While I am not a Mohs surgeon I can tell you generally how the surgery works and what to expect. Mohs is a specialized surgical technique that optimizes control of the tumor margins WHILE MINIMIZING THE AMOUNT OF NORMAL TISSUE THAT MUST BE REMOVED, and therein lies the benefit. It is performed under local anesthesia, usually injected Lidocaine which should be well tolerated and not cause many systemic effects. Similar to standard excision, the defect (opening) is either closed immediately (using side to side closure, a local skin flap or a skin graft) OR allowed to heal secondarily (meaning the defect just heals on its own) following complete removal of the tumor. The decisions about how and when to reconstruct are entirely based on the size of the defect and the area (mouth, eyelid, lip, nose, etc).

The main disadvantage to Mohs is that the procedure can last 2-4 hours or even longer, and reconstruction following Mohs can add another hour to the procedure. A significant amount of those 2-4 hours is taken up by the pathologist reading the results so during that time you will be sitting in the waiting room temporarily bandaged.

Prior to the surgery it's important to avoid any anticoagulant that can lead to increased bleeding: aspirin, ibuprofen, fish oil and even alcohol should be held 1 week prior to the procedure. The issue of bed rest will depend on the size of the defect created by the surgery and the location.

Dr. Orrange