skin cancers and squamous cell cancers never “turn into” melanoma.
Is Mohs surgery used to treat all skin cancers?
No. Mohs surgery is used to treat mostly basal cell carcinomas and squamous cell carcinomas on cosmetically sensitive areas (usually the head and neck), or for those that have recurred after a previous treatment. We also will sometimes utilize a modified version of Mohs surgery to treat thin melanomas in cosmetically sensitive areas.
How large of a scar will I have from the surgery?
The size of the scar depends on the size of the tumor. It is often difficult to predict the size of the tumor prior to surgery.
Will I have stitches following the surgery?
Most patients will have stitches. There are three main ways your surgical wound may be handled:
1. Direct closure of wound with stitches. This is the most common method.
2. Skin graft or flap: In some instances, it is necessary to remove skin from behind the ear or some other site and graft it over the wound. Other times skin that is located near the wound is moved in to fill the defect left from surgery – this is a skin flap.
3. Let wound heal in by itself. The body has an excellent capacity to heal open wounds. This healing period is approximately three to six weeks depending on the size of the wound. It requires regular wound care.
In addition to wound size and location, the surgeon considers other factors in determining how your wound will be handled. This will be fully discussed with you on the day of surgery.
Will I be put to sleep for the surgery?
No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is thus avoided.
How long will the surgery last?
The length of surgery depends on the extent of the tumor. Often surgery lasts half a day or longer. Much of the time is spent waiting for tissue to be processed. Bring reading materials, needlework, etc., with you to help pass the time. Also, you may want to bring a snack or lunch with you on the day of surgery.
What if I live far away from the Kingsport area?
If your travel distance is great you might want to spend the night before surgery in the Kingsport area. There are a few moderately priced hotels nearby. A list of these is available upon request.
Should I bring someone with me?
It is often helpful to bring someone with you on the day of surgery. Depending on the size and location of your tumor, driving is sometimes a challenge after surgery, and having a driver with you is a good idea. Additionally, if someone other than the patient will be performing post-op wound care, the nurse can give this person direct instructions, demonstrate wound care, and answer any questions about the surgery.
What should I wear?
You should wear comfortable clothing. You may want to bring a sweater, as our office is kept cool for the laboratory equipment that is needed for this procedure.
Should I eat breakfast before surgery?
Yes. Breakfast is recommended.
Should I take my regular medications on the morning of the surgery?
Yes. Take your regular medications as they have been prescribed.
Are there any medications I should avoid prior to surgery?
If you take aspirin on a regular basis at the direction of your physician, you SHOULD CONTINUE to take it as prescribed. If you have decided yourself to take aspirin, NOT at the recommendation of a physician, it may be beneficial to stop your aspirin 10 days prior to surgery. If you are on any other blood thinners (coumadin or Warfarin©, Plavix©, Ticlid©, etc) please continue taking these as prescribed.
Will my activity be limited after surgery?
Yes. Physical activity, including sports, will be limited for the first week following surgery. If your work requires significant physical exertion, you may be out of work for several days after surgery. An excuse for your absence will be provided if necessary. Avoid any long trips within the first week following surgery in case you develop any complications. For any questions or special situations please do not hesitate to call our office.
Since I have taken antibiotics before other procedures in the past do I need to take them before Mohs surgery?
If you have taken antibiotics prior to dental or other surgical procedures, or have a history of rheumatic fever, heart murmur, artificial heart valve or artificial joint, we will prescribe one for you prior to Mohs surgery. This will help prevent infection of the heart valve or artificial joint. Pacemakers, implanted defibrillators, mitral valve prolapse and cardiac stents do not generally require antibiotics. The antibiotic used for dental work is best for bacteria found in the mouth and is not as effective for skin surgery. Please contact our office prior to surgery so that we can call or mail a prescription to you for the most appropriate antibiotic.
What are the potential complications of surgery?
Bleeding and infection are the two primary complications. Both of these are uncommon, and can be treated if they do occur. We will discuss how to recognize and deal with these problems when you come for your surgery.
Can you treat melanomas with Mohs surgery?
We use a modified version of the Mohs procedure to treat only thin melanomas (those melanomas with no depth of invasion). For technical reasons, melanomas must be sent to an outside lab for special stains and interpretation and therefore it takes about two days to get the report. Fortunately, we can prepare the tissue in our lab prior to sending it out so that we are able to map the roots with the Mohs technique which allows for the evaluation of 100% of the margin. If a melanoma shows depth of invasion on the biopsy, the area will be excised in the traditional manner with wide margins.
Will my insurance cover the cost of surgery?
Under most circumstances your carrier will pay for surgery. If you are a member of an HMO, it may be necessary to obtain a referral or authorization from your primary physician. If you are in doubt about your particular coverage, you should check with your insurance representative prior to your appointment. If you have specific questions regarding insurance or billing matters, please contact our office at 423-246-4961.