Mohs Surgery

A precise surgical technique used to treat skin cancer is called Mohs surgery which is also known as Mohs micrographic surgery.

During the Mohs surgery, your doctor will remove and examine until only cancer-free tissue remains the thin layers of cancer-containing skin.

To remove as much of the skin cancer as possible while doing minimal damage to surrounding healthy tissue is the main goal of Mohs surgery. This is an outpatient procedure but your doctor will have to use local anesthesia.

In this procedure, it will involve removing a small margin of surrounding healthy tissue and at the same time remove visible cancer.

After this procedure, there will be an increase in reducing the need for additional testing and the chance of a cure.

The main reasons for the Mohs surgery are to treat squamous cell carcinoma, basal cell carcinoma and the most common skin cancers and also unusual skin cancers and some kinds of melanoma.

This is used for skin cancers which:

• Are located in areas where you want to preserve as much healthy tissue as possible, such as around the eyes, ears, nose, mouth, hairline, hands, feet and genitals.
• Have a high risk of recurrence or that have recurred after previous treatment.
• Are aggressive and large.
• Have borders that are hard to define.

Mohs surgery carries the risk of:

• Hematoma or bleeding into the wound.
• Bleeding from the wound.
• Infection.
• Tenderness or pain around the surgical site.

Pain relievers will be recommended by your doctor.

Some of the possible complications include:

• Temporary or permanent weakness of the surgical area if the tumor is large and a muscle nerve is severed.
• Temporary or permanent numbness surrounding the surgical area if small nerve endings are cut.
• Keloid or enlarged scar.
• Shooting pain or itching in the affected area.

In preparing for your Mohs surgery, you must follow your doctor’s orders. 

A dermatologist can perform this surgery because they learn this in their medical training. Some surgeons have a special training called a fellowship to be more proficient and learn about the procedure.

Your risk of complications and errors during surgery may reduce if you select an experienced Mohs surgeon. You can talk to your doctor first about his/her experiences and qualifications.

Before surgery your doctor may ask you to:

• Stop taking certain medications such as blood thinning medications because or supplements that may affect your chances of bleeding after surgery, he will instruct you about the medicines that you are taking.
• Clear your schedule for that day by asking your doctor how long the surgery will take, some will take less than four hours; wear comfortable clothing such as casual clothes so you can easily adapt if the room is cold or warm.
• Bring something to help pass the time so you can do something during your waiting time.

Here’s what you can expect before, during, and after your Mohs surgery.

This is an outpatient procedure in an operating room that is near a laboratory so your doctor can examine the tissue once it is removed.

The procedure lasts up about four hours but doctors often advise reserving the whole day for the procedure because it can be difficult to tell how extensive a skin tumor is just by looking at its surface.

Your surgeon will clean the area to be operated on, outlines it with a special pen and injects the area with a local anesthetic to prepare you for surgery. The anesthetic numbs the skin, so you won't feel any discomfort during the procedure.

Your surgeon will use a scalpel to remove the visible portion of cancer along with a thin, underlying layer of tissue that's slightly larger than the visible tumor once the anesthetic has taken effect.

He will put a temporary bandage on your cut. He will then send the tissue to the laboratory for analysis. Read a book or magazine while waiting for your doctor. The surgeon cuts the tissue sample into sections and examines them with a microscope while you are in the other room.

Your surgeon takes great care to keep track of the exact spot where each piece of tissue was removed so if a small area of cancer is found in one piece of tissue, he will know precisely where to continue with the surgery. Your Mohs surgery will continue if cancer remains.

Your surgeon will again remove an additional layer of tissue from the affected area, taking care to remove tissue that contains cancer while leaving as much healthy tissue as possible intact and he will examine it in the laboratory. The process is repeated until the last tissue sample removed is cancer-free.

You and your doctor can decide on how to repair the wound after all of the cancer has been removed and it may include:

• Using stitches to close the wound or primary closure.
• Letting the wound heal on its own also known as healing by second intention.
• Using a skin graft from another part of the body such as behind the ear to cover the wound.
• Shifting skin from an adjacent area or skin flap to cover the wound.

Your doctor might temporarily close your wound and then refer you to another surgeon for reconstructive surgery to repair the wound if the surgical site is complex or extensive.

You will not leave until all the skin cancer has been removed and your doctor will give you the Mohs surgery results right away. To monitor your recovery to make sure your wound is healing properly you may have a follow-up visit with your surgeon.

You will always have a small risk of cancer recurrence or of developing another skin cancer even if Mohs surgery has a high rate of cure for skin cancer.

Compared with people who have never had skin cancer, people who have been diagnosed with skin cancer have an increased risk of developing skin cancer again or you may develop another skin cancer again within five years.

You should always have regular follow-up visits with your doctor to check for new skin cancer. How often you'll undergo follow-up skin exams depends on your diagnosis. You should also have skin exams at least once or twice a year or more if it the cancer was extensive.