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The Day of Mohs Surgery

Mohs micrographic surgery is considered the gold standard for treating many types of skin cancer because it removes cancerous tissue with the highest precision while saving as much healthy skin as possible. If you have been scheduled for this procedure with Dr. Joshua Freedman, knowing what to expect on the day of surgery can help you feel prepared and at ease.

  1. Arrival and check-in – Your day begins at the office with check-in. Plan to arrive at least 15 minutes early to complete paperwork and allow the staff to review your medical information. Because Mohs surgery can take several hours depending on how many stages are required, it is best to keep your schedule clear for the day. Bring your insurance card, identification, and an updated list of medications. Wear comfortable clothing that allows easy access to the surgical area, and bring a warm layer as surgical rooms are kept cool. Unless told otherwise, most patients can eat breakfast and take their regular medications. If you are taking blood thinners or aspirin, please discuss this with the team prior to the surgical day. Excessive caffeine intake should be avoided the morning of surgery.
  2. Preoperative review and site confirmation –A nurse or medical assistant will review your health history and allergies, confirm medications, and answer any initial questions. The exact location of the skin cancer will be verified with you, a photograph is taken to document the site, and any nearby hair may be removed if necessary. Dr. Freedman will then meet with you to explain the procedure, review the plan, and answer any additional questions. Once you feel comfortable, you will sign a consent form.
  3. Local anesthesia – Mohs surgery is performed under local anesthesia, which means only the area around the tumor is numbed. Local anesthesia avoids the risks and recovery associated with general anesthesia and allows you to go home the same day.

Once the area is numb, Dr. Freedman removes a layer of the visible cancer along with a very thin rim of surrounding tissue expected to contain the invisible portion of the cancer. Unlike standard excision, which removes a wider margin, Mohs surgery focuses on removing the least amount of healthy skin necessary. Each piece of tissue is carefully mapped so that Dr. Freedman can track its exact orientation to your body. This mapping is a critical step that makes it possible to pinpoint even the smallest remaining cancer cells.

After removal, each section of the tissue is immediately taken to an on-site laboratory. There, it is frozen, sliced into paper-thin sections, placed on glass slides, and stained for microscopic examination. This preparation allows Dr. Freedman to evaluate the entire outer and deep margin of the specimen—something not possible with standard pathology. If cancer cells are seen at any edge, their exact location is marked on the surgical map. This process is repeated after each excision of tissue.

While the tissue is processed, you may remain in the surgical room or be shown to a separate waiting area for Mohs patients with a temporary bandage over the site. Each processing and analysis stage typically takes 45 minutes to an hour. Many patients bring a book, tablet, or music to help pass the time. Snacks are allowed in many cases, and the staff will let you know if you need to avoid eating or drinking.

If the microscopic exam shows that cancer cells remain, Dr. Freedman removes another thin layer of tissue only from the area where cancer persists. This targeted approach is repeated stage by stage until all margins are clear. Some cancers are fully removed in a single stage; others may require two or more. Although this process can be lengthy, it ensures the best balance between complete cancer removal and preservation of normal skin.

Once the cancer is fully removed, attention turns to closing the wound. Dr. Freedman will explain your reconstruction options, which depend on the size, depth, and location of the surgical site. Some small wounds may be left to heal naturally. Others can be closed with stitches in a straight line. Larger or more complex sites may require skin flaps (moving nearby skin) or grafts (using skin from another area). The goal is to restore function and achieve the best cosmetic outcome.

Most patients do not complain of pain. If experienced, discomfort is usually mild and easily controlled with acetaminophen. Patients typically go home with a pressure bandage in place for 24 – 48 hours. In some cases, ice packs can reduce swelling during the first 24 hours. Some bruising or tightness is common, especially for procedures near the eyes or mouth. Sutures are generally removed within 5 to 14 days, depending on the location of the wound.

At your follow-up appointment, sutures are removed if present, and the site is checked for proper healing. Dr. Freedman may recommend scar-care strategies such as silicone gel, taping, or massage. Over time, most scars fade significantly and continue to improve for up to a year after surgery.

Because the surgery can last much of the day, keep your schedule free and avoid making other commitments. Bring reading material or something to help pass the time. If your procedure is near the eye, mouth, or nose, you may want someone to drive your home. Avoid wearing makeup or jewelry near the surgical site such as rings, necklaces, or earrings.

Having one skin cancer increases the risk of developing others. For this reason, ongoing skin checks are important. Dr. Freedman will recommend how often you should have a full-body skin exam. You will also be taught how to monitor your own skin and when to call for an earlier appointment if you notice suspicious changes. Sun protection—such as broad-spectrum sunscreen, protective clothing, and avoiding midday sun—is essential for reducing future risk.

Although the process can take several hours, it is highly effective, with cure rates of up to 99% for certain skin cancers. With the expertise of Dr. Joshua Freedman and his team, you can feel confident that you are receiving the most advanced and patient-focused care available. Schedule your Mohs surgery consultation with Dr. Joshua Freedman in Swedesboro, New Jersey today to ensure precise treatment and the best possible outcome for your skin health.

At a Glance

Dr. Joshua Freedman

  • Double Board-Certified in Dermatology and Mohs Micrographic Surgery
  • Providing Comprehensive Medical Dermatology for All Ages
  • Expert in Mohs Micrographic Surgery and Reconstructive Techniques
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