What is Mohs Surgery?
There are five standard methods for the treatment of skin cancers. The two non-surgical treatments are cryotherapy (deep freezing) and radiation therapy. The three surgical methods include simple excision, physical destruction (curettage with eletrodesiccation) and Mohs Micrographic Surgery. Newer methods under investigation include photodynamic therapy and immunochemotherapy.
In 1935, Dr. Frederic Mohs developed a technique for cancer removal known as chemosurgery. Originally, chemicals were applied to the skin during the surgery. These chemicals are now rarely used, but the name Mohs chemosurgery continues to be associated with the procedure now correctly termed Mohs Micrographic Surgery.
Mohs micrographic surgery is a specialized form of skin cancer treatment that removes the visible tumor while sparing the healthy tissue. It is considered the gold standard for treating certain types of skin cancer and delivers the highest cure rate compared to other surgical treatment options. This procedure aims to minimize the loss of healthy tissue while maximizing the cosmetic and functional outcome of the surgery.
How It Works
After the removal of the visible portion of the tumor by excision or curettage (debulking), there are two basic steps to each Mohs Micrographic Surgery stage. First, a thin layer of tissue is surgically excised from the base of the site. Next, this tissue is mapped and processed in a unique manner and examined under the microscope. Our doctors examine the entire bottom surface and outside edges of the tissue on the microscopic slides. This tissue has been marked to orient top to bottom and left to right. If any tumor is seen during the microscopic examination, its location is established, and a thin layer of additional tissue is excised from the involved area. The microscopic examination is then repeated. The entire process is repeated until no tumor is found.
Mohs Micrographic Surgery allows for the selective removal of the skin cancer with the preservation of as much of the surrounding normal tissue as is possible. Because of this complete systematic microscopic search for the “roots” of the skin cancer, Mohs Micrographic Surgery offers the highest chance for complete removal of the cancer while sparing the normal tissue. The cure rate for new basal cell and squamous cell carcinomas exceeds 98%. As a result, Mohs Micrographic Surgery is very useful for large tumors, tumors with indistinct borders, tumors near vital functional or cosmetic structures, and tumors for which other forms of therapy have failed. No surgeon or technique can guarantee 100% chance of cure.
Who is a Candidate for Mohs Surgery?
If you have been diagnosed with skin cancer, the providers at a practice near you will work with you to develop a treatment plan that is best for you. In most cases, Mohs surgery is recommended for the following types of skin cancer:
Basal and squamous cell carcinoma- Recurrent skin cancer
- Skin cancer that grows and spreads rapidly
- Skin cancer in functionally sensitive areas
FAQs
How to prepare for Mohs surgery?
Before your Mohs surgery, you will meet with your surgeon to discuss the procedure in detail. Your surgeon will explain what to expect before, during, and after the surgery. It is essential to ask any questions you may have so you are fully informed and comfortable with the procedure.
The following are some tips to help you prepare for your Mohs surgery:
- If your skin cancer involves the facial area, you may want to arrange for someone to drive you home after the surgery in case your vision is impaired due to bandaging
- Unless your surgeon instructs otherwise, shower and wash the surgery site before your procedure
- Do not wear makeup, lotion, or perfume on the day of the surgery
- Wear comfortable, loose clothing that can easily be removed
- Get a good night’s sleep before your procedure
- Eat a healthy meal before surgery unless your surgeon instructs you otherwise
- If you smoke, try to cut down or quit at least two weeks before surgery, as smoking may delay healing
In addition to these tips, you may need to stop taking certain medications, such as blood thinners or aspirin. Be sure to tell your surgeon about any medications you are taking, including over-the-counter medicines. It is important to follow any pre-operative instructions your surgeon gives you. This will help ensure a successful surgery and optimal outcome.
How long does Mohs surgery take?
Although Mohs surgery can take longer than other techniques to perform, advances in technology, such as automated staining of tissue samples, have made it quicker. While it is impossible to predict exactly what timeframe to expect for each Mohs surgery procedure, the entire procedure usually lasts several hours. Rarely, clearing the tumor and reconstructing the defect can take the better part of a day. A consultation with the Mohs surgeon prior to your procedure will allow for the surgeon to understand the unique qualities of your situation and enable him/her to more clearly estimate the extent of the timeframe for the surgery.
What are the results after surgery?
If your surgeon leaves the wound open to heal naturally, you may see a hole when you remove your bandage. We understand this can be frightening if you are not expecting it. However, in almost all cases, the skin heals nicely with a barely noticeable scar.
The cure rate for Mohs surgery is over 99%. In previously treated cancers in which the tumor is recurrent, Mohs surgery is 95% effective.
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