What is Mohs surgery?
Mohs micrographic surgery was originally developed by Dr. Frederic Mohs in the 1930s. The technique has since been refined into the most advanced, precise, and effective treatment for a variety of skin cancer types. Mohs micrographic surgery offers a cure rate of up to 99% for certain skin cancers.
Tumors are removed in thin layers and analyzed under a microscope for cancer cells. The process is repeated until no cancer cells remain. Using this technique 100% of the surgical margin is evaluated by the Mohs surgeon.
Therefore, it is possible to remove an entire tumor while preserving the surrounding healthy, unaffected tissue.
Mohs micrographic surgery is a highly specialized and precise procedure. A Mohs micrographic surgeon has undergone extensive training as both a surgeon and pathologist.
When is Mohs surgery recommended?
Mohs surgery is often recommended for tumors located in functionally and aesthetically sensitive areas, such as the head and neck, large tumors, tumors with aggressive pathology, and tumors that have recurred/returned. Mohs surgery is not necessary for all skin cancers and is important to discuss with your physician.
What to expect on the day of surgery
The entire procedure is done under local anesthesia. So, the patient remains awake and alert throughout the day.
The area to be treated is numbed with a local anesthetic and the tumor is removed layer by layer. Each layer is processed in the laboratory and the margins are examined under a microscope to identify and map the microscopic tumor cells. The procedure is repeated until no tumor cells remain.
Each layer takes approximately 20 minutes to remove and 60 minutes to process and analyze. Usually between one to three layers of tissue are removed. However, it can occasionally take an entire day to go through all the layers to remove the tumor. This process eliminates the need to overestimate the depth or breadth of the tumor and allows for preservation of the greatest amount of surrounding healthy tissue.
Once the tumor is completely removed the wound is repaired to minimize scarring and optimize functional and aesthetic results. A small, simple wound may be able to heal naturally on its own. A larger wound may require stitches, a skin graft or a flap.
How to prepare for Mohs surgery
You will be provided with complete instructions prior to surgery. However, here are a few things to know beforehand:
- Occasionally, you may be asked to come in for an appointment prior to your surgery to cover details. However, usually your care team can go over details and answer any questions on the day of surgery.
- We ask that you stop taking aspirin (unless prescribed by your physician) or ibuprofen (Anacin, Bufferin, Advil, Motrin) at least one week prior to surgery because it can interfere with blood clotting.
- We recommend that you bring reading material or something to entertain yourself during the day as you may have a few hours of waiting time. We also recommend having something on hand to eat and drink throughout the day.
What to expect after Mohs surgery and Recovery
The temporary side effects of Mohs micrographic surgery include swelling, bruising, tenderness, and tightness at the surgical site as healing takes place. This is normal and temporary. Risks are similar to other surgical procedures that do not require general anesthesia.