The Surgery
The skin tumor is removed one layer at a time and frozen sections are examined under the microscope immediately after they are removed. Using the microscope, the Mohs surgeon can see which way the tumor is growing. Often, these tumors grow like roots of a tree, extending farther under normal-looking skin than what you see with the naked eye.
While the patient relaxes in the waiting room, the tissue is examined. The frozen section tissue processing and microscopic examination of the lesion between stages requires 45 minutes to an hour. During this time, the patient will be allowed to sit in the waiting room with friends or family. We recommend bringing ample reading material (books, magazines, laptop computer, etc.). We will provide a quiet, peaceful environment and beverages such as coffee, tea and water and a variety of small snacks.
The patient reenters the treatment room and additional tissue is removed only in the area where the margin was positive. Most cases are cleared in one to three stages; however, larger or recurrent tumors often require multiple stages. The tumor removal and reconstructive surgery typically occurs in a single day, requiring approximately three to five hours from beginning to end.Occasionally, complex cases require more time and/or delayed reconstructive repairs. In such cases, Dr. Sebben will meet with you to discuss these issues and answer any questions or concerns.
Reconstruction
The Mohs surgeon has extensive training in reconstructive procedures and often performs the wound closure after the tumor is removed. A small wound may be allowed to heal on its own, or the wound may be closed with stitches, a skin graft or a flap. Since Mohs surgery preserves the maximum amount of normal skin, this results in smaller scars. Repairs are more often simple and involve fewer complicated reconstructive procedures.If a tumor is larger than anticipated, another surgical specialist with unique skills may complete the reconstruction. In this situation, the patient may be sent home with a special bandage until the following day or may go directly to the specialist immediately following the tumor removal. Every effort will be made to anticipate these more complex situations and a consultation with Dr Sebben may be necessary prior to the Mohs surgery day. If you would like to meet with Dr Sebben prior to your surgery appointment, he would be happy to schedule a consultation visit.
Dr Sebben repairs approximately 95% of his Mohs cases. If a referral to a subspecialist is necessary, he will coordinate reconstruction with the appropriate specialist in the area.
Patient Preparation for Surgery
Continue taking your usual medications, even on the day of surgery, unless you are directed by a physician. You will be asked to inform the Mohs surgeon whether you are taking any blood-thinning medications such as warfarin, Plavix, aspirin, ibuprofen, vitamin E, or others. Blood-thinners can lead to increased bleeding, swelling and bruising following surgery.
Please get a good night’s rest and eat normally prior to your surgery. It is important that you bring a sack lunch on the day of your surgery. We recommend that you wear comfortable clothing and an extra layer for warmth. Please wear a shirt that can be removed without pulling it over your head (i.e. one with buttons or zippers down the front). A book, magazine, or laptop computer may be helpful during the waiting periods of the day.
Also, you may want to arrange for a friend or family member to drive you home. You will not be allowed sedatives or strong pain medication during surgery if you are planning to drive yourself home.
Medications during and after Surgery
A patient may be given antibiotics on the day of surgery and for a short period post-operatively. Pain after surgery is generally described by patients as “throbbing” or like a “deep bruise” but is not typically sharp in nature. Surgery on the forehead or scalp may trigger headaches on the first night or first few days of recovery. Over-the-counter and/or prescription pain medications may be necessary and will be discussed on the day of surgery.