What Is Mohs Micrographic Surgery?
Mohs micrographic surgery is a specialized technique of treating skin cancer with precision accuracy. It has a higher cure rate than other treatment options, even for cancers that have returned after being treated by another method.
The Mohs technique, first developed over 80 years ago, has been refined and perfected for decades. It allows your physician to remove all cancerous tissue, and less healthy tissue, than traditional methods. It is different from other available treatments because it allows complete, immediate microscopic evaluation of removed tissues. Therefore, the extensions and “roots” of the tumor can be effectively eliminated.
There are times when cancer is aggressive or reoccurring. When this happens, patients may be better suited for Mohs Micrographic Surgery. This surgical procedure is meant for more medically significant skin cancer cases. It is also recommended for skin cancers that are in cosmetically concerning areas such as the face, as it tends to leave less scarring and reconstructive needs than traditional methods of removal. We have a Mohs team that performs this particular treatment with the help of a microscope and a trained Mohs surgeon/dermato-pathologist. During the procedure, the skin is removed layer by layer, and each layer is evaluated for cancerous skin cells. Once the skin cancer cells are completely removed, the skin and surrounding area are evaluated and the most cosmetically appropriate reconstruction is performed; this results in very little scarring in comparison to scalpel removal.
Is It Important to Get a Biopsy Before Mohs Surgery?
There are several types of skin cancer, so it is important for patients to have a biopsy done to determine which one they are dealing with. Once confirmed, our team can work with patients to help them determine which treatment is best for them. Many cancerous lesions are easily removed with a scalpel, but cancer can run deeper beneath the skin. Once the main portion is removed, the skin is biopsied to ensure all cancerous cells have been excised and the patient is officially cancer-free.
Who Is an Ideal Candidate for Mohs Surgery?
Mohs micrographic surgery is suitable for many basal cell carcinomas and squamous cell carcinomas, and even some melanomas. Often, it is believed that Mohs is reserved for specific cases of skin cancers that occur in highly visible areas such as the face. This is not a requirement for candidacy. Your board-certified dermatologist has multiple methods of treating skin cancer. When Mohs is a good option, you can trust that it will be recommended. At your consultation visit for skin cancer treatment, your dermatologist will discuss what Mohs can do, why it is a preferred treatment, and what you can expect from the procedure and its outcome. This discussion will enable you to make a fully-informed decision about your skin cancer treatment.
How Do I Prepare for the Mohs Procedure?
Your Mohs surgery may be scheduled soon after your consultation for skin cancer treatment. At that time, your dermatologist may advise you to stop using medications and supplements that thin your blood. Mohs is a conservative treatment modality that removes only a small "slice" of tissue at a time. However, there is still a risk of bleeding. Avoiding substances that make your blood slower to clot helps reduce this risk, which, in turn, minimizes your chances of bruising after your procedure. After your consultation, when you are scheduled for your Mohs procedure, your doctor may also provide you with pre-surgical care instructions that you can begin to follow immediately. If you have questions before your Mohs procedure, please do not hesitate to contact the office.
What Is the Recovery and Aftercare for Mohs Surgery?
One of the advantages of Mohs micrographic surgery is that this procedure generally requires very little downtime. You may be able to return to work as soon as the day after your procedure. That said, this will depend on the extent of physical activity your job requires. To heal well after your procedure, you will need to avoid strenuous activity that increases your heart rate and thus the risk of bleeding and bruising. Your doctor may place stitches to close your surgical wound if necessary. If you have stitches, you will need to work around them so as not to impair your wound healing process. After the Mohs procedure, your doctor will discuss aftercare as it pertains to your case. Your instructions will include guidelines for keeping your surgical site clean, dry, and moisturized.
Will I Have Any Scars After My Mohs Procedure?
You might have some scarring after your Mohs procedure. This technique was devised to minimize the amount of scarring that can occur from skin cancer treatment but there is still sometimes a need for reconstructive surgery. In some cases, a dermatologist will consult with a reputable plastic surgeon to provide follow-up care as needed to reduce surgical scars as much as possible. During your consultation for skin cancer treatment, your dermatologist should discuss their anticipated outcome in terms of scarring and how that aspect of treatment can be managed when the time comes.
How Long Does the Mohs Procedure Take?
Mohs surgery can take several hours. This technique works by removing small sections of tissue at a time rather than one larger-than-necessary section. The purpose of the technique is to preserve as much healthy tissue as possible. Your doctor may advise you to plan for an entire day at the office for your procedure. This time in the office will include active phases of tissue removal followed by "inactive" phases in which you sit comfortably in your treatment room or a waiting area while your doctor performs their immediate tissue examination. The process may require only a few hours to obtain a clear tissue sample, one that is free of cancer cells. However, it is impossible to predict exactly how quickly this will occur.
What Does the Mohs Procedure Involve?
With the Mohs technique, only the cancerous tissue is removed, leaving healthy tissue intact. However, it is difficult to predict the amount of cancerous tissue. Cancers of the skin may be much larger than they appear. Often, they have “roots” in the skin, or along nerves, blood vessels, or cartilage. If a previous surgery has failed, recurring cancer may extend beneath the scar tissue.
Mohs micrographic surgery is typically performed on an outpatient basis. It involves minimal discomfort and does not require general anesthesia. The procedure begins by numbing and marking the area. Your surgeon then removes the entire visible portion of the cancer, as well as a thin layer of additional tissue. The tissue is microscopically examined. If any sign of cancer is present, another thin layer is removed and examined. The process continues until no cancerous tissue remains.
When Is Mohs Surgery Recommended?
The Mohs method is typically used for cancers that are high-risk for recurrence or those where aesthetic results are important. Although any surgery may leave a scar, Mohs will typically leave a much smaller scar than the alternatives, because less tissue is removed. In some cases, the scar may fade; if not, this small mark is usually corrected easily.