Mohs Micrographic Surgery
About Your Doctor
Mohs Surgery General Information
Preparing for Surgery
What happens the day of surgery?
After Surgery
About Your Doctor:
Dr. Sniezek grew up in East Tennessee and is a graduate of Harvard University and the University of Tennessee School of Medicine, where he graduated with highest honors and was elected to the AOA Medical Honor Society, recognizing the top 1% of medical students in the country. After completing a surgery internship at the National Naval Medical Center in Bethesda, Maryland, Dr. Sniezek served in the United States Navy as an operational flight surgeon.
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Mohs Surgery General Information
What is Mohs surgery?
Mohs surgery is a highly specialized treatment for the total removal of skin cancer. Mohs surgery is named in honor of Dr. Frederic Mohs, the physician who developed the technique. This method differs from all other methods of treating skin cancer by the use of detailed mapping techniques and complete microscopic examination of all the tissues removed.
The procedure is begun after the skin is injected with a local anesthetic to completely numb the area. Then the visible cancer and a very thin layer of skin are removed from that exact location. Next, the tissue is processed using special techniques in our in-office lab. Dr. Sniezek then examines all surfaces of the tissue under the microscope. If any tumor is seen during the microscopic examination, its location is pinpointed and a thin layer of additional tissue is excised from the involved area for microscopic examination. This entire process is repeated until the cancer is completely removed.
What are the advantages of Mohs surgery?
By using these detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The result is: (1) the removal of as little normal skin as possible, and (2) the highest possibility for curing the cancer.
What are my chances for cure?
Using Mohs surgery, the percentage of cure is more than 99 percent for most skin cancers, even when other forms of treatment have failed. Other methods of treatment offer only a 50 percent chance of success if previous treatments have failed.
Preparing for Surgery
The Morning of Surgery: Please bathe or shower and wash your hair to minimize your risk of surgical site infection.
Breakfast: The day of surgery, we suggest that you eat your normal breakfast.
Medical History: Upon arrival at our office you will be asked to complete a medical history form. It may be helpful for you to bring a list of medications and illnesses.
Medications: Continue any medications prescribed by your doctor. However, aspirin is a drug that may prolong bleeding. If not prescribed by your doctor, we ask that you avoid aspirin and aspirin containing products (including Anacin®, Bufferin®, Excedrin®, Alka Seltzer® and Percodan®) for ten days prior to surgery. Aspirin affects the blood’s ability to clot and could lead to extra bleeding during surgery. Even a single “baby” aspirin will have this effect. Non-steroidal anti-inflammatory agents such as Ibuprofen (Advil®, Motrin®) or Naproxen should be stopped five days prior to surgery, as well as vitamin supplements containing vitamin E, garlic, ginger, and gingko. You may take Tylenol® anytime before surgery if needed for pain. If you are taking Coumadin/ Warfarin or Plavix, you may continue taking these medications. In addition, alcohol will also promote bleeding, so avoid alcoholic beverages 48 hours before surgery. Please avoid wearing make-up, perfume, nail polish, and jewelry.
Transportation: It is necessary that you arrange to have a companion drive you to and from the doctor’s office. You may also be more comfortable with someone to keep you company in the waiting room.
What happens the day of surgery?
Your appointment will be scheduled early in the day. This allows us to continue the surgical steps throughout the entire day, if necessary. Our staff will escort you into a surgical suite where Dr. Sniezek will meet with you and the area around the skin cancer will be numbed. Once it is numb, the visible cancer and a thin layer of tissue will be removed. The tissue is carefully mapped and coded and taken to our laboratory where the technician will immediately process the microscope slides. You will have a temporary dressing placed over the wound and you will be free to return to the waiting room.
The surgical procedure alone takes only 10-15 minutes. However, it takes a minimum of 1 ½ -2 hours to prepare and microscopically examine the tissues of each layer. Several surgical stages and microscopic examinations may be required, and you will be asked to wait in the patient waiting area between stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in three stages or less.
We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for the microscope slides to be processed and examined.
Additionally, we are pleased to offer complimentary WiFi access. We also have a refrigerator to store food or snacks that you may want to bring.
The most difficult part of the procedure is waiting for the results of the surgery. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be in the office the entire day and that you make no other commitments.
Will I be hospitalized?
No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day. Hospital facilities are available if necessary.
Will the surgery leave a scar?
Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose (1) to leave the wound to heal itself, (2) to repair the wound with stitches, or (3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic results. Your doctor is committed to giving you the best possible results.
Will I have pain after surgery?
Most patients do not complain of pain. If there is any discomfort, Tylenol is all that is usually necessary for relief. If necessary, prescription pain pills will be prescribed.
After Surgery
What can I expect after surgery?
Swelling around the surgery site is very common after Mohs surgery, especially when it is performed around the eyes. This will resolve with time, usually a few days. Infection is unusual. If it does occur, it can be treated with antibiotics. Rarely, nerves are cut while removing your skin cancer. We will discuss with you preoperatively if we feel this may be a problem in your case. Loss of muscle function is rare after Mohs surgery; loss of sensation is more common. There may be numbness to the skin for several months, but this usually resolves with time.
Will I need to come back?
Usually one return visit is needed about one week after surgery. There may be other appointments scheduled to check on the healing of the area. Follow-ups with your referring physician are essential not only to examine the treated skin cancer, but also to monitor your skin for possible new skin cancers.
How can I prevent more skin cancers?
The best protection from skin cancer is avoidance of the harmful ultraviolet rays of the sun. Patients who have developed one skin cancer often develop more at a later time. Protect your skin from further damage by wearing a high SPF sunscreen with UVA/UVB protection, avoiding the sun during the peak hours of the day (10 a.m. to 4 p.m.), and wearing sunglasses and a broad brimmed hat. Regular check-ups are important to monitor for new skin cancers, and any changing lesions or new spots should be reported to your dermatologist.
Insurance and Referral information
We participate in most insurance plans and Medicare. Some health insurance policies cover the total cost of Mohs surgery. Most plans cover at least part of it. Our Mohs surgery scheduler will contact your insurance company the week before surgery to obtain any prior authorizations needed. They will also call you to confirm any surgery copay or deductible amounts that you will need to bring on the day of surgery.
