Treating Skin Cancer with Mohs Surgery

What is Mohs Surgery?

Total Skincare Centre Mohs Surgery Operating Room

Mohs Micrographic Surgery is a highly effective technique for the removal of skin cancer. It was developed by Dr. Frederick Mohs more than 60 years ago. This procedure is used to treat any type of skin cancer that can be visualized under microscopic evaluation. Mohs Micrographic Surgery is the most advanced treatment for skin cancers that occur in areas where preservation of tissue is important, achieving a high cure rate of 99%. For this reason, skin cancers that occur on very sensitive areas such as the head and neck are ideal candidates for treatment by Mohs Micrographic Surgery, as are cancers that have recurred after previous therapy, have an aggressive growth pattern and/or are large.

We have two Mohs surgeons at the Total Skincare Centre. You will see one or both of them on your surgical date.  Before starting, the surgeon will confirm with you the spot to be treated and will take a look at your entire face to ensure that there are no others areas of concern.  The area to be treated is first cleansed and anaesthetized with local anesthetic. Then the surgeon will remove the area that is obviously involved with your skin cancer, and take this tissue into the lab for processing. A pressure dressing is put on to cover the surgical site and you will then return to the waiting room. Coffee and tea is provided, as well as television for your viewing pleasure while waiting.

The tissue is then processed in our on-site pathology laboratory, which involves your tissue being frozen, sliced, mounted on slides and stained with special dyes. Your slides are then reviewed by Dr. Arlette or Dr. Guillemaud to assess for any evidence of residual cancer. If cancer cells are found in the tissue specimen, you return to the operating room where the technique is repeated to remove another level of tissue that then goes for further examination. Tissue specimens are removed and examined until the area is found to be clear of any cancer cells. On average, it takes three stages of tissue excision to achieve clear margins. Once all the disease has been removed, you will be brought back into the surgery room and set up for the repair of your surgical defect. Your surgeon will discuss the options of how best to proceed in reconstructing this area. These options may include a simple primary closure of the area with stitches, the use of local skin flaps or a skin graft.

Each of the steps in Mohs Micrographic Surgery requires a significant amount of time. We ask for your patience as we attend to your care. It takes approximately 60-90 minutes to process the pathology slides for each stage of tissue removal and one hour for the surgical repair. Depending on the size, location and type of skin cancer you have, the processing time will vary from patient to patient. You can expect to be present at the office for 4-6 hours.

Meet Your Doctors

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About Dr. Arlette

Dr. Arlette has been practicing Mohs Micrographic Surgery since 1992 and is one of 20 Fellowship Trained Mohs Micrographic surgeons in Canada. Dr. Arlette has treated more than 24,000 skin cancers using Mohs Micrographic Surgery, with a cure rate of 99%. Dr. Arlette is the only dermatologist  in Canada who holds the rank of Clinical Professor of Surgery. Dr. Arlette, along with our experienced staff welcomes your comments and questions.

Dr. Arlette
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About Dr. Guillemaud

A native Calgarian, Dr. Guillemaud completed her medical training at the University of Alberta. She then completed additional training in the highly coveted surgical subspecialty Otolaryngology – Head & Neck Surgery program at the University of Toronto. During this comprehensive five-year training program she worked with worldwide experts in the fields of Head and Neck Oncology, Facial Reconstruction, Facial Plastic Surgery and Nasal/sinus surgery. She then completed one of only three Canadian Mohs Micrographic Surgery fellowships, and now focuses her practice on skin cancer and facial reconstruction.

Dr. Guillemaud

Before Your Surgery


Breakfast

Be sure to eat breakfast on the day of Surgery, unless you have been instructed otherwise. You may wish to bring a lunch with you as Mohs Micrographic Surgery may extend into the afternoon.

Clothing

Wear clean, comfortable, and loose fitting, washable clothing.  AVOID white clothing.

Companions

If you require a caregiver for any of the reasons listed below, please confirm with the Mohs Coordinator prior to the day of your appointment. Otherwise we are unable to accommodate family members staying with you.

We welcome you to bring a caregiver if:

  • You require assistance toileting
  • You require assistance getting in and out of a surgical chair
  • You suffer from cognitive impairment (such as dementia, Alzheimer’s, or developmental delays)
  • There is a considerable language barrier between you and the surgeon
  • You require someone to administer medications while you are here during your appointment.

Medications

Please continue to take all of your regular medications as your doctor has instructed you.

If you take Aspirin on a daily basis, please avoid for 7 days prior to the procedure.

If you take any anticoagulants (blood thinners) other than Aspirin, such as Warfarin/Coumadin, Plavix, Pradaxa and Xarelto please do not stop these medications. ONLY Aspirin should be held.

Transportation

The College of Physicians and Surgeons of Alberta requires that you do not drive yourself to or from your Surgery.

Please arrange to have someone drop you off at the clinic in time for your Surgery and return to pick you up.

You will be able to call your ride to pick you up once your surgery is complete.

Please Avoid Smoking

Please do not smoke or use tobacco for one day prior to your surgery (and two days after).

Let Us Know

Please let us know if there has been any change in your medical condition or if you have been hospitalized within the week prior to your Surgery.

Complete Your Patient Health History

Please take the time to read, review and fill out the Patient Health History from. Please click the button below:

Plan Ahead

You must be able to transfer independently to and from the Surgery room and Surgery bed with minimal assistance.

You are not allowed to leave the office until you have been discharged by the nursing staff or Dr. Arlette/ Dr. Guillemaud.

If you are on oxygen therapy, please ensure you have an adequate supply for a minimum of 8 hours.

If you wish to cancel your appointment we ask for a minimum of 48 hours’ notice.

Your photo will confirm the location of your spot and provide an idea of the size of the cancer. This will give us information to help with planning your surgery and reconstruction.

We expect you to be here 4-6 hours. The length of time is related to how long it takes to cure your cancer and then reconstruct the area.

During Your Surgery

Make sure you have all contact information for the person picking you up.

We suggest that you bring along a snack or refreshment as you may be at our surgical facility for up to 5 hours.

You can expect several wait times on the day of your surgery while the tissue specimens are processed. This may take 60-90 minutes each time.

Please dress in warm clothing or bring extra layers such as a sweater. Surgical procedures may be a stressful experience which causes the body to react by cooling down.

Please bring indoor shoes or slippers as you will be asked to remove your outdoor footwear upon arrival.

You will be asked to stay in the building during your surgery so you will not be able to leave the building until discharged by a nurse or medical professional. (this includes not being able to leave the building to smoke)

Please do not wear makeup or moisturizer.

Please respect our fragrance free environment by not wearing any perfumes, colognes or other scented products.

We suggest that you bring any reading material or other activities to occupy your time while you wait.

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After Mohs Surgery

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Please do not smoke or use Tobacco for one day prior and two days after surgery.

We will give you clear written directions on how to care for yourself and any special instructions pertaining to your unique situation.

We ask that you refrain from physical activity for three days after surgery.

After surgery there may be some discomfort; it is rare for you to require anything other than Tylenol for pain relief. If you are having significant pain, please contact the emergency number that you are provided.

Please inform us if you are hospitalized for any reason during the 10 days following your surgery.

Restart Aspirin 48 hours after your surgery.

I can't see the spot anymore; do I still need surgery?

There is still cancer in the biopsy scar, even if you can’t see it. Our goal is to ensure that your cancer is completely clear when you leave.

Do I need a referral to be seen at Total Skincare Centre?

All patients that come to the Total Skin Care Centre for Mohs surgery are referred by their primary care physician or dermatologist. We anticipate that you will return to their ongoing care.

I was asked to send a photo; why is this necessary?

Your photo will confirm the location of your spot and provide an idea of the size of the cancer. This will give us information to help with planning your surgery and reconstruction.

Do I need someone to drop me off and pick me up?

Our goal is your safety. You may be tired or you may have a bandage larger than you anticipated and not feel comfortable to drive. It is much safest if someone brings you here and takes you home. This is the expectation of the College of Physicians of Alberta.

How long will my surgery take?

We expect you to be here for 4-6 hours. The length of time is related to how long it takes to cure your cancer and then reconstruct the area.

How will I know about care after my surgery?

We will give you clear written directions on how to care for yourself and any special instructions for your unique situation. You can be prepared by having non-stick dressings, paper tape and Polysporin ointment at home.

Should I expect pain after the surgery?

After any surgery there may be some discomfort; it is rare for you to require anything other than Tylenol.

If you are having significant problems, contact the emergency number provided at our office.

How long will my recovery time be?

How soon you can return to normal levels of activity depends on the location of the lesion and how it’s repaired.

We ask that you refrain from physical activity for three days after surgery.

For more information about treating skin cancer,

Contact Total Skincare Centre's Mohs Coordinator: