What is Mohs Micrographic Surgery?

Have you heard of Mohs micrographic surgery? If your doctor has detected skin cancer, Mohs might be the treatment recommended. A state-of-the-art treatment, Mohs surgery allows for the precise removal of skin cancer, with the highest cure rate and minimal scarring. Because we know that the idea of any kind of surgery can be nerve-racking, we’d like to walk you through this outpatient procedure, so you’ll know exactly what to expect.

There are many advantages to Mohs micrographic surgery. First, as previously mentioned, it offers the highest cure rate possible. Because it’s performed with microscopic accuracy, the amount of healthy, tissue removed is minimized. Mohs surgery has the lowest functional and cosmetic morbidity of any procedure, which means that you’re less likely to lose function or experience scarring than with other surgeries to remove skin cancer. What’s more, it’s a one-day outpatient surgery, using only local anesthesia. Mohs is generally reserved for cancers that are large, have recurred after conventional treatment, or are in certain locations on the body, like the central face. It’s most often used for the treatment of basal cell carcinoma, squamous cell carcinoma, or lentigo maligna, an early form of melanoma. In some cases, though, it can also be used to successfully treat less common forms of skin cancer.

Here’s what you’ll need to know, in order to prepare for your procedure.

• You’ll have a consultation over the phone with a nurse preceding the procedure. Make a list of questions in advance, so that you can be sure you’ve gotten the answers you need before you arrive on the day of surgery.
• Get some rest and eat breakfast. The night before your surgery, make sure to get a full night’s sleep. Your doctor will probably also recommend that you eat a light breakfast before coming to the office.
• Understand that the process takes time. The lab work between each layer is labor-intensive and can take an hour or two, so it’s recommended that you bring a book or something else to occupy your time while you wait for results. Plan to spend a minimum of three hours at the clinic, with the knowledge that you might finish earlier than expected.
• Ask your doctor about your medications. If you have been prescribed aspirin, Plavix or Coumadin by your physician, do not discontinue it, unless you are specifically told to do so. If you have not been prescribed aspirin or other blood thinners by your physician, avoid aspirin for at least seven days prior to surgery and two to three days after surgery. All patients should try to avoid other NSAIDs (non-steroidal anti-inflammatory drugs) such as Advil/Motrin/ibuprofen, Naprosyn/Aleve/naproxen and similar medications and vitamin E as these medications also increase the tendency of bleeding. Plain Tylenol may be taken if pain medicine is needed.
• Come to the appointment clean, comfortable, and with company. Bathe or shower with antibacterial soap the morning of your procedure, don’t wear makeup if the surgery is on your face, and dress in comfortable clothes for your appointment. Even though we only use a local anesthetic, we recommend that you arrange for someone to drive you home after you’re done.

During the procedure, a local anesthetic will be injected around the skin cancer. The visible portion of the skin cancer will then be removed, after which the doctor will remove a thin layer of tissue around the edges and at the base of the cancer. The tissue will be dyed so that the physician will be able to distinguish between the top, bottom, left, and right, and a drawing is made so that any areas of persistent tumor may be pinpointed.

At this point, the tissue will be sectioned into very thin slices, and the edges and underside will be examined with a microscope. If the tissue still contains cancer, the physician will use the map to outline the areas of involvement. Additional tissue will then be removed only from the specific areas of involvement. This allows your doctor to preserve as much healthy tissue as possible, minimizing scarring. The specimen will be processed in the laboratory, and the cycle of examining tissue and removing only unhealthy tissue will be repeated as many times as necessary to remove all cancer cells. When all of the cancer is gone, the surgical flap is stitched closed, using a skin flap, skin graft, or an elliptical closure for the best outcome in terms of aesthetics and function.

During recovery from Mohs, it’s important to follow your doctor’s instructions. Right after the surgery, the treated area will probably feel tight and sore, and it may become swollen and bruised. An ice pack may help with the discomfort, but make sure you follow the instructions you’re given about caring for the wound. The incision line should start to look better over the first three to six months, but it’s very important that you stay out of the sun, in order to avoid permanent scarring and reduce your risk of recurring cancer.

Whether you need a skin cancer screening or a treatment like Mohs micrographic surgery, you can trust Skin Cancer Specialists, P.C. & Aesthetic Center to take care of you.  Our practice was originally entirely devoted to treating people with skin cancer, and though we have grown to become a premier dermatology practice including an aesthetic center, we’re still committed to caring for those with skin cancer, providing compassionate treatment that maximizes effectiveness and respects aesthetic implications. Continually adapting our practice to reflect new and improved technique and procedures, we adhere to the highest standards in the industry.

We perform procedures onsite in our affiliate surgery center, Skin Cancer Specialists Surgery Center, LLC. Because of our commitment to safe and effective patient care, we’ve earned the Joint Commission’s (JCAHO) prestigious Gold Seal of Approval® for Ambulatory Health Care. Call one of our offices or contact us through our website to learn about our personalized care and what we can do for you.