Mohs Surgery: Step by Step

Mohs Surgery: Step by Step | St Louis Dermatology | Shiloh | BellevilleMohs surgery is considered the gold standard in treatment of certain types of skin cancers. The key is to choose a skilled and experienced Mohs surgeon for best results.

During the initial consultation, the Mohs surgeon will explain the steps involved in the procedure.

Accomplished board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner), who both treat general derm patients, provide skin care treatments to patients in Shiloh, IL; St. Louis, MO, and surrounding locations across the landscape.


Step 1

The patient may be able to wear their regular clothes or put on a hospital gown depending on the location of their skin cancer.

The Mohs surgeon will evaluate the area where the patient had their biopsy and may mark it with a pen for reference. The surgeon will position the patient for best access to the treatment area which may include sitting up or lying down.

A surgical drape will be placed over the treatment site. In case the skin cancer is on the face, the patient may not be able to see the proceedings. However, the surgeon will talk them through it. They will inject a local anesthetic to numb the area fully. The patient remains awake during the procedure.


Step 2

The surgeon will use a scalpel to remove a thin layer of visible malignant tissue. In the case of some skin cancers, this may be the “the tip of the iceberg” which implies that they have extensions or roots that are not apparent from the surface.

The subsequent lab analysis will determine whether this is the case. The surgeon will then temporarily bandage the wound, and the patient can relax as the lab work commences.  


Step 3

The surgeon dissects the tissue into various sections, color codes them using dyes, and draws a map of the surgical area. The lab technician then freezes the dissected tissue and cuts very thin horizontal slices akin to a layer of cake. These slices are mounted on microscopic slides, stained, and covered. This process is quite detailed and time-consuming.


Step 4

The surgeon will evaluate all the sides and the underside of the tissue placed on the slides. In case there are any cancer cells remaining, they will mark the location on the map. The surgeon will then inform the patient of whether they will require another tissue layer to be eliminated.


Step 5

In the operating room, the doctor will administer more anesthetic if necessary and remove another skin layer at the location where the cancer cells persist based on the map. The patient will then wait as the lab work starts. This process will be repeated until there are no more cancer cells remaining.


Step 6

After there are no more cancer cells remaining, the surgeon may leave the wound open to heal or suture it, depending on its size and location. Sometimes the wound may require reconstruction using a skin flap. The surgeon will move surrounding tissue into the wound or use a skin graft.

In most cases, the Mohs surgeon will repair the wound right away after attaining clear margins. However, at times, they may repair the wound in coordination with another specialist.


Step 7

The patient should be prepared to spend several hours for this procedure, especially if more than one or two rounds of skin removal are required. The upside is that this precise technique has the highest rate of cure of any treatment technique and preserves the largest amount of normal tissue while leaving behind the tiniest scar possible.

The patient should carefully follow the surgeon’s wound care, scar care, and follow-up guidelines for best results. Cordial board certified dermatologist Dr. Jamie McGinness and Jackie McGinness, FNP (Nurse Practitioner) receive patients from Shiloh, IL; St. Louis, MO, and other suburbs and cities in this part of the US for various skin treatments.

If you would like to learn more about procedures and treatments at Metro East Dermatology & Skin Cancer Center by Board Certified Dermatologist Dr. Jamie L. McGinness please contact us here or call (618) 622-SKIN (7546)

Taking new patients in and around the greater St. Louis, Missouri and Illinois area: East St. Louis Missouri, Shiloh Illinois, Belleville, Millstadt, Saint Clair County, Madison County and more.

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