• How do I prepare for surgery and what happens beforehand?

  • Prior to your procedure, please read our Complete Dermatology's pre-surgical instructions for Mohs surgery.​

  • Mohs procedures are performed in minor surgical procedure rooms at our Mililani clinic location. Prior to surgery, a local anesthetic is used to numb the area. You might feel a brief stinging or burning sensation.

• How long will I be at the clinic on the day of surgery?​

  • Plan to spend the entire day at the clinic for the surgery and slide preparation time.​

• What will happen during my Mohs procedure?​

  • Our Board-Certified Mohs surgeon, Dr. Flament, will begin by cutting around the skin cancer with a scalpel. Only the area that appears abnormal will be removed initially. The surgery itself only takes a few minutes.

  • After surgery, the area is temporarily bandaged and you can return to the patient lounge, Mohs waiting room area, or your car while the sample is processed. Patients who have more than one skin cancer may require multiple visits, as each cancer is managed individually. We will only process two cancers per patient per day, depending on the case.

  • While you are waiting, our histotech will process the specimen and Dr. Flament will examine each biopsy section under a microscope to see if there is any remaining skin cancer on the outer edges. If cancer is spotted, we know some cancer remains at the excision site.

• What happens after my first Mohs stage (surgery)?

  • If cancer is found in the margins, we bring you back into the surgical suite, re-numb the area, and repeat the Mohs procedure.​

  • This procedure is repeated until the entire area has been cleared of skin cancer. Each Mohs surgery is referred to as a "stage", and it can potentially take multiple stages to fully remove the cancer.

• Should I expect any bruising?​

  • Bruising around the surgical site is common, especially in people who take anticoagulant medication such as aspirin or warfarin (Coumadin). Bruising normally goes away in 7 to 10 days.​

• What results should I expect after Mohs surgery? ​

  • Our goal is to remove all of your skin cancer while preserving as much healthy surrounding skin and tissue as possible. This surgery offers a high cure rate, minimizes removal of healthy tissue, resulting in the best overall cosmetic results possible as well.

• Will I have many stiches?​

  • Mohs surgery usually leaves a round wound after the cancer is removed. Simply stitching this circle would cause puckering of your skin. To fill in this area, new skin must be taken from surrounding areas to fill in the hole. This requires more extensive stitching.

• ​Why is there a big surgical spot for such a small cancer?

  • Unfortunately, not all surgical sites are small. What you saw on the top layer of your skin was only the "tip of the iceberg". Often, the cancer extends much further underneath the skin surface with roots that can only be seen with a microscope.

  • Some skin cancers may be more aggressive and extensive. Choosing this surgery does not guarantee a small surgical area; this is determined by the size and nature of your skin cancer.

• ​What happens after my Mohs Surgery?​

  • Mohs has the highest cure rate for several skin cancers, but is not 100% successful. Recurrence is 1 to 5% for most cancers treated this way (depending on location and type) with recurrent cancers being more difficult to treat. Certain cancers and situations may have a higher risk of recurrence.

  • In all cases, the area of your surgical site should be closely monitored by your referring provider. Once you have been diagnosed with skin cancer, you are at a higher risk for developing a second skin cancer. Regular check-ups with your dermatologist are very important so any new spots can be treated early.

  • Please read our post-surgical information for Complete Dermatology Mohs patients​.

• Is some dried red blood on my bandage normal?​

  • A small amount of oozing in the early  postoperative period is completely normal. If you have bleeding that wets through your bandage, apply direct pressure with another gauze pad over the surgical site for 15 minutes without peeking. If bleeding fails to stop, contact us at the telephone number on your wound care instruction sheet.

• When will my bruising and swelling go away?

  • Bruising and swelling fade over several days to weeks. Some locations, like around the eye, may take a little longer than others. Products with arnica may help bruising to resolve faster.

• Is it normal for the site to still hurt?

  • It is normal for the site to be mildly tender after surgery. Most of the tenderness improves within the first week. There may be some tightness or tenderness that takes longer, depending on the site of surgery. This will continue to improve gradually with time.

• Is it still possible to get infected after my stitches are removed?

  • Infection is rare after the suture removal but still possible. To minimize the risk for infection avoid swimming or soaking the wound in water until the skin surface is fully healed. Showering is ok.

If you notice any signs of infection, please call our office (808-621-1000) or Dr. Flament’s cell phone (808-798-2377) if after clinic hours.

• Increasing redness, warmth and swelling beyond the borders of the wound.

• Foul smelling, purulent (white or yellow pus) drainage.

• Increasing pain of the surgery site.

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• When will my scar start to fade?

  • The appearance of the scar and surrounding redness will decrease gradually over time but may last several months. Everyone heals differently and the final scar appearance depends on the individual’s ability to heal. If you are unhappy with the appearance of your scar, please see Dr. Flament to discuss. There are often options to improve scar appearance.

• Why is my scar bumpy?

  • The scar is often raised in the first several weeks after surgery. This is done on purpose to give a more subtle permanent scar. Scars tend to contract and indent after surgery if this is not done. If the scar is still bumpy or the skin is still tight after one month, you may start gentle massage to the area a few times daily to encourage flattening and softening of the scar. Before one month, even though the wound may appear fully healed on the surface, it is not healed under the surface and has minimal strength before one month.

• What is one of the most important things I can do to help the scar to fade faster?

  • Sun protection of the surgical site! Wounds often darken or hyperpigment after surgery. This is more common if the site is exposed to the sun. To minimize this risk protect the wound with clothing or be sure to wear sunscreen (SPF >30 at least). Make sure the sunscreen is reapplied at least every 1-2 hours while the area is exposed to the sun. The sunscreens containing zinc oxide or titanium dioxide in the ingredients work best.