Mohs Surgery Sydney

The Mohs surgery process is designed to ensure precision and patient comfort at every stage, from consultation to recovery. Below is a detailed overview of what patients can expect during each phase.

Initial Consultation

The initial consultation is a vital step in preparing for Mohs surgery. During this appointment, Dr Flood conducts a thorough assessment of the patient’s medical history, current health status, and skin cancer diagnosis. This evaluation includes:

• Medical History Review: Assessing the patient’s overall health and any prior treatments for skin cancer.
• Examination: Evaluating the size, location, and characteristics of the tumour to determine its suitability for Mohs surgery.
• Discussion: Explaining the procedure, including its goals, risks, and expected outcomes. Patients are encouraged to ask questions and express any concerns.

By the end of the consultation, patients have a clear understanding of the procedure and what to expect during and after surgery.

Pre-Surgery Preparations

Proper preparation is essential for ensuring that Mohs surgery is carried out safely and effectively. Each step in the pre-operative process is tailored to the patient’s circumstances, addressing medical, logistical, and lifestyle considerations to promote a smooth surgical experience and optimal recovery.

• Medical Tests: In some cases, patients may need to undergo pre-operative tests to assess their overall health and confirm their suitability for surgery. These tests could include blood work or imaging studies, depending on the complexity of the procedure and the patient’s medical history. The goal of these evaluations is to minimise risks and identify any conditions that might affect the surgical outcome.
• Medication Adjustments: Patients who are taking medications such as blood thinners, anti-inflammatory drugs, or certain supplements may be required to temporarily discontinue or adjust their dosage. This precaution helps to reduce the risk of excessive bleeding during and after surgery. Dr Flood provides clear guidance on which medications need to be adjusted and when they can be safely resumed. Patients should also disclose any over-the-counter medications or herbal supplements they are taking, as some may interfere with the healing process.
• Lifestyle Recommendations: Smoking and alcohol consumption can significantly impact the body’s ability to heal. Smoking reduces oxygen levels in the blood and constricts blood vessels, which can delay wound healing and increase the risk of complications. Patients are advised to stop smoking at least a few weeks before and after surgery. Similarly, reducing alcohol intake before surgery helps maintain hydration levels and supports overall health during the recovery period.
• Logistical Planning: The day of Mohs surgery can be lengthy due to the detailed process of layer-by-layer tissue removal and microscopic analysis. Patients are encouraged to plan accordingly by arranging transportation to and from the clinic, as they will not be able to drive after the procedure. It is also helpful to prepare for the possibility of multiple hours at the clinic by bringing comfortable clothing, snacks, and reading material to pass the time.
• Emotional Preparation: Undergoing surgery can be a source of anxiety for some patients. Dr Flood and his team are available to answer any questions and provide reassurance during the preparation process. Patients are encouraged to discuss any concerns they may have during their consultation to feel fully informed and confident about their surgery.

By following these preparation steps, patients can help ensure a smoother surgical experience and recovery.

What to Expect During Surgery

Mohs surgery is a meticulous, stepwise procedure performed in a controlled clinical setting. It is designed to remove cancerous tissue while preserving as much healthy tissue as possible. The process is methodical, allowing for high precision and effectiveness in treating skin cancer.

• Anaesthesia Administration: The procedure begins with the administration of local anaesthesia to numb the surgical site. This ensures that patients remain comfortable throughout the procedure. Unlike general anaesthesia, local anaesthesia allows patients to stay awake, reducing recovery time and potential risks associated with full sedation.
• Initial Layer Removal: The surgeon starts by removing the first thin layer of tissue, which includes the visible tumour and a small margin of surrounding tissue. This step is performed with precision to target the affected area without disrupting unnecessary healthy tissue.
• Tissue Mapping and Examination: The removed tissue is immediately processed and examined under a microscope. During this step, the surgeon uses a detailed map to correlate the tissue sample with its exact location on the patient’s body. This process ensures that any remaining cancer cells can be precisely identified.
• Subsequent Layers: If cancer cells are detected in the examined tissue, additional layers are removed and examined. This iterative process is repeated until no cancer cells are visible under the microscope. The stepwise approach ensures complete cancer removal while minimising the removal of healthy tissue.
• Reconstruction of the Wound: Once all cancerous cells have been removed, the surgical site is reconstructed to facilitate healing and minimise scarring. Depending on the size and location of the wound, this may involve closing the site with stitches, using a skin graft, or performing a local flap reconstruction. Dr Flood selects the most appropriate method based on the patient’s unique circumstances.

The length of the procedure varies, often taking several hours due to the detailed nature of the microscopic examination and repeated tissue removal. Patients are closely monitored throughout the surgery to ensure their comfort and safety.

Post-Surgery Recovery

Recovery after Mohs surgery focuses on promoting proper wound healing, reducing discomfort, and minimising the risk of complications. Each patient’s recovery experience may vary based on the size and location of the surgical site and whether reconstruction was required.

• Wound Care: Patients are provided with clear instructions on how to care for the surgical site. This typically includes cleaning the wound with a gentle solution, applying prescribed ointments, and changing dressings as needed. Keeping the wound clean is crucial to prevent infection and support healing.
• Managing Swelling and Bruising: Swelling and bruising are common in the initial days after surgery. Applying cold compresses to the affected area and keeping the head elevated, especially while sleeping, can help reduce these symptoms. These measures also promote circulation and minimise fluid retention.
• Pain Management: Mild discomfort is common during the recovery process and can usually be managed with over-the-counter pain relievers such as paracetamol. For patients with more significant discomfort, Dr Flood may prescribe additional medications. It is important to avoid medications such as aspirin unless otherwise directed, as these can increase bleeding risk.
• Activity Restrictions: Patients should avoid strenuous activities, heavy lifting, and bending over during the first one to two weeks after surgery. These actions can place strain on the surgical site and may delay healing. Light activities, such as walking, are generally permitted and can aid circulation. Patients are also advised to protect the surgical site from direct sunlight, wearing sunscreen and protective clothing to prevent scarring and pigmentation changes.
• Follow-Up Appointments: Regular follow-up visits are an essential part of the recovery process. These appointments allow Dr Flood to monitor the surgical site, address any concerns, and ensure the wound is healing as expected. If stitches were used, they may be removed during these visits, depending on the type of sutures employed.
• Healing Timeline: Most patients recover within a few weeks, with the initial swelling and bruising subsiding during this time. However, for larger wounds or more complex reconstructions, complete healing may take several months. Residual swelling or redness may persist but will gradually diminish over time.

By adhering to the aftercare instructions provided, patients can help optimise their recovery and minimise the risk of complications. Regular communication with the surgical team is encouraged to address any questions or concerns during the healing process.