Surgery begins either early in the morning or early in the afternoon and is performed on an outpatient basis. Our staff will escort you into an exam room where Dr. D’Souza will discuss your case and further explain the procedure. A local anesthetic is injected into the skin to numb the area to be treated so you are awake during the procedure.  You may experience some discomfort during the initial needle stick but this should only last a few seconds as the numbing is almost immediate – you should not experience significant pain during the surgery. Once the area is numb, the visible cancer is removed as well as a thin layer of tissue around the cancer. A temporary dressing is applied and then you are escorted to our waiting area. This part of the procedure only takes a few minutes. The tissue is then mapped by Dr. D’Souza and taken to our laboratory where it is color coded, processed, and examined under the microscope. This part of the procedure takes 1-2 hours while you wait in the patient lounge. If any additional affected area is identified, the precise location of the tumor is mapped, and the process is repeated until all of the cancer is removed. The number of stages or layers required varies for each patient and depends on the size and depth of the tumor. Please do not be discouraged if your cancer is not removed in one step, and instead remember that we are trying to preserve as much skin as possible. On average, half of tumors are removed in 1 stage, and the great majority of tumors are removed in 3 stages or less.  Since one cannot predict in advance the number of stages necessary to fully remove the tumor, you should plan on spending the whole day with us (at least 4-6 hours).  Please do not make other plans or appointments for your surgery date.

Once the area is cancer free, Dr. D’Souza will discuss the options of wound healing and surgical repair. This generally includes reconstructive surgery with stitches, occasionally involving a skin graft or flap, or allowing the area to heal on its own. If surgical repair is deemed appropriate, it is generally done in our office on the same day as the Mohs surgery. Following the repair, a dressing is applied and you will be given instructions on wound care and dressing changes.