What is Mohs surgery?
Mohs surgery is a surgical technique that is used to remove skin cancers with a high level of precision. With Mohs surgery, your surgeon will take what is visible of the tumor and process that tissue, then look at it under the microscope to determine whether there is still residual tumor. If there is, then she will go back and take more skin—taking only what is needed to clear the tumor. That process is repeated until all the tumor is gone and reconstruction can begin. The technique has the advantage of being both tissue sparing and highly effective.
Why am I getting Mohs surgery?
The results of your biopsy indicate that you have a skin cancer. Your dermatologist has determined that your skin cancer would be best treated by Mohs micrographic surgery, a specialized procedure and technique for removing skin cancers. The following information will explain to you what to expect before, during, and after surgery.
Advantages of Mohs surgery
Mohs surgery is unique and effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margin. The pathologic interpretation of the tissue margins is done on-site by the Mohs surgeon, who is specially trained in the reading of these slides and is able to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include:
- Ensuring complete cancer removal during surgery
- Minimizing the amount of healthy tissue lost
- Maximizing the functional and cosmetic outcome after surgery
- Repairing the site of the cancer the same day the cancer is removed, by the same surgeon, in most cases
- Curing skin cancer when other methods have failed
- Mohs differs from other techniques in that
- Microscopic examination of all excised tissues occurs during rather than after the surgery
- In contrast to a standard surgical excision in which only a few slices of tissue are examined, Mohs involves examination of the entire surgical margin of the tissue.
Before your surgery
Prepare for your surgery by getting plenty of rest and eating a good breakfast. Please try to reduce or refrain from taking any non-essential non-steroidal anti-inflammatory medications (NSAIDs), supplements, or fish oil 7 days prior to surgery unless specifically recommended by your doctor. Examples of these types of medications are ibuprofen, aspirin, Aleve, Motrin, Excedrin, or fish oil. Tylenol is acceptable. If you are on any prescription blood thinners (like coumadin, Xarelto, Eliquis, etc.) or are on aspirin for medical reasons, you should continue these medications and let us know on the day of surgery. Refrain from consuming any alcohol for at least three days before your surgery and try to stop or reduce smoking for 1 week before surgery and for a few weeks afterward to speed the healing process.
The day of your surgery
Due to the nature of this surgery, your appointment will be scheduled for early morning or early afternoon. After you check in, you will be escorted to our surgical treatment room. The cancer site will be prepared for surgery with a local anesthetic. The visible cancer is removed along with a very thin margin of surrounding tissue in a procedure that takes about 10-15 minutes. A dressing is placed on the surgical site and you are free to leave the treatment room and wait in the waiting room. Be prepared to spend a total of at least 2-4 hours in our office during the course of your treatment. Please bring a book, iPad, or something to occupy your time. If someone is going to wait with you, ask him/her to do the same.
While you wait, the specimen is taken to a specially trained technician who carefully maps, freezes, and cuts the tissue into thin sections. After the tissue is stained the surgeon will examine each section of the tissue under a microscope to determine if cancer cells are present. Processing and examining the tissue takes about 60 minutes. If your surgeon detects residual tumor, he or she will remove another layer of tissue from the area where tumor was found. These stages are repeated as necessary until the doctor determines that the entire tumor has been removed. In most cases treatment is completed in two or three stages. However, because every person's skin cancer is different, we cannot predict how much time will be needed to remove the cancer completely and repair the surgical wound (if needed). Therefore, we advise that you do not make any other commitments for the remainder of the day.
Following your surgery
Once the tumor has been removed, your surgeon will evaluate the surgical wound and discuss wound management options with you. The options may include closing the wound with stiches, a skin graft, or skin flap or letting the wound heal by itself. Surgical repair may be done that day or may be scheduled for a later date in situations where a delayed surgical repair can achieve a better result. Because you may be very tired by the end of the procedure, we recommend that you make arrangements for a ride home.
Swelling, pain, bruising, or numbness in the area of your surgery are normal after surgery. It is best to sleep with your head elevated to minimize swelling (with an extra pillow or recliner) for the first 48 hours. All of these symptoms should improve over the next 1-2 weeks. If your symptoms do not improve over the next 4-5 days or if they initially improve but then start to worsen again, please call our office. Most patients will be seen one week after their Mohs micrographic surgery and/or surgical repair for follow-up and possible suture removal.
Will Mohs surgery leave a scar?
• Yes. As will any treatment for skin cancer, Mohs surgery will leave a scar. Mohs surgery preserves as much healthy skin as possible and maximizes options for repairing the surgical defect, once the tumor is completely removed. Once your surgeon has completely removed your skin cancer, reconstruction for optimizing the final functional and cosmetic result becomes the highest priority. Generally, a post-surgical scar improves with time and can take up to 1 year to fully mature.
• In addition, the normal healing process involves a period of skin contraction, which often peaks 4 to 6 weeks after the surgery. This may appear as a bumpiness or hardening of the scar. On the face, this change is nearly always temporary and the scar will soften and improve with time. Sometimes injection of a medication is needed to soften the scar if it remains firm and raised.
If you have any questions or concerns, please call our office at (949) 824-0606.