Skin Cancer & Surgery Center

Dr. Robert Cook-Norris is the Mohs Surgeon and Cosmetic Surgeon at the Skin Cancer & Surgery Center of Irving, Texas

Robert Cook-Norris, M.D.
Dermatology, Dermatologic, Cosmetic & Mohs Surgery

Robert Cook-Norris is a board certified dermatologist who received his bachelor’s degree from the University of North Texas cum laude and his M.D. degree from the Texas Tech University Health Sciences Center School of Medicine.

He completed his internship in internal medicine and his dermatology residency at the Mayo Clinic in Rochester, Minnesota.

He then completed a fellowship in Dermatologic Surgery at the Mayo Clinic.  This fellowship provides advanced training in Mohs surgery as well as other forms of surgery on the skin, hair and nails.

Dr. Cook-Norris is a Diplomate of the American Board of Dermatology, a Fellow of the American Academy of Dermatology and a Fellow of the American College of Mohs Micrographic Surgery and Cutaneous Oncology.  He is also a member of the American Society of Dermatologic Surgery.

Mohs Surgery - Patient Information

Advantages of the Mohs Surgical Procedure

Some skin cancers can be deceptively large—far more extensive under the skin than they appear to be from the surface.  These cancers may have “roots” in the skin, or along the blood vessels, nerves, or cartilage. 

Skin cancers that have re-occurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. 

Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots.”  For this reason, prior to Mosh surgery it is impossible to predict precisely how much skin will have to be removed. 

The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally that removal of the deep “roots” of a skin cancer results in a sizeable defect. 

The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while normal tissue is spared.

Is Mohs Surgery right for me?

If this is your first time having Mohs surgery, the doctor would like to meet with you prior to having the procedure done. This will allow the doctor to examine your skin cancer, obtain a medical history and determine whether the technique of Mohs Surgery would be the best treatment for your skin cancer. It will also allow you to learn about the procedure and ask any questions that you may have.

How is Mohs Surgery performed?

First, the area is numbed around the tumor using local anesthesia to eliminate pain. This usually stings for a few seconds and is usually the only pain felt throughout the whole procedure.

Then, the visible portion of the tumor is carefully removed using a scalpel or curette.

The next step involves removal of a layer of tissue to check the margins for presence of tumor. A 1-3mm margin around the tumor is drawn and a thin pancake-shaped piece of tissue is removed using a sharp scalpel. 

We then bring this tissue to the laboratory, process this tissue and make slides. This slide making process may take several hours and during this time, a bandage is placed on your wound, and you may be brought to the waiting room area to await the results.

When the slides are ready, the doctor then examines both the lateral and deep margins of the tissue with a microscope and checks for tumor. The results of this step are plotted on a map of the treatment area.

If there is any tumor left in any section, you are brought back to the surgery room, and another tissue layer is taken, to again check the margins for tumor. This process is repeated until the base and sides of the tumor no longer contain tumor cells.

Repair Surgery

Once the tumor is removed, you are left with a surgical wound. The doctor will discuss the repair options with you and make recommendations on the option that will achieve the best cosmetic and functional result. These options may include:

1) Natural Healing

In certain areas of the face and body, wounds heal better when left to heal naturally. Wounds healing on their own may take a month or more to fill in and you may need to change the bandages regularly during this time.

2) Closing with stitches

This involves pulling the wound edges together and closing the wound with surgical stitches. If this option is recommended to you, then the stitching usually takes approximately 1-2 hours to complete. You will need to return to have the stitches removed, which is usually 1 week on the face and 2 weeks on other parts of the body.

3) Skin Graft

This option involves taking skin from another part of the body and stitching it into place to close the wound. You should not get the skin graft wet during this time. It may be recommended that you bathe using a sponge bath during this week. The stitches on the skin graft usually need to be removed in 1 week.

4) Skin Flap

This process involves surgically cutting and pulling skin from an area adjacent to the wound and stitching it in place. Usually you will need to return in 1 week to have the stitches taken out. Sometimes skin flaps may require a second stage or additional surgery to complete which may be in 2-3 weeks.

5) Consultation with Another Surgical Specialist

The doctor may recommend that you see another surgical specialist to discuss repairing the surgical wound after Mohs Surgery.

They will often require that you meet with them in consultation prior to surgery. Our office will make arrangements with the other surgical specialist's offices to arrange your surgery dates. You may be having surgery with the specialist on the same day or several days after your Mohs surgery procedure.

Sometimes the surgical specialist will require that you do not eat the day of the surgery if your repair will be done in a hospital operating room and require general anesthesia.

How to Prepare For Mohs Surgery

In general, you should treat your day of having Mohs Surgery similar to any other day. Be sure to take all your regularly scheduled physician prescribed medications. If you are on blood thinners, the doctor can discuss with you the risks and benefits of taking these medications.

The main thing to prepare for with Mohs surgery is a full day long procedure and spending most of the day waiting for slide results. As such, you should bring food to eat and something to read or entertain yourself.

Note that if your wound repair following Mohs surgery is scheduled with an outside surgical specialist, it is possible they may have advised you not to eat prior to their procedure.

What to Expect on the Day of Mohs Surgery

Our nurses will bring you to our surgical suite. Together, we will identify and confirm with you the locations of the tumors. We will then anesthetize the area with local anesthesia. We then perform the first stage of Mohs surgery which usually takes 20-30 minutes. You will then be bandaged and taken to the waiting room.

It takes approximately 2 hours for the tissue to be processed and stained. After this we will repeat the Mohs surgery stages and tissue processing as necessary to clear the tumor. It usually takes most patients 2-3 stages to clear a tumor, with each stage taking approximately 2-3 hours. Occasionally, it can take 4-5 or more stages to clear the tumor.

Sometimes, but rarely, we are not able to complete clearing the tumor in one day, and we may have you come back the following day to continue the Mohs surgery procedure. After the Mohs surgery procedure is complete, we will discuss the repair options with you. The repair procedure may take an additional 1-3 hours to complete.

Once the surgery is complete, our nurses will give you written and verbal instructions on how to care for your wound. If prescriptions for antibiotics or pain medications are indicated, you will receive them at this time.

There may be other patients who are getting Mohs surgery the same day as you and some patients may be finished earlier or later than you. Every patient is unique and some patient's procedures and slides may take a longer or shorter time to process.

After Mohs Surgery

Healing and wound care will be explained in depth to you following Mohs surgery. In general, wounds tend to heal better when covered with ointment and a bandage. We usually recommend the use of plain vaseline as a covering ointment to be applied 1-2 times per day.

It is common to experience mild pain for several days following the Mohs surgery procedure. Usually over-the-counter Tylenol (acetaminophen) taken at recommended doses is enough to relieve the pain. If you are still having pain, please contact our office so we can evaluate your symptoms.

It is also common to feel fatigue for 1-2 days following Mohs surgery and most people elect to rest and not work during this time.

Look for signs of infection including tenderness, warmth, fever, and pus at the wound site. If you notice these or other signs, please contact our office immediately.

It is important to make an appointment and see your referring dermatologist or physician for a complete skin check 3-6 months after completion of the Mohs surgery. Regular skin surveillance is critical for early detection and prevention of skin cancer.

Dr. Robert Cook-Norris is the Mohs Surgeon and Cosmetic Surgeon at the Skin Cancer & Surgery Center of Irving, Texas, a division of The Dermatology Center