Mohs surgery is typically a relatively minor surgical procedure performed on an outpatient basis in the office. Be prepared to spend the entire day in the office, although three to five hours is the average time required.

Eat a full breakfast and bring some reading material. It is also important to bring a friend or family member along. Although you will be physically able to drive yourself home, you may be tired and have some swelling.

The surgery is performed in steps or stages. Each stage involves about five minutes of surgery to remove the cancerous tissue, at which point we will microscopically examine the tissue to determine if any skin cancer remains. The number of steps or stages required depends upon the size and depth of the cancer.

The actual procedure is as follows:

1. A local anesthetic will be injected into the area of surgery. This is the only part of the surgery that will cause any discomfort -- the sensation of stinging or burning. The pain is typically quite mild, temporary, and very easily tolerated.
2. Once the cancer and the surrounding areas are numb, a smaller layer of tissue will be removed with a scalpel. Unless the cancer is quite small, more surgery than a single, initial layer is often required. Remember, it is always better to remove too little tissue initially and perform a second stage than to remove more normal tissue than necessary.
3. The small amount of predictable bleeding will be stopped with a machine that coagulates the blood vessels, a sterile dressing will be applied, and you will return to the waiting room.
4. The tissue will be brought to the laboratory, where it is processed. Microscopic slides are prepared by a technologist and examined by your physician to determine if the cancer is persistent.
5. If the microscopic examination of the surgical specimen by your physician reveals remaining tumor, a precise, three-dimensional map is produced, indicating the exact location of the remaining cancer.
6. If additional cancer is discovered on the examination of your initial surgical specimen, you are then brought back to the operating suite, and additional anesthetic is injected to reinforce the first injection. In most cases, the initial anesthetic has not entirely worn off, and you will feel little or no discomfort.
7. The second stage now involves the removal of another layer of tissue -- but only where the map indicates residual cancer. The healthy tissue is left alone, and only the diseased tissue is excised.
8. This tissue is brought to the laboratory and the process is repeated until all evident cancer is removed. The average tumor requires two to three stages for removal. Do not be discouraged if your cancer is not removed in one step. We are tracing the extent of the tumor very carefully and trying hard not to remove any uninvolved, normal tissue. This process must be done in small layers.

Read more about Mohs surgery:

• What is Mohs Surgery?
• Mohs Pre-Surgical Checklist
• What to Expect After Mohs Surgery
• How to Care for Your Wound After Mohs Surgery