Mohs micrographic surgery is an advanced surgical technique designed specifically for the removal of skin cancers. Named after Dr. Frederic Mohs, the inventor of the technique, this procedure is based on the principle of using a microscope to trace skin cancer roots so that the cancer may be completely removed. This technique has the highest cure rate for the most common types of skin cancer: basal cell carcinoma and squamous cell carcinoma. The entire tumor is removed with the smallest possible defect, potentially resulting in less scarring at the site.
What to Expect During the Mohs Procedure
During Mohs micrographic surgery, the Mohs surgeon removes a piece of tissue just around the visible tumor on the skin surface. This tissue is examined with a microscope to identify any cancerous roots that extend beyond the visible boundaries of the tumor. If any remaining cancerous cells are identified by microscope, the Mohs surgeon will then return to the remaining tumor cells and remove another layer of tissue.
This tissue will then be examined for any additional cancer cells. This process continues until no further cancerous cells are identified. By taking the tissue in layers and examining each with the microscope, this technique ensures that all the cancerous tissue is removed and prevents the unnecessary removal of healthy tissue.
Once the tumor has been removed, reconstructive surgery typically will be performed to repair the resulting defect. Reconstructive surgery typically will require the placement of sutures to achieve the optimal cosmetic appearance.
Frequently Asked Questions
Q. What are the advantages of Mohs micrographic surgery?
A. The advantages of Mohs includes the following:
- The Mohs technique provides the highest cure rate for the treatment of basal cell carcinoma and squamous cell carcinoma. These rates are approximately 99% if Mohs surgery is the initial form of treatment.
- Mohs surgery minimizes the amount of healthy tissue removed so the resulting wound is as small as possible. This decreases the potential for scarring or disfigurement at the site.
- The entire procedure, including cancer removal and reconstruction, is performed in a single outpatient visit under local anesthesia. You will not be put to sleep for the procedure, which results in less potential health risk.
Q. There is hardly anything visible left on my skin. Do I really need any more treatments?
A. Yes. It is important to recognize that the tumor that is visible may be just the “tip of the iceberg.” Skin cancers often have roots that continue to grow if not adequately removed. Mohs surgery involves evaluating the tissue with a microscope to identify any remaining roots of the cancer in order to remove it in its entirety.
Q. Will I be put to sleep for the Mohs procedure?
A. No. The Mohs procedure is performed under local anesthesia on an outpatient basis in an o ce-based setting.
Q. Will I have a scar after the procedure?
A. Yes, there will be a scar at the site of the removed skin cancer but the amount will depend on the size and location. The Mohs technique minimizes the degree of scarring by limiting the amount of healthy tissue that is removed.
Q. What risks, if any, are associated with Mohs?
A. Mohs micrographic surgery is usually a well-tolerated procedure; however, as with any surgery there are potential risks. As each patient and case is unique, it is impossible to list every potential risk in this pamphlet. The following potential risks associated with the procedure are considered the exception rather than the rule.
- Infection at the surgical site, which may require an oral antibiotic
- Excessive bleeding during or after surgery
- Scar formation resulting in unsatisfactory cosmetic result
- Poor wound healing
- Allergic reaction to the local anesthetic or other medications
- Damage to nerves resulting in loss of sensation or loss of muscle movement
- Damage to normal tissue surrounding the cancer
Q. How should I prepare for the procedure?
A. Ways that you can prepare yourself for Mohs surgery can be found below:
- On the morning of surgery, eat a normal breakfast, take all of your regular medications as scheduled, and wear comfortable, loose-fitting clothing.
- If you are on doctor-prescribed aspirin, please continue to take it – including on the day of surgery. If you are on Warfarin (Coumadin) , you will need your INTC checked within one week of surgery.
- If not doctor-prescribed, please avoid aspirin, aspirin-containing medications (Alka-Seltzer, Anacin, Bufferin, Ecotrin, Empirin, Excedrin, Goody’s Powder), ibuprofen, naproxen, Advil, Aleve, and Motrin for two weeks prior to surgery and five days following surgery. Failure to do so could result in excessive bleeding. Tylenol or acetaminophen are acceptable to take during this time period.
- Do not apply make-up if the surgery is to be performed on your face.
- If you have been given an antibiotic to take before the surgery, please take it as directed one hour prior to the procedure. Failure to do so could result in the delay or cancellation of the procedure.
- Prepare to spend at least three hours at the o ce. The procedure may take 4 to 5 hours if multiple stages are taken.
- Avoid strenuous exercise, sports activities, heavy lifting, bending, twisting, or straining in the week following the surgery. Failure to do so may cause bleeding at the surgery site leading to poor healing and an unsatisfactory cosmetic result.
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