Mohs Surgery

Mohs Micrographic Surgery

What is Mohs Micrographic Surgery?

Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. The procedure was developed in the 1930s by Dr. Frederic Mohs at the University of Wisconsin, and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue, so that all "roots" and extensions of the cancer can be eliminated. Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate.

Advantages of the Mohs Surgical Procedure

Some skin cancers can be deceptively large – far more extensive under the skin than they appear to be from the surface. These cancers may have "roots" in the skin, or along blood vessels, nerves, or cartilage. Skin cancers that have recurred following previous treatment may send out extensions deep under the scar tissue that has formed at the site. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous "roots". For this reason, prior to Mohs surgery it is impossible to predict precisely how much skin will have to be removed. The final surgical defect could be only slightly larger than the initial skin cancer, but occasionally the removal of the deep "roots" of a skin cancer results in a sizeable defect. The patient should bear in mind, however, that Mohs surgery removes only the cancerous tissue, while the normal tissue is spared.

Special Indications for Mohs Surgery

It is important to note that Mohs surgery is not appropriate for the treatment of all skin cancers. Mohs micrographic surgery typically is reserved for those skin cancers that have recurred following previous treatment, or for cancers that are at high risk for recurrence. Mohs surgery also is indicated for cancers located in areas such as the nose, eyelids, lips, hairline, hands, feet, and genitals, in which maximal preservation of healthy tissue is critical for cosmetic or functional purposes.

The Mohs Surgical Procedure

Typically, Mohs surgery is performed as an outpatient procedure in the physician’s office. Although the patient is awake during the entire procedure, discomfort is usually minimal and no greater than it would be for more routine skin cancer surgeries.

Patient Preparation for Surgery

It is important that you obtain a good night’s rest and eat normally on the day of the surgery. If you are taking prescription medications, continue to take these unless otherwise directed by a physician. However, you should avoid taking aspirin-containing medications for ten days prior to your surgery. You also should avoid aspirin substitutes (such as Advil, Motrin, Nalfon, Naprosyn, etc.) within seventy-two hours of surgery. Tylenol, however, may be taken at any time prior to surgery. For your comfort, it is recommended that you wear casual, layered clothing on the day of your surgery. You may also wish to bring a light snack and a book or magazine to help occupy your waiting time. Also, it is highly recommended that you arrange for someone to drive you home following surgery.

Duration of Procedure

Most Mohs cases can be completed in three or fewer stages, requiring less than four hours. However, it is not possible to predict how extensive a cancer will be, as the extent of a skin cancer’s "roots" cannot be estimated in advance. Therefore, it is advisable to reserve the entire day for this surgical procedure, in case the removal of additional layers is required.

Minor Post-Surgical Discomfort Expected

Most patients do not complain of significant pain. If there is some discomfort, normally only Tylenol is required for relief. However, stronger pain medications are available and will be prescribed when needed. You may experience some bruising and swelling around the wound, especially if surgery is performed near the eye area.

What are the risks of the procedure?

There are minimal risks. The most common side effect is redness of the skin which usually resolves within 24 hours and is easily covered with make-up.