What to Expect on Your Days of Mohs Surgery

Hello, my name is Dr. Thomas Knackstedt, and I’m a board-certified dermatologist and board-certified, fellowship-trained Mohs surgeon at Peak Skin Center.

I know that nothing can be more stressful than not knowing what to expect, so I wanted to take a few minutes to review what your Mohs procedure day and recovery are going to look like. Obviously, the extent of your procedure and recovery will be influenced by your overall health and the nature of your cancer, but there is still a lot of general information I can share to help make the day more predictable and less stressful.

On the day of your Mohs surgery, please take all of your prescriptions including blood thinning medications as you normally would unless our office has instructed you otherwise. Be sure to eat beforehand—there’s no need to arrive on an empty stomach. You’re welcome to bring a family member or friend with you. We don’t require someone to accompany you unless you’ve been told otherwise, or if your cancer is close to the eye or nose and a bandage may interfere with wearing glasses or driving home safely.

When you arrive, you’ll be greeted by a member of the Peak Skin Center medical staff and brought back to the treatment room. The team will review your medications, confirm there haven’t been any major changes to your health history, and talk through the specifics of your skin cancer and how I expect the procedure to go. I’ll explain how Mohs surgery works and discuss the most likely options for managing your wound.

We’ll use local numbing medication, similar to what you experienced during your biopsy. Once you’re comfortable and the area is fully numb, we’ll remove the skin cancer with a small margin of safety. You’ll then wait with a bandage in place while the tissue is processed in our lab and examined under the microscope. This waiting period is usually the longest part of the procedure, so feel free to bring a book, electronic tablet, or snack.

Once the slides are ready, I’ll examine them under the microscope. If any cancer remains, we can precisely map where it is and return to remove another small layer of tissue. This process continues until all the cancer is removed, while preserving as much healthy tissue as possible.

When the margins are clear, we’ll discuss how best to manage your wound. Some wounds are best left to heal on their own, similar to a biopsy, while others are better closed with stitches depending on the location and size. We’ll review those options together at that time.

After the procedure, you’ll leave with a pressure bandage in place. In most cases, this is a fairly bulky bandage that should remain on for 48 hours. When it’s time to remove it, many patients find it easiest to do so in the shower, allowing warm water or steam to help loosen the bandage.

At that point, you’ll begin regular wound care. We provide detailed written instructions and instructional videos, but in most cases, this involves cleaning the area daily and applying a thin layer of Vaseline or Aquaphor.

Depending on how your wound is managed, you may or may not have stitches. If stitches are used, they may be dissolvable and break down within 7 to 14 days, or they may need to be removed in our office during that timeframe. Several factors influence this decision, including the location of the wound, how tight the skin feels, and your convenience and preferences.

Follow-up visits are sometimes needed—often at one week, three weeks, six weeks, or at multiple intervals—to ensure healing is progressing well.

On the day of surgery, most patients experience only minimal discomfort. Pain is typically well managed with acetaminophen and ibuprofen, which together have been shown to be very effective and safer than low-dose narcotic medications.

After your procedure, especially if stitches were placed, we recommend taking it easy for 7 to 10 days. Most patients can return to work the next day or shortly after, but we advise limiting strenuous activity, heavy lifting over 10 pounds, cardio exercise, running, cycling, and golfing during this time. Anything that significantly raises your heart rate or blood pressure can increase the risk of bleeding, which may affect healing and cosmetic outcomes.

I hope this video has helped give you a better sense of what to expect during your Mohs surgery experience. Any procedure can feel stressful, and if you have questions at any point, please don’t hesitate to reach out to us at Peak Skin Center. We’re here for you and your skin.