Mohs Surgery

What is Mohs Surgery?

Mohs surgery, short for Mohs micrographic surgery, is a highly specialized treatment for the removal of skin cancer. It was developed by Dr. Frederick Mohs in the early 1940’s. Mohs surgery eliminates the guesswork used with all other methods of treating skin cancer. It allows a detailed microscopic evaluation of all edges of the skin cancer by the Mohs surgeon, ensuring complete removal. By using detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. This results in complete removal of the skin cancer while removing as little normal skin as possible.

Today, Mohs surgery has come to be accepted as the single most effective technique for removing Basal Cell Carcinomas and Squamous Cell Carcinomas (BCCs and SCCs), the two most common skin cancers. It accomplishes the nifty trick of sparing the greatest amount of healthy tissue while also most completely expunging cancer cells; cure rates for BCC and SCC are an unparalleled 98 percent or higher with Mohs, significantly better than the rates for standard excision or any other accepted method.

Who Performs Mohs Surgery?

Dr. Meghan Morrow is a trained Mohs Surgeon and leads a team of nurses, medical assistants, and histology technicians. Dr. Morrow is fellowship trained and recognized by the American College of Mohs Surgery. The histology technician prepares the tissue slides, which are examined under the microscope by the Mohs surgeon.

How Do I Prepare for Surgery?

The morning of surgery

Please shower and wash your hair. Avoid wearing make-up, using hair products, or wearing jewelry. Eat your normal breakfast, unless otherwise specified. Wear comfortable clothing. Also, because the day may be quite tiring, we suggest you arrange to have a companion drive you to and from the office.

What to pack

You will be in the office for most of the day; therefore, you may want to bring a snack or sandwich. Please bring a book or something to do during the waiting period. Once the surgery has begun, you will need to remain in the office. If you require oxygen, be sure to bring enough to last the entire day.

Medical history

You will be asked to review your medical history when you arrive the morning of the surgery. Bring a list of medications and illnesses. Please arrive at least 15 minutes before your scheduled appointment to allow time to complete any necessary paperwork.

Medications

Continue all prescribed medications, including blood thinners like Coumadin, Eliquis, Plavix, and aspirin. However, if you are taking aspirin, ibuprofen, or supplements (including Vitamin E, fish oil) without your doctor’s orders, then discontinue them 10 days prior to your surgery. Call the office if you are unsure. Avoid alcoholic beverages 48 hours before surgery as they can promote bleeding.

What Happens the Day of Surgery?

Checking in

Upon arrival, check in at the front desk. You will be escorted to the procedure room where your medical history, medications, and allergies will be reviewed.

The procedure

After all of your questions are answered and the correct surgical site has been confirmed, the skin is cleansed and numbing medication is injected. After the area is numbed, the visible cancer will be removed by the surgeon. This usually only takes a few minutes. A temporary bandage is placed and you will return to the waiting room while the tissue is processed. Tissue processing and mapping often takes 1-2 hours. If the surgeon sees cancerous cells under the microscope, the entire process is repeated.

The repair

Once the surgeon is certain that the entire tumor is removed, she will discuss with you what kind of reconstructive surgery, if any, is necessary. We may choose to (1) let the wound heal by itself, (2) repair the wound with stitches, or (3) close the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result. Once all surgery is completed, a bandage will be applied and wound care instructions will be provided. Follow-up appointments for wound checks or suture removal can be scheduled before you leave.

How long will I be there?

The most difficult part of the procedure is waiting for the results from our laboratory. Since we do not know in advance how much time is necessary to remove your skin cancer and repair the wound, plan to be in the office the entire day and make no other commitments.

What Can I Expect After the Surgery?

For most patients, wound care is simple and consists of daily cleansing of the wound with tap water, applying Vaseline with a clean Q-tip, and covering the wound with a bandage. Written wound care instructions will be provided the day of surgery. You will need to refrain from strenuous activity for 1-2 weeks following the surgery. Most patients can return to work the day after surgery, though you will have a bulky dressing in place. An appointment for follow up and suture removal, if necessary, will be scheduled.

Pain

Most people are concerned about pain. The majority of patients will experience very little pain after surgery. Extra strength Tylenol is recommended for pain and, if needed, a stronger pain reliever can be prescribed.

Bleeding

A small number of patients will experience some post-operative bleeding. It can usually be controlled by applying firm pressure to the wound. If bleeding persists, see your wound care instructions for further instructions.

Swelling and bruising

Swelling and bruising are common following Mohs surgery, especially around the eyes and mouth. Sometimes these can occur even up to 3 days following the procedure. Keeping the affected area elevated while lounging or sleeping can help minimize swelling. Compression stockings should be worn for at least one month after surgery on the lower legs.

Scarring

Although every effort will be made to offer the best possible cosmetic result, any form of surgery will result in a scar. Mohs surgery removes as little normal tissue as possible, so scarring is minimized. The scar can be also be minimized by the proper care of your wound and avoiding smoking.

Complications

Complications after Mohs surgery are rare, but may include bleeding or infection. For any complications or questions following surgery, please review the written instruction sheet we provide you on the day of surgery.

For more information, please visit the American College of Mohs Surgery website.

How Mohs Surgery works

The Mohs surgery procedure seems simple: the surgeon removes the cancer, carefully checks to be sure the he or she got it all, then repairs the wound. Mohs surgeons train in and practice the complex nuances of this process for years so they are prepared to handle any situation they may encounter. This page describes the steps they follow for each Mohs surgical procedure.

Mohs skin cancer surgery is the most effective treatment for most types of skin cancer.

The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. We start with examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia, and the Mohs surgery begins.

The surgeon removes the visible portion of the tumor using careful surgical techniques.

The surgeon next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated.

In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and returns to the patient to remove another deeper layer of skin — but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

At this point, the surgeon discusses reconstruction options, should they be required, and then post-operative care. Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.

Step 1

The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. We start with examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia, and the Mohs surgery begins.

Step 2

The surgeon removes the visible portion of the tumor using careful surgical techniques.

Step 3

The surgeon next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated.

Step 4

In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

Step 5

If the surgeon finds cancer cells under the microscope, he or she marks their location on the “map” and returns to the patient to remove another deeper layer of skin — but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

Step 6

The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgey removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

At this point, the surgeon discusses reconstruction options, should they be required, and then post-operative care. Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.