STEP 1. CONFIRMATION OF BIOPSY SITE
The first step of Mohs surgery is to identify your biopsy site. Even if the skin appears to have healed over this spot, cancer roots can remain invisible to the naked eye and may extend below the skin’s surface. If the cancer is not treated, it will continue to grow and may require a much larger surgery when it later resurfaces. Once the biopsy site is confirmed, Dr. Gharavi and his team will mark the border with a surgical marker and prep the area with disinfectant agents.

STEP 2. NUMBING WITH LOCAL ANESTHESIA
Following confirmation of the site, the surgical area is then anesthesized with local anesthesia (typically lidocaine). This should be the only time during the procedure that you feel discomfort. After an initial “pinch and burn,” the surgical site will go numb, allowing you to be comfortable and pain-free during the procedure.

STEP 3. FIRST STAGE
Following administration of local anesthesia, a small, thin, “deli slice” of skin will be removed around the biopsy site. It will be marked, precisely colored, and taken to our Mohs lab for processing.  A map of the surgical site is also drawn to track exactly where each small portion of tissue originated. A temporary, thick bandage will be placed over your wound. You may remain in your suite while the tissue is being processed and evaluated. During this time, you can rest, read, or use your cellphone or laptop. Lab processing is typically performed over 30 minutes but may be longer depending on the size of your tumor.

STEP 4. MICROSCOPIC ANALYSIS
Once the skin has been processed by the lab, Dr. Gharavi will examine it closely under the microscope. He will examine 100% of the base and edges of the skin piece to determine if any cancer roots remain. If a root is identified, you will be taken back to your treatment room for a second “stage.” If no roots are identified, Dr. Gharavi will begin discussing options regarding reconstruction (Step 7). Sometimes cancers are removed with one stage of Mohs surgery, but oftentimes, a cancer may extend much further than anticipated. Because of this, we ask you to keep your schedule free for several hours.

STEP 5. STAGE TWO (IF NECESSARY)
Additional local anesthesia will be added to the treatment area, and a small piece of skin corresponding only to the localized cancer root will be removed. The process will repeat again, where the tissue will be marked, precisely colored, and taken to our Mohs lab for processing. Our team will rebandage the area while you wait.

STEP 6. MICROSCOPIC ANALYSIS
Once the skin has been processed, Dr. Gharavi will closely examine this second stage under the microscope and identify if any cancer roots remain. If a root is identified, steps 5 and 6 will repeat again. Once all the cancer has been removed, Dr. Gharavi will bein discussing options regarding reconstruction.

STEP 7. RECONSTRUCTION
When all of your skin cancer has been removed, Dr. Gharavi will discuss reconstruction options with you, which will vary, depending on the location and size of your surgical wound. Sometimes wounds are left to heal by nature. Sometimes they are stitched directly, either side to side, using adjacent skin as a skin flap or using distant skin as a skin graft. Dr. Gharavi will explain the advantages and disadvantages of these options and together, you will determine the best option for your wound.

STEP 8. WOUND CARE
Once reconstruction is complete, our team will place a final bandage over your wound and provide you with detailed instructions on how to best care for your surgery site. It is vital that you follow these instructions carefully. You will be asked to return in 1-2 weeks to make sure the healing process is going well and/or to remove any sutures used during reconstruction.