It’s important to understand that, although Mohs surgery is performed in an office setting, it is still a surgical procedure, and patients should plan accordingly. Most Mohs surgeries are completed by mid to late afternoon, and many patients prefer to take the rest of the day off from work.

Mohs surgery is safely and comfortably performed without the need for a hospital or ambulatory surgery center, making the experience more efficient, comfortable, and cost-effective. The procedure is done under local anesthesia, and our skilled team ensures the anesthesia is administered as comfortably as possible. We also use a long-acting anesthetic to keep the area numb throughout the day. If you feel you may need additional relaxation, a mild sedative prescription can be provided at your consultation.

On the day of surgery, most of your time will be spent waiting for lab results and preparing for any necessary repairs. We recommend bringing snacks and entertainment to pass the time while you wait in our comfortable, welcoming waiting rooms. Many patients also use headphones during the procedure. On average, patients spend about 4 to 6 hours in the office, though we ask that you reserve the entire day to ensure thorough treatment of your skin cancer.

After surgery, a pressure dressing is typically applied to the surgical site, which can often be removed after 24 hours. Surgical tape is usually placed over the incision line(s) to protect the area. Our team will provide detailed instructions on how to care for your surgery site and give you written instructions to take home. Please arrange for someone to drive you home after surgery. Your companion is welcome to wait in our office or provide a mobile number to be contacted when your procedure is complete.

These instructions are intended for patients of Advanced Dermatology & Skin Surgery and are not meant to be comprehensive. If you have any questions or concerns, please contact our office at 828-210-7989.

If you have a surgical procedure scheduled with one of our providers, please follow these guidelines to minimize the risk of complications before, during, and after your surgery.

Bleeding Complications:
Certain medications can increase the risk of bleeding during surgical procedures. Please follow these guidelines:

• Anticoagulants (blood thinners):
  If you are taking aspirin, Plavix (clopidogrel), Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), or Eliquis (apixaban), it’s important to consult with your doctor before stopping any medications. If taking aspirin as a preventative measure, discontinue it 10-14 days prior to surgery unless instructed otherwise. You may resume aspirin 72 hours after surgery.
• Ibuprofen and NSAIDs:
  Medications like ibuprofen, Advil, Aleve, Celebrex, and other non-steroidal anti-inflammatory drugs (NSAIDs) should be discontinued 3 days before surgery, if possible. Acetaminophen (Tylenol) may be taken if needed.
• Supplements and Alcohol:
  Vitamin E, multivitamins, fish oil, and alcohol may increase bleeding. Please discontinue them 3 days prior to your procedure, and you may resume them the day after surgery.

If you are taking any of these medications as prescribed by your physician, continue them unless advised otherwise by our office.

Infection Prevention:
Skin infection is a potential risk with any surgery, but you can minimize the chances of infection by following these steps:

• If you have a history of infections after surgery, let us know; oral antibiotics may be prescribed before the procedure.
• On the day of surgery, cleanse the surgical area with soap and water (use antibacterial soap if available).
• Avoid wearing cosmetics if the surgical area is on the face.
• Do not shave the area the morning before surgery, as this can increase the risk of infection. If needed, we will shave the surgical site just before the procedure.

Mohs surgery is performed safely under local anesthesia, meaning you will be fully awake but will not feel pain during the procedure. If more than one sample is needed, we will reapply anesthesia to ensure the area remains numb throughout the day. We also use a special long-acting anesthetic to prevent numbness from wearing off during any wait times. If a repair is necessary after the tissue removal, a local anesthetic will be used for that as well. Our goal is to make sure you are comfortable and pain-free during both the surgery and any required repair work.

After surgery, most patients experience only minor discomfort, which typically subsides quickly. However, pain levels can vary depending on the extent of the procedure. To help with any discomfort, a prescription for pain medication will be provided after surgery, if needed.

To aid in your recovery, keep the dressing dry for 24 hours, so it’s a good idea to shower before your appointment. We also suggest avoiding heavy lifting or strenuous exercise for about a week after surgery, though light activity like walking is fine. If your job involves physical exertion, consider adjusting your work schedule accordingly. If that’s not feasible, please discuss options with our surgery team. For non-physical jobs, you may feel well enough to return to work as soon as the day after the procedure. However, visible swelling, bruising, or surgical dressings might influence your decision, so feel free to consult with our staff about what to expect.

Swelling and bruising near the surgery site are common but usually resolve within several days. Using ice packs can help reduce swelling and speed up recovery.

To ensure proper healing, follow these guidelines after your surgery:

• Limit physical activity for 24-48 hours post-surgery.
• Avoid lifting anything heavier than 10 pounds for at least one week.
• Any activity that raises your blood pressure could cause post-operative bleeding. After 48 hours, your activity restrictions may vary depending on the surgical site and whether you have stitches. Consult with your provider for specific recommendations.

If you have a scheduled activity that may interfere with your healing, consider postponing your surgery to avoid complications.

For any questions, feel free to call our office at 828-274-4880.

If you have scarring from Mohs surgery, it may be beneficial for you to have a consultation with our Aesthetics team. Learn more about our aesthetic dermatology services here.