Mohs Micrographic Surgery & Reconstruction

UNMC Dermatology has two fellowship-trained Mohs surgeons, Dr. Adam Sutton and Dr. Ashley Wysong. Mohs surgery is a highly specialized surgical procedure in which a skin cancer is completely removed from the skin surface, or just below the surface. This is a very common procedure performed in the Mohs surgeon’s office and is named for its inventor, Dr. Frederic Mohs.  Both Dr. Sutton and Dr. Wysong are active members of and leaders in the American College of Mohs Surgery (ACMS) that was founded by Dr. Mohs and serve in national leadership roles for the organization.  Our Mohs surgeons are "grandchildren" of Dr. Mohs having been trained by Dr. Hugh Greenway at Scripps Clinic who trained directly with Dr. Mohs.

There are THREE main steps to Mohs Surgery:

  1. The surgical removal of the visible portion of the skin cancer and a thin layer of tissue immediately surrounding. This is called a “stage”.
  2. The tissue is processed in the lab and examined under the microscope by the Mohs surgeon.
  3. The Mohs surgeon will repeat steps 1 and 2 until the tumor is completely removed and the area will then be repaired.

 Drs. Sutton and Wysong operating

Specifically, after the planned surgical lines are drawn, the area will be numbed by skin injections using a local anesthetic (usually Lidocaine). Please notify the doctor’s office prior to your surgery date if you have ever had any reactions to anesthetics. Once the specimen is removed by the Mohs surgeon, it will be immediately processed in our on-site pathology lab and 100% of the margins will be checked under a microscope. This process will take approximately 60 to 90 minutes. If there is still tumor noted under the microscope (“positive margins”), you will undergo an additional Mohs stage to remove the remainder of the abnormal cells. This process will continue until the tumor has been completely removed.


Please note, there are certain types of tumors (i.e. melanoma, sarcomas, other rare tumors) that may call for special laboratory staining methods requiring an overnight processing of the specimen (i.e. “permanent sections”). In these cases, we will perform the surgery, bandage the area and schedule follow-up. We will repair the area after the final pathologic results are received which may take up to one week. This process is necessary due to this type of tumor. Please feel free to discuss any questions directly with our staff or with Dr. Wysong or Dr. Sutton.

When the skin cancer has been completely removed, a decision is made on the best method to repair the wound. The options include but are not limited to:

  1. Allowing the wound to heal by itself (granulation)
  2. Closing the wound directly (sutures or stitches)
  3. Closing the wound with a skin graft or skin flap
  4. Outside closure/repair with another surgical specialist

We will discuss the options for reconstruction with you after the tumor is completely removed and will recommend the methods best for your individual care. Repairs may be completed by Dr. Wysong or Dr. Sutton or by another surgical specialist. Every one of our patients is unique and we believe in individualizing and optimizing your treatment to achieve the best results. After the wound is repaired stitches/sutures usually need to be removed 1-2 weeks after the surgery. This is typically a quick nurse visit to remove the stitches and to check the wound.