Do I need a driver?

We suggest that you bring someone with you to keep you company during the procedure and to drive you home. It is recommended that you have someone to drive you home after the surgery for a variety of reasons. If surgery is to be performed on the face, especially near the eyes or nose, you will likely have swelling around your eyes making it difficult to see or the bandage may obstruct your vision and you will be unable to drive.

If a sedative is taken, you will not be able to drive. You should plan to take the day off work and possibly a couple extra days depending on the nature of your employment. We can provide you with a work excuse if needed.

We will ask that you take it easy for the two weeks following the procedure by not engaging in any strenuous activity. We also will ask that you limit your bending and heavy lifting for the two weeks following the procedure as well.

We may ask that you take an antibiotic once you arrive to prevent infection in areas that are considered high risk. If you normally take antibiotics prior to going to the dentist or before procedures, you should take your normal dose before coming to our office. Please bring an updated list of your medications and allergies with you to your appointment. If you are on a blood thinner medication, you should continue taking it normally unless a physician has instructed you otherwise. If you take Coumadin or Warfarin, please bring a copy of your most recent INR or Coumadin level.

What to expect the day of surgery

You will arrive for your scheduled appointment in the morning and should plan to spend the whole day with us. You may wish to bring snacks or lunch and reading material. Once you are checked in, the first layer of tissue will be removed by cutting around the visible skin cancer. This is done under local anesthesia, meaning an injection of medicine into the skin which causes the area to be numb during the procedure and while you are waiting. After the first layer of tissue is taken, you will head to our waiting room with a bandage over the area to relax while the tissue goes to the lab and is then examined under the microscope. This process usually takes around an hour. If there is more skin cancer identified, you will be taken back to the procedure room and another piece of tissue will be taken. Each time tissue is taken to our lab, you will have to wait while the tissue goes is examined. If more skin cancer is not identified, you will be brought back to the procedure room, and the area where the skin cancer was removed will be repaired. Sometimes, we allow the area to heal by itself, but usually we will use sutures (stitches) to repair the area. Occasionally we will need to do a skin flap or a skin graft. We will discuss these procedures with you prior to repair.

Most skin cancers require one to two layers for removal, but some may require many more for complete removal.

Each stage of the surgical procedure can require up to 2.5 hours, half hour for surgery and one to two hours to process the tissue for microscopic examination. Again, several layers or stages may be required and you should plan on being at the office all day. In rare instances, the patient may have to come back the next day to have the process completed.

Will I have a scar?

Yes, like almost any form of treatment for skin cancer, there will be a scar. However, Mohs micrographic surgery preserves as much normal tissue as possible. As a result, the defect created during surgery to remove the skin cancer is as small as possible. Each repair is designed to reconstruct the unique skin cancer defect to give the smallest and least noticeable scar possible. On occasion, a multi-specialty team of doctors may be needed to work in conjunction with the Mohs surgeon to maximize the optimal result for the patient.

Will the surgery be painful?

A local anesthetic, usually lidocaine, is injected around the skin cancer to anesthetize the skin. A slight discomfort is experienced initially until the skin becomes numb. Once the numbness has begun, no discomfort is experienced. Anesthesia generally will keep the patient pain free for a couple hours. If additional stages of surgery are required, additional anesthetic may be injected to keep the patient pain free. After the surgery is completed, most patients experience very little discomfort. Any pain after the procedure can usually be controlled with Tylenol or acetaminophen.

Using the MART-1 Stain Technique in Treating Melanoma In Situ

At Dermatology & Mohs Surgical Institute, we prioritize precision in the diagnosis and treatment of skin cancers, including melanoma in situ, the earliest form of melanoma. One of the most advanced tools we use to ensure accurate treatment is the MART-1 (Melanoma Antigen Recognized by T-cells) stain technique.

What is MART-1 Staining?

MART-1 is a specialized immunohistochemical stain that specifically binds to melanocytes, the cells responsible for producing pigment in the skin. Melanoma, a cancer that originates in these cells, can be difficult to distinguish from benign lesions or early-stage melanocytic activity under standard microscopic evaluation. By using the MART-1 stain, we can highlight and accurately detect even small clusters of melanoma cells, helping us to clearly define the boundaries of melanoma in situ.

Why is MART-1 Important for Melanoma In Situ?

Melanoma in situ means that the cancer cells are confined to the outermost layer of the skin, the epidermis, making early detection and precise treatment critical for preventing progression. Traditional methods might miss isolated melanoma cells or leave behind residual cancer cells, leading to potential recurrence. MART-1 staining enhances our ability to:

• Identify Subtle Melanoma Cells: It reveals hidden or poorly defined melanoma cells that may not be visible through routine staining techniques.
• Define Clear Margins: The stain helps us determine the true extent of melanoma in situ, ensuring that all cancerous cells are removed during excision.
• Reduce Recurrence Risk: By providing a more accurate picture of the tumor margins, MART-1 helps minimize the risk of incomplete excision and recurrence of melanoma in situ.

How is MART-1 Staining Used in Treatment?

Once a biopsy or excision is performed for suspected melanoma in situ, the tissue sample is sent to a lab for histopathological examination. MART-1 staining is applied to the sample, highlighting melanocytes and allowing the pathologist to clearly see if melanoma cells are present and if they extend to the edges of the excised tissue. This enables the surgeon to ensure complete removal, reducing the need for additional surgeries and improving long-term outcomes.

The Benefits of MART-1 Staining for Patients

• Higher Accuracy: MART-1 provides a clearer, more detailed understanding of melanoma spread within the skin.
• Improved Outcomes: Early and precise treatment of melanoma in situ leads to better patient outcomes and a lower likelihood of recurrence.
• Minimally Invasive Approach: By allowing for more targeted excisions, the technique helps preserve healthy skin and minimize scarring.

At Dermatology & Mohs Surgical Institute, we combine expertise with advanced diagnostic techniques like MART-1 staining to ensure that melanoma in situ is treated effectively and efficiently. If you’re concerned about skin cancer or have been diagnosed with melanoma in situ, we’re here to provide the highest level of care and support.