Question: When is it done? Answer: Mohs Micrographic Surgery is not done as a routine procedure. For most routine skin cancers, simple cutting out (excision) or scraping is done. The patients who come for Mohs Surgery have been selected as having unusual or more difficult tumours because of their type, size, location, or failure of other techniques to produce a cure.
Question: What can I expect? Answer: Your procedure typically begins in the morning. The area around the skin cancer is frozen using local injection. The affected area is tested to ensure it is numb, then the skin and tissue around the obvious cancer is removed. This tissue is divided into smaller pieces which are prepared in our laboratory for examination. A map of the cancer site is made showing the relationship of the specimens which are then viewed under the microscope. During this preparation of specimens for microscopic examination, a bandage is applied, while you wait for the results; usually an hour.The doctor studies the specimens for the presence of cancer at the edges. If there is any area of remaining cancer it is cut out exactly as before. The process is repeated until no residual cancer can be found.
Question: How Long does it take? Answer: It is unpredictable how complicated your surgery will be. Cancers may be present in skin, fat, muscle and, less frequently, in nerves, arteries, cartilage and bone. In more difficult cases, more time is required to remove all the cancer. It is not uncommon to stay for the full morning and part of the afternoon. Some patients will require less time, and some more. You should plan no other activities for the day. Remember, a large portion of the time spent is waiting while your cancer is examined in the laboratory. Family members can telephone in the mid-morning to get a better estimate of how much more time is required. Bring reading materials, needlework, etc., with you to help pass the time. Also, bring a snack or lunch with you on the day of surgery. A water bottle is a good idea. A cellphone can be helpful so you can keep your 'driver' up to date.
Question: Is there parking near by? Answer: Yes paid parking is available on Carlton street as well as side streets. Green P parking lots close by at 51 Aberdeen Ave and 405 Sherbourne St, as well as others.
BEFORE SURGERY
Question: What if I live far from The Carlton Skin Clinic? Answer: If your travel distance is great you might want to spend the night before surgery in Toronto. There are several moderately priced motels nearby. A list of these is available
Question: Should I bring someone with me to stay? Answer: No. Unless you need support (significant emotional concerns, physical assistance in moving, or challenges communicating in english) you will be expected to be in the procedure room without family or friends. We are trying to reduce the number of people in the clinic to minimize risk of viral infection. You will likely not be able to drive home after surgery. We cannot predict who will need a bandage that may obstruct vision so we want everyone to have a safe way home, and not as a driver. Someone other than the patient may need to assist with postoperative wound care. The nurse can give this person direct instructions, demonstrate wound care, and answer any questions after the surgery. We are also trying to maintain social distancing between patients and other families, so less extra people really helps. If possible, we suggest you have someone pick you up to take you home after. A taxi cab is an appropriate way to return home, if you are generally mobile enough to take taxi cabs.
Question: What should I wear? Answer: Wear something comfortable and easy to remove because you will be removing your top and putting on a gown. Loose shirts or blouses which have front buttons are recommended. Pants are recommended. There is a chance some blood may get on your clothes, so plan accordingly.
Question: Should I eat before coming? Answer: Yes. Breakfast is recommended.
Question: Should I take my regular medications? Answer: Yes. Take your regular medications as they have been prescribed.
Question: Are there any medications I should avoid? Answer: No. Please bring a list of all of your medications with you on the day of surgery. If you take ASA then please ask your Family MD if they feel it is safe for you to stop this two weeks in advance of your surgery. Generally, if your doctor has recommended that you be on ASA or any blood thinner then you should continue as you normally would.
DURING SURGERY
Question: Will the surgery be painful? Answer: A local anesthetic, usually lidocaine, is injected around the skin cancer to anesthetize the skin. A slight discomfort is experienced initially until the skin becomes numb. Once the numbness has begun, no discomfort is experienced. If additional removal is required, additional anesthetic may be injected to keep the area pain free. After the surgery is completed, most patients experience very little discomfort. Any pain after the procedure can usually be controlled with Tylenol (acetaminophen) or Advil (ibuprofen).
Question: Will I be put to sleep for my surgery? Answer: No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is thus avoided.
Question: What happens once my skin cancer is removed? Answer: Once the skin cancer is removed, the area of removed tissue is attended to. In most cases, the surgery to stitch up the wound is done following the excision and you return home the same day. Although the vast majority of cases are fixed in the Carlton clinic that day, rarely for large, more complex tumours, arrangements may be made for any of the following: referral to another specialist for the reconstruction, admission to hospital or surgery requiring a general anesthetic. We will discuss these options as soon as they become possible and these are unusual situations.
AFTER SURGERY
Question: Will my activity be limited after surgery? Answer: Yes. You may need to be off work for a variable number of days after surgery. If your work requires significant physical exertion, or appearance in front of the public, you may be out of work longer, up to 14 days. A note for your absence will be provided if necessary. You should plan to rest at home for the first week after your surgery, avoiding any vigorous physical activity. Do not plan any travel until at least 14 days after your surgery.
Question: What are the potential complications from the surgery? Answer: Complications are infrequent but possible. There is always a permanent scar of varying quality. Infection and bleeding are the two primary complications. These may require treatment with another surgery and or antibiotics. We will discuss these complications, how to recognize and treat them when you come for your surgery.
Question: Will I have a scar? Answer: Yes, as almost any form of treatment for skin cancer will leave a scar. However, Mohs micrographic surgery preserves as much normal tissue as possible thus helping us limit the scar. Each repair is designed to reconstruct the unique skin cancer defect to give the least noticeable scar.