Skin cancer Mohs surgery

You may need to have Mohs surgery if you have been diagnosed with skin cancer. The procedure can be used to treat:

• Basal cell carcinoma
• Squamous cell carcinoma
• Some other types of skin cancer

Your consultant may recommend Mohs surgery if:

• Your cancer lesion is large
• Your cancer is aggressive (is showing signs of spreading)
• Your cancer has come back after previous treatment or has a high risk of coming back 
• Your cancer lesion is located in an area such as your head, neck, fingers, toes or genitals where it is important to keep as much healthy tissue as possible 
• You have a weakened immune system due to an organ transplant, medication or disease 

Mohs surgery is considered the gold standard of skin cancer treatment and has the highest cure rate (around 99%) of all current skin cancer treatments. 

Some other benefits of Mohs surgery include:

• Typically all the cancerous tissue is removed, significantly reducing the chances of the cancer returning 
• The procedure and repair of the surgical site can usually be done on the same day 
• The procedure aims to preserve as much healthy tissue as possible, resulting in a better cosmetic and functional outcome
• Mohs surgery may offer a permanent cure for skin cancer, where other methods have failed

Why is this first consultation so important?

At Circle Health Group, your first appointment is where you meet your consultant, the doctor responsible for your care. Your consultant will spend time getting to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is very important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so please take the opportunity to discuss any questions or concerns with your consultant at your appointment.

At the end of your appointment, your consultant will decide if Mohs surgery is a suitable treatment for you depending on your diagnosis and general health. They will talk through the procedure with you including how to prepare for your surgery, what happens during the procedure and what to expect during your recovery. 

Your consultant will tell you everything you need to do to prepare for your Mohs surgery. Instructions on how to prepare for your surgery will also be in your appointment letter. If there’s anything you’re not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication you are taking, including over-the-counter medicines.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

On the day of your Mohs surgery

Take a shower on the morning of your surgery. You can use normal shampoo and face/body wash but do not apply makeup, creams, gels or lotions to your skin 

• Eat a normal breakfast (unless you are instructed otherwise) 
• Wear loose, comfortable clothes
• Leave any jewellery at home 
• Bring drinks/snacks and something like a book or newspaper to pass the time. It’s a good idea to bring someone with you if possible. You can expect to spend most if not the whole day in hospital while having your Mohs surgery.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for at least 24 hours before and after your Mohs surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise 

During Mohs surgery

After injecting the area with local anaesthetic, your consultant will clean your skin with an antiseptic solution and mark the area to be treated by drawing a circle around your lesion with a pen.

Once the anaesthetic has taken effect, your consultant will use a sharp surgical knife called a scalpel to remove thin, saucer-shaped layers of skin from your lesion.

During the procedure, your consultant marks areas of removed skin with coloured dyes and creates a map of the surgical area either by drawing or using a computer application. This is a process called ‘mapping’. It helps your consultant plan the removal of each layer and identify areas where cancerous cells are still being found.

After each layer of tissue is removed, the specimen is frozen, sliced into very thin sections and processed onto glass slides to be examined for cancer cells. You may need to wait in the department for up to an hour for the results.

If there are any remaining cancer cells at the margins, your consultant will inject more local anaesthetic and use the map to identify and remove more tissue in the area where cancer cells remain.

Your consultant will continue this technique until all the removed tissue is cancer-free.

Your consultant may apply a dressing over your wound and leave it to heal on its own, close the wound with stitches or use reconstructive techniques (such as a skin graft) to repair your wound.

Reconstruction may be done on the same day as your surgery or in a separate procedure.

Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

You can help your recovery to go more smoothly by taking things at your own pace, getting plenty of rest and giving your body time to heal after your surgery. Follow your consultant’s postoperative instructions carefully and call the hospital if you have any questions or concerns.

Your consultant will give you instructions on how to care for your surgical wound after your procedure. This may include applying topical ointments to your skin to reduce the risk of infection and minimise scarring.

After your Mohs surgery

You will have a dressing or bandage over your surgical wound. Your consultant will give you instructions on how to care for your wound and a follow-up appointment to remove any stitches if necessary.

You may have some mild pain or discomfort in the days after your surgery. Over-the-counter painkillers like paracetamol or ibuprofen can help manage this.

Avoid applying skin products or makeup to the surgical area for at least a week after surgery.

Avoid strenuous activity for around two weeks after your surgery. Depending on the size and location of your surgical wound, your consultant may advise you to restrict certain activities for a few weeks after your operation.

Avoid immersing your surgical wound in water, for example when swimming or bathing, until any stitches have been removed and your wound has closed up (normally two to three weeks after your surgery).

Avoid further sun damage by staying out of the sun where possible, wearing a high-SPF sunscreen and covering up after your surgery.

Take any medications as prescribed.

Keep any follow-up appointments you have been given after your procedure.

How many nights will I need to stay in hospital?

Mohs surgery is a day-case procedure, meaning you can normally go home the same day.

Will I be able to drive home?

If you received a local anaesthetic and no sedation, you may be able to drive yourself home from the hospital after your Mohs surgery. Check with your consultant about driving after your Mohs surgery.

How soon can I go back to work?

How long you need to take off work after Mohs surgery depends on the complexity and size of the area being treated, how quickly you recover from your procedure, and the type of job you do. You can expect to take two to three days off work for a minor procedure, three to four days for a medium procedure, and five to seven days for a large or more complex procedure.

How soon can I drive?

Driving after Mohs surgery depends on how complex the surgery was, and the part of the body involved. If you had a local anaesthetic and no sedation, you may be able to drive straight away after your surgery. Talk to your consultant about when you can drive after your Mohs surgery.

When will I be back to normal?

Recovering from surgery is different for everyone, and it’s important to go at your own pace during your recovery. Most people recover from Mohs surgery quickly and you can expect to return to your normal day-to-day activities within about two weeks.

Mohs surgery is a generally safe procedure, but like all types of surgery, there is a small risk that complications can develop. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision, so please ask your consultant any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to Mohs surgery include:

• Excessive bleeding
• Scarring 
• Poor wound healing
• Wound infection
• Nerve damage (can be temporary or permanent)
• The cancer may come back 

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about Mohs surgery, book your appointment online today or call a member of our team directly.

1. Mohs micrographic surgery (MMS) for skin cancer Cancer Research UK 
2. What is Mohs Surgery? American Academy of Dermatology Association  
3. Mohs Surgery Johns Hopkins Medicine  
4. Removal of skin tumours using Mohs micrographic surgical technique NHS Cambridge University Hospitals NHS Foundation Trust