Facial Skin Cancer Treatment: Expert Mohs Surgery in London
Being diagnosed with facial skin cancer can be both physically and emotionally challenging. Beyond the health concerns, you may worry about how treatment might affect your appearance, whether the cancer will be completely removed, and what recovery will entail. As a dual-qualified Consultant Oral and Maxillofacial Surgeon, I understand these concerns and specialise in the advanced Mohs technique specifically because it addresses these important issues.
Mohs micrographic surgery is the gold standard for treating facial skin cancers because it offers the highest cure rate (up to 99%) while preserving the maximum amount of healthy tissue. The technique involves removing thin layers of cancer-affected skin one at a time, examining each layer microscopically until all cancer cells are removed. This precision is particularly valuable on the face, where conserving tissue is crucial for both function and appearance.
Most patients return to light activities within 1-2 days following Mohs surgery, with complete healing typically progressing over 2-3 weeks. Throughout your recovery, my team and I provide comprehensive support to ensure optimal healing and the most natural-looking results. My dual qualification gives me a unique perspective on facial anatomy, allowing me to approach reconstruction with both medical precision and aesthetic sensitivity.
Every patient’s case is unique, which is why I invite you to book a consultation to discuss your specific concerns and treatment options. Together, we’ll create a personalised treatment plan focused on effectively treating your skin cancer while preserving your natural appearance.
Table of Contents
- Understanding Mohs Surgery: What to Expect and Why
- Your Initial Consultation: Planning Your Treatment Path
- Pre-Operative Medication Guidelines for Mohs Surgery
- Can I Eat Before Mohs Surgery? Dietary Instructions
- What to Bring to Your Mohs Surgery Appointment
- Day Before Surgery: Essential Preparation Steps
- Recovery Planning: Arranging Support After Surgery
- Post-Procedure Care: Ensuring Optimal Healing Results
Understanding Mohs Surgery: What to Expect and Why
Mohs surgery represents the gold standard for treating certain types of skin cancer, particularly in cosmetically and functionally important areas of the face. As a dual-qualified Consultant Oral and Maxillofacial Surgeon, I specialise in this precise technique that offers the highest cure rates while preserving the maximum amount of healthy tissue.
The procedure involves removing the visible cancer and a small margin of surrounding tissue, which is immediately examined under a microscope. This methodical, layer-by-layer approach continues until all cancer cells are removed, ensuring complete excision while minimising damage to surrounding healthy tissue.
What makes Mohs surgery unique is its precision. Unlike standard excisions where pathology results come days later, Mohs provides immediate confirmation that all cancer cells have been removed before reconstruction begins. This is particularly valuable for cancers on the face, where preserving function and appearance is crucial.
The procedure typically takes several hours, as each removed layer must be processed and examined microscopically. While this may seem lengthy, this thoroughness is what provides Mohs surgery’s exceptional cure rates of up to 99% for certain skin cancers. Proper preparation ensures your experience is as comfortable and stress-free as possible.
Your Initial Consultation: Planning Your Treatment Path
Your journey begins with a comprehensive consultation at my London practice. During this vital pre-surgical planning session, I’ll thoroughly assess your skin cancer, review your medical history, and discuss your specific concerns. As both a medical doctor and dental surgeon, I bring a unique perspective to facial skin cancer treatment that considers both functional and aesthetic outcomes.
We’ll discuss why Mohs surgery is recommended for your specific case, typically because of the cancer’s location, type, size, or recurrent nature. I’ll explain how the procedure’s precision is particularly valuable for preserving tissue in functionally and cosmetically important areas like the nose, eyes, lips, and ears.
During your Mohs surgery consultation, we’ll cover:
- A detailed explanation of the procedure tailored to your specific case
- Expected timeline and number of potential stages
- Reconstruction options based on the anticipated defect
- Personalised pre-operative instructions
- Recovery expectations and aftercare requirements
This consultation is also your opportunity to ask questions and express any concerns. My patient-centred approach ensures you’ll never feel rushed, and all aspects of your care will be explained clearly. Together, we’ll develop a treatment plan that addresses both the medical necessity of removing the cancer and your personal goals for healing and appearance.
Pre-Operative Medication Guidelines for Mohs Surgery
Managing your medications properly before Mohs surgery is essential for a safe procedure and optimal healing. As your surgeon, I’ll provide personalised guidance based on your specific medical history, but there are several general principles to be aware of.
Blood-thinning medications require special attention as they can increase bleeding during and after surgery. These include:
- Prescription anticoagulants: Warfarin, rivaroxaban, apixaban, dabigatran
- Antiplatelet medications: Clopidogrel, ticagrelor, dipyridamole
- Over-the-counter medications: Aspirin, ibuprofen, naproxen
- Supplements: Fish oil, vitamin E, ginkgo biloba, garlic supplements
Never discontinue prescription blood thinners without explicit instructions from both myself and the prescribing physician. For many patients, the risk of stopping these medications outweighs the risk of increased surgical bleeding. If adjustment is necessary, we’ll coordinate with your other specialists to ensure your safety.
Continue taking all other regular medications, particularly those for high blood pressure, diabetes, or heart conditions. If you’re unsure about any medication, please contact my office at least two weeks before your procedure for clarification.
Be sure to inform me of any new medications started after your initial consultation, as well as any allergies to medications, adhesives, or topical antibiotics that might be used during your procedure.
Can I Eat Before Mohs Surgery? Dietary Instructions
Yes, you can and should eat normally before your Mohs surgery. Unlike procedures requiring general anaesthesia, Mohs surgery is typically performed under local anaesthesia, meaning there are no restrictions on food or drink before your appointment. In fact, I recommend having a normal breakfast on the morning of surgery to help maintain your energy and comfort throughout what can be a lengthy procedure.
Proper nutrition and hydration before surgery can help:
- Prevent lightheadedness or weakness during the procedure
- Maintain your blood sugar levels, especially important for diabetic patients
- Keep you comfortable during what might be several hours in the surgical facility
- Support your body’s healing processes after the procedure
If you have diabetes, it’s particularly important to maintain your regular eating schedule and medication routine unless specifically instructed otherwise. Please bring snacks and any necessary medications with you, as Mohs surgery can sometimes extend longer than anticipated due to its layer-by-layer nature.
While caffeine is not strictly prohibited, I generally advise limiting caffeinated beverages on the day of surgery as they can increase anxiety and may contribute to elevated blood pressure. Stay well-hydrated with water before and during your appointment, and inform my team if you have any specific dietary needs or restrictions that might affect your comfort during the procedure.
What to Bring to Your Mohs Surgery Appointment
Being well-prepared for your Mohs surgery appointment helps ensure a smooth, comfortable experience. Based on my experience treating numerous patients in London, I recommend bringing the following items:
- Identification and insurance information: Even if you’ve provided this previously, having it on hand can expedite any administrative processes.
- Complete list of current medications: Include dosages and when you last took each medication.
- Comfortable clothing: Wear loose-fitting clothes that button up the front rather than pull over your head, which could disturb bandages after surgery.
- Entertainment materials: Bring a book, tablet, or other quiet entertainment for waiting periods between stages of the procedure.
- Snacks and water: While we provide refreshments, having your preferred snacks can make your wait more comfortable.
- Support person: Consider bringing a friend or family member, particularly if the surgery is on your face or if you’ll need assistance getting home.
- Glasses if you wear contacts: You may need to remove contact lenses for surgeries near the eye area.
If your surgery is near your eye, ear, or affects your vision or balance, you should arrange for someone to accompany you home. While Mohs surgery doesn’t typically impair your ability to drive in the same way general anaesthesia would, bandages or swelling might temporarily affect vision or comfort.
I also recommend bringing any questions that may have arisen since your consultation. My team and I are committed to ensuring you feel informed and comfortable throughout the entire process.
Day Before Surgery: Essential Preparation Steps
The 24 hours before your Mohs surgery are crucial for ensuring optimal surgical conditions and a smooth recovery. As a specialist in facial skin cancer treatment, I recommend these essential preparation steps to my London patients:
Skin Preparation:
- Gently cleanse the surgical area with mild soap and water
- Avoid applying any creams, lotions, makeup, or topical medications to the treatment area unless specifically instructed
- Do not shave near the surgical site, as this can create micro-cuts that increase infection risk
Lifestyle Considerations:
- Avoid alcohol for at least 24 hours before surgery, as it can increase bleeding
- Get a good night’s sleep to support your body’s healing capacity
- If you smoke, try to abstain for at least 24 hours before and after surgery, as smoking impairs healing
Practical Preparations:
- Confirm your appointment time and ensure you know exactly where to go
- Arrange transportation if your surgery involves the face, particularly near the eyes
- Prepare your home for recovery, including easy access to essentials and comfortable resting areas
- Fill any pre-surgery prescriptions so they’re ready when you return home
If you develop any new symptoms such as a fever, significant cold symptoms, or an active infection near the surgical site, please contact my office immediately. These conditions might necessitate rescheduling your procedure to ensure optimal healing and reduce complications.
Recovery Planning: Arranging Support After Surgery
Planning for your recovery before undergoing Mohs surgery is an essential part of your preparation. As a dual-qualified surgeon with extensive experience in facial procedures, I emphasise to my patients that proper recovery planning significantly impacts healing outcomes and overall satisfaction.
The extent of support needed varies depending on the location and size of your surgery. For facial procedures, particularly those near the eyes or affecting mobility, I strongly recommend arranging for:
- Transportation assistance: Have someone available to drive you home after surgery, especially for facial procedures that may temporarily affect vision or comfort.
- Home support: Arrange for someone to assist you for at least the first 24 hours after surgery, particularly if you’ve had extensive facial surgery or reconstruction.
- Meal preparation: Prepare simple meals in advance or arrange for food delivery, as you may experience discomfort or fatigue that makes cooking challenging.
- Medication management: Ensure you have any prescribed pain medications or antibiotics filled before surgery so they’re readily available.
Consider your professional obligations as well. While many patients can return to desk work within 1-2 days, those with physically demanding jobs or public-facing roles may need additional time off. I provide personalised guidance on work restrictions based on your specific procedure and occupation.
Remember that visible healing after facial surgery takes time. If appearance concerns are important for your work or social obligations, factor this into your recovery timeline. My artistic approach to reconstruction aims to minimise visible scarring, but initial healing may include swelling, bruising, or temporary dressings that should be considered in your planning.
Post-Procedure Care: Ensuring Optimal Healing Results
Proper post-procedure care is essential for optimal healing and aesthetic outcomes after Mohs surgery. As your surgeon, I provide comprehensive, personalised aftercare instructions, but understanding the general principles in advance helps prepare you for recovery.
Immediately following surgery, the wound will be dressed with appropriate bandages. You’ll receive detailed instructions on:
- Wound care: How and when to clean the surgical site and change dressings
- Activity restrictions: Specific limitations to protect the surgical site, typically including avoiding strenuous exercise for 1-2 weeks
- Pain management: Appropriate use of prescribed or over-the-counter pain relief
- Scar care: When to begin scar management techniques to optimise long-term appearance
Most patients experience minimal discomfort after Mohs surgery, typically manageable with paracetamol. Significant pain, increasing redness, warmth, discharge, or fever could indicate complications and should be reported immediately.
Facial surgery requires special consideration. Sleeping with your head elevated for the first few nights reduces swelling. Cold compresses applied intermittently during the first 48 hours can also help manage swelling, but should never be placed directly on the wound.
Sun protection is crucial for optimal healing and scar appearance. Once your wound has healed sufficiently to remove bandages, apply broad-spectrum SPF 50+ sunscreen daily to the area for at least six months.
Follow-up appointments are an integral part of your care. These allow me to monitor your healing, remove sutures if necessary, and address any concerns. My commitment to your care extends throughout your entire healing journey, ensuring both functional and aesthetic outcomes meet the highest standards.
Frequently Asked Questions
How long does Mohs surgery typically take?
Mohs surgery typically takes several hours to complete, though this varies based on the complexity and size of your skin cancer. The procedure involves removing layers of tissue incrementally and examining them microscopically, which creates waiting periods between stages. Most patients should plan to spend 3-5 hours at the surgical facility, though complex cases may take longer.
The time investment is worthwhile as this methodical approach ensures all cancer cells are removed while preserving as much healthy tissue as possible. I recommend bringing reading materials or other quiet entertainment for the waiting periods between surgical stages.
Do I need someone to drive me home after Mohs surgery?
Yes, you should arrange for someone to drive you home if your Mohs surgery is on your face, particularly near your eyes or if it may affect your vision or balance. While the procedure uses only local anaesthesia and doesn’t impair your abilities the way general anaesthesia would, post-surgical bandages, swelling, or discomfort may temporarily affect your vision or concentration.
Having a support person with you also provides practical assistance with post-operative instructions and helps ensure a smooth transition home. For extensive facial procedures, I recommend having someone stay with you for at least the first 24 hours after surgery.
What medications should I avoid before Mohs surgery?
Blood-thinning medications should be discussed with me before Mohs surgery as they can increase bleeding risk. These include:
- Prescription anticoagulants (warfarin, rivaroxaban, apixaban, dabigatran)
- Antiplatelet medications (clopidogrel, ticagrelor, dipyridamole)
- Over-the-counter NSAIDs (aspirin, ibuprofen, naproxen)
- Supplements (fish oil, vitamin E, ginkgo biloba, garlic supplements)
Never discontinue prescription blood thinners without explicit instructions from both myself and your prescribing physician. For many patients, the risk of stopping these medications outweighs the risk of increased surgical bleeding. We’ll create a personalised plan for your specific medical situation.
Will I have a scar after Mohs surgery?
Yes, all surgical procedures including Mohs surgery will leave some form of scar, but as a specialist in facial reconstruction, I take great care to minimise scarring and achieve optimal aesthetic results. The visibility of your scar will depend on several factors including the size and location of the cancer, your skin type, and your natural healing tendencies.
Mohs surgery offers a significant advantage by preserving the maximum amount of healthy tissue, which often allows for less extensive reconstruction and better cosmetic outcomes. Following your post-operative care instructions diligently, including proper wound care and sun protection, will significantly improve your final scar appearance.
How should I prepare the day before Mohs surgery?
The day before Mohs surgery, focus on these essential preparation steps:
- Gently cleanse the surgical area with mild soap and water
- Avoid applying any creams, lotions, makeup, or topical medications to the treatment area
- Avoid alcohol for at least 24 hours before surgery
- Get a good night’s sleep to support healing
- Confirm your appointment time and transportation arrangements
- Fill any pre-surgery prescriptions
Continue eating normally and maintain your regular medication schedule unless specifically instructed otherwise. If you develop any new symptoms such as fever or infection near the surgical site, contact my office immediately as we may need to reschedule your procedure.
