Mohs Surgery Information
Please read this document in full at least 1 week before your surgery
Location: 85 Lincoln Street, Ste 510, Framingham, MA 01702
Surgeon: Rebecca K. Jacobson MD.
Phone Number: 617-540-5570
Fax Number: 617-540-5571
(Please arrive at least 15 min in advance of your appointment time)
Welcome
Thank you for trusting Greater Boston Dermatology with your Mohs surgery care. We provide the highest quality surgical care and offer consultations to address any questions prior to your procedure. The purpose of this packet is to help you prepare for your surgical visit.
Be Sure to Bring the Following to Your Appointment:
Insurance Card
Name, address, and phone number of your preferred pharmacy
All your medications if you have an extended day
Any information on implanted medical devices such as a device card
Any snacks and entertainment you may need (books, iPad, headphones)
Please Notify Our office if : (Office #: 617-540-5570 Fax #617-540-5571)
If you take Coumadin (Warfarin). You should continue to take it and have your INR/coumadin level checked within 1 week of your surgical procedure. Please forward the results to our office.
If you have history of an infected artificial joint or a history of endocarditis
If you have any other implanted electrical device (e.g. pacemaker/defibrillator/neurostimulator)
If you require use of a wheelchair, are not weight-bearing, cannot transfer to a surgical chair or need extra assistance with mobility such as going to the restroom. Unfortunately, we are not able to help transfer patients but can help you plan your day and better anticipate your needs.
If you have an allergy to any anesthetics including lidocaine
If you are pregnant or nursing
If you have any upcoming procedures or surgeries
If you have any upcoming vacations or travel plans
Preparing for Your surgery
Medications
Take all your medications per usual the day of surgery.
If you take blood thinners, continue to take them as usual including aspirin.
Unless necessary, do not take any Vitamin E, Fish Oil, or other over the counter supplements including herbal remedies 1 week prior to your surgery.
If you are prescribed Ativan (lorazepam) or Valium (diazepam), do not take it until after you have seen the doctor and signed your consent form, or the procedure will be cancelled. You will also need a driver if you take these medications prior to procedures. Please bring your bottle to the visit as Dr. Jacobson will need to confirm the prescription.
Other activities
Do not drink alcohol for 3 days prior to surgery and 2 days after surgery. It can thin your blood and increase your risk for bleeding.
Smoking can slow down and severely impact wound healing. Please do not smoke. If you cannot stop completely, cut back as much as you can before and after your surgery. It will make a difference in how well your wound heals.
Get a good night’s rest. Our goal is to make you as comfortable as possible.
We ask that you to eat breakfast before your surgery.
Length of Procedure
The duration of surgery is difficult to predict. You should expect to be at our office for several hours to the entire day. Your length of stay will depend on how many stages are needed to clear the cancer on your surgery day. This is not something that we can predict ahead of time.
You should bring reading materials or a tablet/phone with earphones to help pass the time while waiting. You may also bring snacks.
Drivers and Family members
You must have a driver on the day of your surgery if you are having surgery on or near your eye.
Please let us know if you need a family member or companion in the room at the time of surgery for medical reasons.
If the patient cannot provide medical consent for procedures. The patient’s power of attorney will need to be present or present by proxy on the day of surgery.
Antibiotics
While antibiotics are not usually prescribed prior to Mohs surgery, you may be given antibiotics before or on the day of surgery on a case-by-case basis.
Pain
All surgery is performed under local anesthesia. We use a local anesthetic called lidocaine with epinephrine to numb the area prior to surgery as well as throughout the surgery.
Post-operatively, there is usually minimal discomfort. It can usually be managed with extra strength Tylenol.
Scarring
In most cases, the Mohs surgeon will immediately repair the wound after the tumor has been removed. It will often require stitches.
While a scar is unavoidable when removing a skin cancer, a fellowship trained Mohs surgeon has extensive experience in facial reconstruction and repairing wounds to minimize scars as much as possible.
How well you take care of the wound after surgery can also influence how your scar looks.
Wound Healing and Bandaging
The exact details of your bandage and wound care will be addressed on the day of your surgery and will be specific to your case.
Written wound care instructions will be provided.
You should expect to wear a bandage after your procedure.
The bandage may be on for 48 hours or 7 days depending on your procedure.
You will have to continue bandage changes for several weeks after your procedure.
You may not be able to get it wet for anywhere from 48 hours to 7 days depending on your procedure.
Depending on the area involved, some patients will need family members to assist them with bandage changes.
If the surgical site is near your eye, cheek, or nose, it may be necessary for us to cover your eye with a bandage after surgery. We will try our best to bandage it in such a way where you can still where your glasses. In this case, for your safety, please arrange to have a ride home.
If the surgical site is on your ear, the bandage may affect your ability to wear a hearing aid in that ear temporarily.
It would be advisable to buy a fresh tube of Vaseline, non-stick/non-adherent gauze and surgical/paper tape as this will likely be part of your wound care regimen.
Scheduling Considerations
You may need to return in 1 - 3 weeks to have your stitches removed and may have follow-up appointments to monitor wound healing. •
Do not schedule any trips or vacations in which you will be away from the area until at least 2 weeks after your surgical appointment. This timeframe may vary depending on the extent of your surgery and wound healing requirements.
While most patients only experience minor discomfort, you may need to take at least the next day off work depending on the extent of your surgery. We are happy to write a work note at the time of surgery.
You also should not perform any heavy lifting for 2 weeks after your surgery (Nothing > 5 lbs.).
In general, you should reduce your physical activities, including exercise for 1-2 weeks following surgery. Exact recommendations will be given at the time of surgery.
Mohs Surgery Contact Information:
Office Phone Number: (617)540-5570
Office Fax Number: (617)540-5571
Feel free to contact our office with any questions or concerns.
What is Mohs Surgery and What to Expect
Mohs surgery is an advanced outpatient procedure used to treat various types of skin cancer with a cure rate of up to 99%. This highly precise technique is performed by a fellowship-trained Mohs surgeon alongside a dedicated team of nurses, technicians, and medical assistants.
The main advantage of Mohs surgery is its precision: the surgeon uses a microscope to remove only the tissue affected by cancer, preserving as much healthy skin as possible.
Before the Procedure
Appointment Time: Most Mohs surgery appointments begin in the morning.
Check-In: After arriving and checking in, you'll be brought into one of our surgical suites.
Preparation: We’ll review your medical history, allergies, and medications. The surgeon will explain the procedure's risks, benefits, and alternatives, and you’ll sign a consent form.
Identifying the Surgical Site: The site will be confirmed using photographs, and we’ll also ask you to confirm the correct location.
During the Procedure
Numbing the Area: We use local anesthesia (usually lidocaine with epinephrine) to numb the area. We’ll ensure you’re comfortable and reapply anesthesia as needed throughout the surgery.
Removing the Tumor: The surgeon will carefully remove a small layer of tissue around the tumor. Bleeding is minimal and controlled with a cautery device. A bandage will then be applied.
Processing the Tissue: The removed tissue is taken to our lab, where it’s processed, frozen, and examined under a microscope by Dr. Jacobson.
If any cancer is detected, the process is repeated until no cancer cells remain. Each stage of tissue removal requires some waiting time (at least 1 hour-90 minutes) while the lab processes and examines the tissue. Each piece of tissue takes a different amount of time in the lab to prepare. Depending on the size and location of the tumor, you may need several stages. It’s important to plan to spend the day with us. While most surgeries are completed in a single day, there are rare cases where it may take more than one day to completely remove the tumor and close the wound.
After the Tumor is Removed
Repairing the Area: Once the cancer is fully removed, we’ll discuss the best way to repair the wound. Options vary based on the tumor’s location, size, and your medical history. Repairs may include:
Letting the wound heal on its own.
Closing the wound with stitches.
Using a skin graft or flap to cover the area with healthy skin from another location.
While scarring is unavoidable when skin cancer is removed, your fellowship-trained Mohs surgeon is highly skilled in facial reconstruction and will strive for the best cosmetic outcome possible. We encourage you to schedule a consultation prior to your surgery. Dr. Jacobson can address your specific concerns, tumor type, and discuss reconstruction options.
Risks of Surgery
While complications are rare and the benefits outweigh the risks, there are risks involved with any surgery including Mohs surgery. You need to be aware of the possible risks prior to having surgery. These risks include but are not exclusive to:
Post-operative bleeding: Some minimal bleeding during the procedure is expected and usually electrocautery is used to stop any bleeding. After surgery, there is always a risk of bleeding which can usually be managed with pressure.
Infection: Infection rarely occurs, but if it does it can be treated with antibiotics. After your surgery, you should let us know immediately if you have any fevers, drainage, increasing swelling, sudden tenderness or expanding redness.
Numbness: Most scars are numb, and this may persist for several months or longer but will often improve. Very rarely, the skin cancer may involve a nerve or come close to the nerve so that tumor removal could result in motor nerve damage.
Allergic reactions: Allergic reaction can occur due to the local anesthesia or bandaging material. Please let us know if you have had this problem in the past.
Pain: There is usually minimal post-operative discomfort. If discomfort does develop, it usually responds to Tylenol. If your procedure occurs on the forehead or scalp, you may develop a headache for 1 - 2 days following surgery.
Swelling and Bruising: It is common to have swelling and bruising after surgery. This can occur around the eye especially when working on the forehead, nose, or cheek.
Scarring: A scar will always result from the procedure. It usually matures over several months and improves depending on wound healing. A Mohs surgeon is highly trained and attempts to minimize the appearance of scarring when possible. The cosmetic outcome of surgery will also depend on patient factors including how well the wound is taken care of and the patient’s medical issues including diabetes or smoking. We also ask patients to limit their activities postoperatively to reduce the chance of bleeding or trauma to the wound, which can affect the cosmetic outcome.
Recurrence: Rarely, some patients will have skin cancers that recur even after Mohs surgery has been carefully performed. Recurrences are almost always treated by Mohs surgery again because it has the highest cure rate for recurrent skin cancers. Now that you have had at least one skin cancer, you are also at risk of developing new skin cancers in the same location or elsewhere. Early detection is key. You will need to make sure that you have regular followup/skin checks with your dermatologist.
Follow-up treatments: Rarely, follow-up surgery may be required depending on the reconstruction required and wound healing process. Depending on the type of skin cancer and its aggressiveness, imaging is sometimes needed before or after your surgery. Also, you may be referred to other specialties such as plastic surgery, ENT, or radiation oncology in specific cases to assist with management of your skin cancer.
While complications are rare and the benefits of Mohs surgery often outweigh the risks, it’s important to understand the possible risks before your procedure. These risks include:
Bleeding: Minimal bleeding during the procedure is common and controlled with a cautery device and pressure dressing at the end of your surgery. After surgery, some bleeding may occur but can usually be managed by applying pressure. • Infection: Infections are rare but can be treated with antibiotics if they occur. Let us know immediately if you experience fever, drainage, increased swelling, sudden tenderness, or spreading redness around the surgical site.
Numbness: Scars may feel numb for several months, but sensation often improves over time. In rare cases, if the tumor is close to a nerve, removing it or the reconstruction, if extensive, may result in nerve damage.
Allergic Reactions: Allergic reactions to the local anesthesia or bandaging materials can happen. Please inform us if you’ve had allergies to these in the past (i.e. glue, tape, anesthetic).
Pain: Most patients experience minimal discomfort after surgery. If pain occurs, it usually responds well to Tylenol. Procedures on the forehead or scalp may cause mild headaches for 12 days.
Swelling and Bruising: Swelling and bruising are common, especially around the eyes when surgery involves the forehead, nose, or cheeks. Bruising around the jaw and neck can be common when working on the cheek, lips, or jawline.
Scarring: Your Mohs surgeon is highly trained to minimize scarring and achieve the best possible cosmetic result. All surgeries leave scars. These typically improve over many months. Factors like proper wound care and medical conditions such as diabetes or smoking can affect healing and scar appearance. Avoiding strenuous activities post-surgery helps reduce the risk of bleeding or trauma to the wound. Sometimes, depending on a patient’s wound healing, additional treatment is needed to treat redness or thickened scars.
Recurrence: Rarely, skin cancer may return even after Mohs surgery. Recurrent cancers are often treated with Mohs surgery again, as it offers the highest cure rate. Having one skin cancer increases your risk of developing others, so regular follow-up visits and skin checks with your dermatologist are essential for early detection.
Follow-Up Treatments: In some cases, follow-up procedures may be necessary, such as additional surgery, imaging, or referrals to specialists like plastic surgeons, ENT doctors, or radiation oncologists.
If you have any questions or concerns about these risks, please don’t hesitate to reach out. We’re here to support you throughout your care.
Helpful Links:
American College of Mohs Surgery https://www.mohscollege.org/for-patients
American Academy of Dermatology https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery
Skin Cancer Foundation https://www.skincancer.org/treatment-resources/mohs-surgery/
YouTube Videos:
“Mohs Surgery: The Most Effective Treatment for Skin Cancer” by the American College of Mohs Surgery
“Post-Operative Care for Mohs Surgery” by the American College of Mohs Surgery