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Insurance Coverage for Mohs Surgery
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Most insurance policies cover the costs of Mohs surgery and the reconstruction of the resultant surgical area. Please contact your
insurance carrier directly for the most current payment information relative to this surgery. The insurance billing department in your
Mohs surgeon’s office also may be able to assist you.
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Patient Preparation for Surgery
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It is important that you obtain a good night’s rest and eat normally on the day of the surgery. If you are taking prescription medications,
continue to take these unless otherwise directed by a physician. However, you should avoid taking aspirin-containing medications for
ten days prior to your surgery. You also should avoid aspirin substitutes (such as Advil, Motrin, Nalfon, Naprosyn, etc.) within
seventy-two hours of surgery. Tylenol, however, may be taken at any time prior to surgery. For your comfort, it is recommended that you
wear casual, layered clothing on the day of your surgery. You may also wish to bring a light snack and a book or magazine to help
occupy your waiting time. Also, it is highly recommended that you arrange for someone to drive you home following surgery.
Most Mohs cases can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to predict
how extensive a cancer will be, as the extent of a skin cancer’s “roots” cannot be estimated in advance. Therefore, it is advisable to
reserve the entire day for this surgical procedure, in case the removal of additional layers is required. Patient Preparation for Surgery Duration of Procedure
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Minor Post-Surgical Discomfort Expected
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Most patients do not complain of significant pain. If there is some discomfort, normally only Tylenol is required for relief. However,
stronger pain medications are available and will be prescribed when needed. You may experience some bruising and swelling around the
wound, especially if surgery is performed near the eye area.
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Options for Post-Surgical Reconstruction
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After the skin cancer has been removed, your Mohs surgeon will discuss the following options with you:
- Allowing the wound to heal naturally, without the necessity of additional surgery (which may produce the best cosmetic result).
- Simple or complex wound repair performed by the Mohs surgeon.
- Referral to the original referring physician for wound repair.
- Referral to another surgeon for wound repair.
If your wound requires daily care at home, you will be given detailed
instructions following your surgery. For small post-surgical sites, direct closure by suturing the sides of the wound together may be
possible. However, in certain areas of the body, there is very little tissue that can be stretched for coverage of a wound, and either a
skin graft or skin flap must be used. In closing wounds with a skin flap, the skin adjacent to the surgical defect is partially cut free, and
then rotated or moved forward to cover the surgical area. Stitches are then placed to hold the flap in its new position. This provides
immediate coverage for the wound. Other areas may require a skin graft to provide coverage. Skin from the side of the neck, behind the
ear, or over the collarbone may be cut free, placed over the wound, and then sewn into place. The original site of the graft is then closed
with stitches or allowed to heal on its own.
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Wound Healing, Scarring, and Scar Revision
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Wound Healing, Scarring, and Scar Revision As with all forms of
surgery, a scar will remain after the skin cancer is removed and the surgical area has completely healed. Mohs micrographic surgery,
however, will leave one of the smallest possible surgical defects and resultant scars. Often, wounds allowed to heal on their own result in
scars that are barely noticeable. Even following extensive surgery, results are frequently quite acceptable. In addition, scars do have the
ability, through the body’s own natural healing properties, to remodel and improve in appearance for a six to twelve month period. There are
also many other techniques available to the patient for enhancement of the surgical area following skin cancer surgery. Depressed or
indented scars may be elevated, using an implant such as Zyderm collagen. Likewise, a raised or roughened scar may be smoothed,
using laser resurfacing or chemical peeling techniques. Skin flaps and grafts also may require a subsequent “touch up” procedure, to
further improve their appearance.
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Potential Complications Associated With Mohs Surgery
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Patients should understand that there is not an absolute guarantee
that any given procedure will be totally free of complications or adverse reactions. Mohs surgery is no exception. During surgery,
tiny nerve endings are cut, which may produce a temporary or permanent numbness in and around the surgical area. If a large tumor
is removed or extensive surgery is required, occasionally a nerve to muscles may be cut, resulting in temporary or permanent weakness in
a portion of the face. This is, however, an unusual complication. The surgical area may remain tender for several weeks or months after
surgery, especially if large amounts of tissue were removed. Rarely, some patients experience intermittent itching or shooting pain in the
surgical area. In addition, the skin grafts and flaps used to cover surgical areas may not fully survive, requiring additional repair.
Potential Complications Associated With Mohs Surgery.
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