What is Mohs Surgery?

Mohs surgery is an outpatient procedure for removing skin cancer with the highest cure rate while preserving as much normal skin as possible. In this procedure, cancers are removed layer by layer and examined under the microscope immediately afterwards until all the cancer cells are eliminated. With this technique, cure rates can be as high as 99% and the chances of a disfiguring scar are minimized. Dr. Bittar has specialized expertise in Mohs surgery and completed his fellowship training in the technique at Yale School of Medicine, where he also served on faculty.

What can patients expect the day of Mohs surgery?

On the day of surgery, the surgical site is numbed with local anesthesia and the skin cancer is removed with a narrow margin of normal skin. The tissue is then brought to the on-site laboratory where it is processed and evaluated under the microscope by Dr. Bittar. If residual skin cancer is noted at any margin, then additional tissue is removed from the area where skin cancer is still present. This tissue is again processed and evaluated for residual tumor and repeated until the entire skin cancer is removed. At each stage, only areas with cancer cells are removed while normal skin is left intact.

Once the cancer is completely removed, Dr. Bittar will have a discussion with you about surgical reconstruction. In some cases, especially if the wound is small and superficial, the wound may best heal naturally. In other cases, the wound will be sutured into a straight or curved line. Sometimes, a more advanced repair such as a skin flap or graft is needed to repair the defect. The choice of reconstruction is generally based on several factors including the size and location of the wound, the quality of the surrounding tissue, smoking status, and patient goals of care. The vast majority of reconstruction is performed by Dr. Bittar on the same day as the procedure, also under local anesthesia.

In some cases, coordination with our highly qualified colleagues in other medical and surgical specialties may be required.

How long does Mohs surgery take?

Patients should plan to spend the entire morning at our office on the day of Mohs surgery. About 50% of the time, the cancer is sometimes completely removed on the first stage. However, multiple stages are often required. Each stage of the procedure takes about 30-60 minutes, the majority of which is time needed for the on-site laboratory to process the tissue so that it can be examined under the microscope. Patients are awake during the entire procedure, so it is a good idea to bring a book, laptop, or other device to pass the time while waiting.

Will I need follow up monitoring after Mohs surgery?

In most cases, you will be asked to come back to the office to remove sutures (if the wound was reconstructed) and/or make sure the wound is healing well. It is also very important to receive regular skin checks with your general dermatologist after the procedure to monitor for potential future cancers. If you have a single basal cell skin cancer, the chance of developing a second one is about 40% in the next 5 years. The frequency of monitoring will depend on your overall skin cancer risk.