Pre-Surgery Checklist for Mohs

Key Takeaways

Continue all medications including blood thinners, aspirin, and fish oil — do not stop them without explicit approval from your primary care doctor or cardiologist, as the stroke/clot risk exceeds surgical bleeding risk
Mohs surgery is safe on blood thinners — your surgeon is experienced in managing bleeding during the procedure and post-operatively
Stop alcohol 48 hours before surgery — alcohol thins blood and increases perioperative bleeding risk
Quit smoking or reduce dramatically if possible — smoking increases wound healing complications 3.6×; ideally stop 4 weeks before surgery
Arrange transportation home — have someone drive you, even if you feel fine after surgery
Plan for 5–6 hours at the surgery center — bring activities to keep you occupied while your surgeon reviews pathology between stages
Eat a normal breakfast the morning of surgery — most Mohs patients use local anesthesia only and do not need to fast; ask your surgeon if you need to

What You Need to Know Right Now

Your Mohs surgery is scheduled. You probably have a lot of questions. This guide walks you through exactly what to do before you arrive—what medications to adjust, what to eat, what to bring, and what to expect on surgery day. Your surgeon gave you a specific instruction sheet. Follow that first. This guide covers the basics that apply to almost everyone.

One Week Before Surgery: Medication Review

The Most Important Rule: Do NOT Stop Any Medications on Your Own

Do not stop blood thinners, aspirin, fish oil, or any other medication before Mohs surgery unless your primary care doctor or cardiologist has specifically approved the change. Mohs surgery is safely performed on patients taking all types of blood thinners and supplements.

This includes:

Prescription blood thinners: Coumadin (warfarin), Plavix (clopidogrel), Eliquis (apixaban), Xarelto (rivaroxaban), and others
Aspirin — Continue taking it as prescribed
Fish oil and omega-3 supplements — Continue taking them
Other supplements — Ginkgo, ginseng, garlic, vitamin E — continue unless your surgeon specifically tells you otherwise

The risk of stopping a blood thinner or aspirin (stroke, heart attack, blood clot) is far greater than the risk of extra bleeding during Mohs surgery. Your Mohs surgeon is experienced in managing bleeding during the procedure.

Medications to Keep Taking

Continue taking all of these exactly as prescribed:

Blood pressure medicine — Do take it the morning of surgery
Blood thinners — Yes, keep taking them
Aspirin — Yes, keep taking it
Diabetes medicine — Talk to your surgeon about timing on surgery day
Cholesterol medicine — Yes, keep taking it
Heart medicine — Yes, unless your surgeon says otherwise
Thyroid medicine — Yes, keep taking it
Fish oil and supplements — Yes, keep taking them
Any other prescription — Keep it unless told to stop

Pain and Fever Control

Ibuprofen (Advil, Motrin) — OK to take before or after surgery
Acetaminophen (Tylenol) — OK to take before or after surgery
Naproxen (Aleve) — OK to take before or after surgery

Antibiotics

If you need antibiotics before surgery (for example, if you have a heart valve problem or joint replacement), your surgeon will send a prescription. Take it 1 hour before your surgery time.

Questions to Ask Your Surgeon

Call your surgeon's office at least one week before surgery with these questions. Write down the answers.

About medications:

Do I need to adjust any of my medications?
Which medications should I continue the day of surgery?
Do I need an antibiotic before surgery?

About the procedure:

Where on my body is the surgery?
How long will it take?
What type of anesthesia do you use?
Will I need stitches?
What happens if the cancer is deeper than expected?

About recovery:

When do I see you for follow-up?
What should I do if something looks wrong?
When can I go back to exercise and normal activities?

Two Weeks Before Surgery: Start Preparing

Stop Smoking

If you smoke, stop now. Smoking slows wound healing and increases infection risk. Every day you don't smoke helps.

Arrange Transportation

Important: If the surgery is near your face or eyes, or if you're being sedated, arrange a ride home. Even if you feel fine, it's a good idea to have someone drive you.

Make sure your ride:

Knows when to pick you up (ask your surgeon how long surgery takes)
Can stay in the waiting room
Is reliable and on time

Three Days Before Surgery: Adjust Alcohol

Stop drinking alcohol 48 hours (2 days) before surgery. Alcohol thins blood and can increase bleeding during surgery.

This applies to:

Beer, wine, spirits
All alcoholic drinks

Resume after: You can drink alcohol again 24 hours after surgery, but avoid it if you're taking strong pain medicine.

Day Before Surgery: Prepare Yourself

Do This the Night Before

Shower or bathe. Wash the surgical area with soap and water. You can use a gentle cleanser.

Cut your fingernails. After surgery, you'll need to avoid scratching the wound. Short nails help.

Lay out what you're wearing. See the "Morning of Surgery" section below for what to wear.

Pack a bag. See "What to Bring" section below.

Get a good night's sleep. Your body needs rest for surgery. Try to get 7-8 hours.

Do NOT eat or drink after midnight — unless your surgeon said it's OK. Most Mohs surgeries use local anesthesia only, so you can eat. Ask your surgeon about eating before surgery.

Sleep and Rest

Go to bed at a normal time
Avoid alcohol
Turn off screens 30 minutes before bed
You might feel nervous. That's normal. Deep breathing helps.

Morning of Surgery: Final Checklist

What to Eat

Good news: You don't usually need to fast for Mohs surgery. Most patients use local anesthesia only.

Eat a normal breakfast or lunch:

Cereal with milk
Toast with peanut butter
Eggs
Oatmeal
A banana
Yogurt

Drink water. Stay hydrated.

Avoid:

Very heavy food (you'll be sitting for hours)
Too much caffeine (it can make you nervous)

If your surgeon said not to eat: Follow that instruction.

What to Wear

Wear loose, comfortable clothing that:

Allows easy access to the surgical area (for example, if surgery is on your leg, wear shorts)
Is easy to wash if it gets bloodstained
Won't rub or irritate the wound after surgery
Is not tight around the neck, arm, or waist

Avoid:

Tight clothing
Clothes with lots of buttons or zippers if they're near the surgical area
Heavy makeup or nail polish (it interferes with checking circulation)

What to Bring

Pack a bag with:

Essential:

Insurance card (front and back copy)
Photo ID
List of all medications (with dosages)
Allergy information
Your surgeon's pre-op instructions (the sheet they gave you)

Helpful:

Comfortable pillow from home
Phone charger
Book or tablet (for waiting)
Snacks (crackers, granola bar, nuts)
Headphones for music
Glasses or contacts if you wear them

After-surgery:

Extra shirt or jacket (in case the bandage soaks through)
Comfortable loose shirt to go home in

Medications on Surgery Day

Take your regular medications (blood pressure, diabetes, etc.) with a small sip of water unless your surgeon said otherwise.

If your surgeon prescribed an antibiotic for before surgery, take it 1 hour before your appointment time.

When You Arrive at the Surgery Center

What Happens First

You'll check in and give them:

Insurance information
ID
Pre-op instructions they sent you

A nurse will:

Check your blood pressure
Ask about medications
Confirm you didn't eat (if that was required)
Ask about allergies
Answer your last-minute questions

Your surgeon will:

Look at the area to be treated
Mark the surgical site
Answer any final questions
Have you sign consent forms

Expect to Wait

Mohs surgery isn't like traditional surgery in an operating room. Your surgeon operates right there. You'll be:

Sitting or lying down
Awake and alert (you can talk)
Feeling pressure but not pain (the anesthetic blocks pain)
Hearing the surgeon talk (you might hear them say "that looks good" or discuss the findings)

The whole procedure usually takes 4-6 hours, but this varies. It's longer because:

The surgeon removes skin
Sends it to the lab
Looks at it under the microscope
Removes more if cancer is still present
Repeats until no cancer remains

Bring something to keep you occupied during the waiting.

Pain Control During Surgery

Your surgeon will numb the area with local anesthesia (a shot of numbing medicine). You'll feel:

A pinch when the needle goes in
Burning for 10-20 seconds as the medicine enters
Then numbness

The numbness usually lasts through the surgery. If you feel pain during the procedure, tell your surgeon immediately. They can add more numbing medicine.

Medication Decision Table: Continue, Discuss, or Stop?

Medication	Action	Why
Blood pressure pills	CONTINUE	Important for heart health
Diabetes medicine	DISCUSS WITH SURGEON	Timing depends on surgery time
Cholesterol medicine	CONTINUE	Safe to continue
Aspirin	CONTINUE	Do not stop without PCP/cardiologist approval
Coumadin/Plavix/Eliquis/Xarelto	CONTINUE	Do not stop without PCP/cardiologist approval
Fish oil / Omega-3	CONTINUE	Safe to continue
Ibuprofen	OK TO TAKE	Safe before and after surgery
Tylenol	OK TO TAKE	Safe before and after surgery
Other supplements	CONTINUE	Unless surgeon specifically says otherwise
Antibiotics (if prescribed)	TAKE 1 HOUR BEFORE SURGERY	As directed

Pre-Surgery Checklist (Printable)

One Week Before

☐ Call surgeon's office with any medication questions
☐ Continue all medications including blood thinners, aspirin, and fish oil
☐ Arrange transportation home
☐ Confirm surgery date and time
☐ Write down surgeon's after-hours phone number

Three Days Before

☐ Stop drinking alcohol
☐ If you smoke, stop or cut way back

Day Before

☐ Shower and wash the surgical area
☐ Get a good night's sleep
☐ Lay out comfortable, loose clothing
☐ Pack your bag (insurance card, ID, medications, comfort items)
☐ Confirm your ride is ready
☐ Cut your fingernails short

Morning of Surgery

☐ Eat a light breakfast (unless told not to)
☐ Drink water
☐ Take your regular medications with a sip of water
☐ Put on loose, comfortable clothing
☐ Bring everything you packed
☐ Leave for surgery on time
☐ Bring your insurance card and ID
☐ Bring list of medications

Frequently Asked Questions

Q: Should I stop my aspirin before Mohs surgery?

A: No. Continue taking your aspirin as prescribed. Mohs surgery is safely performed while you are on aspirin. The risk of stopping aspirin (stroke, heart attack) is far greater than the risk of minor extra bleeding during the procedure. Your surgeon is experienced in managing this.

Q: Can I take my blood pressure medicine the morning of surgery?

A: Probably yes, with a small sip of water. But ask your surgeon to confirm. Some surgeons have specific instructions.

Q: What if I'm nervous?

A: That's completely normal. Everyone is nervous. The surgical team has done this thousands of times. You're in good hands. Tell the nurse if you're very anxious—sometimes a conversation helps. Deep breathing also works: breathe in for 4 counts, hold for 4, breathe out for 4.

Q: How long will I be at the surgery center?

A: Plan for 5-6 hours. This includes check-in, the procedure (which can take 2-4 hours depending on how much skin needs to be checked), and recovery. Bring something to do.

Q: Do I need someone to stay with me the whole time?

A: They can wait in the waiting room. You'll be fine for a few hours without them there. Have them come back 30 minutes before you expect to be done.

Q: What should I do if I have a cold or flu before surgery?

A: Call your surgeon. They might want to reschedule to avoid infection risk.

Q: Can I wear makeup to surgery?

A: If the surgery is on your face, no. Remove it before you come. Makeup can interfere with the surgery. If surgery is elsewhere, you can wear makeup, but be aware it might get bloodstained.

Q: Can I take pain medicine before surgery?

A: Yes. Ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) are both safe to take before and after Mohs surgery.

Q: Should I shower the morning of surgery?

A: You can, but most people shower the night before. Ask your surgeon if they prefer a certain time.

Evidence Snapshot

Your pre-op preparation is based on surgical best practices:

✓ Continuing all medications — including blood thinners, aspirin, and fish oil — is the standard of care for Mohs surgery. The risk of stopping them is far greater than the risk of extra bleeding.

✓ Continuing blood pressure and diabetes medications prevents complications during surgery.

✓ Local anesthesia (used in Mohs) is safe without fasting, unlike general anesthesia.

✓ Smoking cessation even days before surgery improves wound healing and lowers infection risk.

✓ Pre-op questions and clear communication reduce anxiety and surgical complications.

Medical Disclaimer

This guide provides general pre-operative preparation information and is not a substitute for professional medical advice. Your surgeon has specific protocols for your procedure based on your medical history and the location of your surgery. Always follow the specific pre-operative instructions from your surgical team. If you have questions about your medications or preparation, contact your dermatologic surgeon immediately. Do not change or stop any medications without permission from your surgeon.

References

Dr. Thomas L.H. Hocker Triple Board-Certified Dermatologist Harvard Medical School | Mayo Clinic Mohs Fellowship Dedicated to patient education and excellent skin cancer care.