MOHS Surgery for Treatment of Skin Cancer in Orange County

What is Mohs Surgery?

Named after the surgeon who developed the technique in the late 1930’s, Mohs surgery is an outpatient form of excisional surgery which can effectively remove most skin cancers one layer at a time. After each layer is removed, it is examined under a microscope to determine whether residual cancer remains.

The Benefits of Mohs Surgery

  • It is a highly effective means of treating common skin cancers with a success rate of up to 99%.
  • It eliminates the “roots” of the skin cancer which can produce recurrences if not eradicated.
  • You do not have to be put asleep and can be performed in the doctor’s office, usually in 1 day.
  • Use of a microscope allows the dermatological surgeon to be precise, thereby preserving as much normal tissue as possible while optimizing the chance for cure.

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A Nationally Recognized Leader

Dr. Lorrie Klein’s rare combination of technical expertise and aesthetic sensibility puts her at the forefront of dermatologists nationwide. Dr. Klein’s reputation for providing natural-looking results is why she’s the choice of women and men from throughout Southern California and beyond.

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How is Mohs Surgery Performed?

  1. A local anesthetic is used to eliminate pain. The skin cancer plus a small area around it is then removed.
  2. Once removed the tissue is then color-coded with special dyes.
  3. A dressing is applied to the wound and you return to the waiting room while the tissue is being processed.
  4. A careful “map” is made of the treatment area corresponding to the color code used on the removed tissue.
  5. The tissue is then rapidly frozen, cut into thin sections, placed on microscope slides and stained.
  6. Using the microscope the dermatological surgeon examines the stained tissue and determines whether any cancer persists. If an edge of the piece removed still contains cancer cells, it is noted on the map.
  7. If examination of the edges indicates remaining cancer, you are brought back in the surgery room and another layer of tissue is removed from the appropriate location. This may only be a very small piece, or could be larger. The entire process is repeated until the area no longer contains cancer cells.
  8. The removal and preparation of tissue takes 20-60 minutes for each layer. You will spend only 5-10 minutes of that time in the surgery room. The average patient requires 2-3 layers for complete removal.

Repair Surgery

Once all of the skin cancer cells have been removed the wound is usually repaired. This may involve simply suturing two edges together or may involve a more complicated repair such as a flap or graft. This can usually be done in our office following the Mohs Surgery. Occasionally a consultation with a plastic or reconstructive surgeon may be required if the wound is very extensive.

Patient Preparation for Surgery

Please inform us if you take coumadin, aspirin, aspirin-containing compounds, ibuprofen (Advil, Motrin, Aleve, Nuprin, etc.), or other medications for arthritis or pain. These medications interfere with blood clotting; thus making you bleed more than normal during surgery. If you are taking aspirin only for preventative reasons and it is not prescribed by your physician for medical problems, please stop it for 14 days prior to your Mohs procedure. Stop all other pain medications (Advil, etc.) for 7 days before. Acetaminophen (Tylenol) is okay to take at anytime. Coumadin should be discontinued if possible but you must check with your prescribing physician first. Always check with your regular physician before stopping any of these medications if you are unsure whether you need to be on them.

  • Get a good night’s sleep the night before your surgery. MAKE SURE YOU EAT A GOOD BREAKFAST.
  • Be prepared to spend at least half the day with us (3-4 hours or more.) Bring reading material if you like.

After Surgery

  • Most patients have little to no pain after skin surgery. If you have discomfort, you can take Tylenol.
  • Some bleeding may occur in a few patients. Apply constant pressure for 10 minutes if bleeding occurs.
  • Swelling and bruising commonly occur. A “black eye” is common after surgeries around the eyes or upper face. Ice packs help if applied for 10-15 minutes every 1-2 hours until bedtime the first night after surgery.
  • Infection is unusual but if pus or increasing pain, warmth or redness occur you must notify our office.
  • You will be given wound care instructions after your surgery. If tape is placed directly over the wound it may be left in place until it comes off by itself. You must then begin wound care once the tape is off. If a bulky dressing is placed over the tape, it can usually be removed the day following your surgery.

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