MOHS Surgery

Mohs surgery is a special type of skin cancer surgery, named after its inventor, Dr. Frederic Mohs. It consists of removing skin cancer with the use of a microscope, so that all of the skin margins can be evaluated. Mohs surgery results in the highest cure rate for skin cancer, and removes the most minimal amount of tissue necessary.

Yes, there are actually many different types of skin cancer. Depending on the type of skin cancer and its location on your body, there are several different ways to treat the skin cancer, including Mohs surgery.

Basal Cell Carcinoma is the most common type of skin cancer, and is named after the basal layer cells of the skin. Basal cell carcinomas slowly enlarge and grow, but fortunately they do not usually spread (metastasize) to distant parts of the body. As the basal cell carcinomas grow, they will invade and destroy structures in their paths. It is therefore very important for these skin cancers to be treated as early as possible.

Squamous Cell Carcinomas are the second most common type of skin cancer, and are named after the squamous cell layer of the skin. Squamous cell carcinomas slowly enlarge and grow, and they can rarely spread (metastasize) to distant parts of the body. In addition, the squamous cell carcinomas will grow locally, destroying the normal skin in the process. It is therefore very important for these skin cancers to be treated as early as possible.

Melanoma Skin Cancer is the most dangerous type of skin cancer. It is an overgrowth of the melanocytes, the pigment producing cells of the skin. Melanomas usually appear as a brownish-black spot or bump on the skin that enlarges and sometimes bleeds. Sometimes melanomas arise in moles that have been present for many years. Melanoma is different from other types of skin cancer because it has a risk of spreading (metastasizing) to distant areas of the body. While many melanomas are considered “low risk”, melanoma can be deadly if not treated properly. In most cases, melanomas should be removed with appropriate surgical margins.

Mohs surgery allows for the total removal of a skin cancer in one day, with the advantage of finding out the results the same day. 100% of the margins of the skin removed are examined with a microscope, which reduces the possibility of having to “go back” to remove more skin later if all of the cancer was not removed.

Because we examine all of the margins of the skin removed, the percentage of success is very high, often 95-99%, even if other previous treatments have failed. However, no one can guarantee a 100% chance of cure. Also, because we only remove tissue where we see skin cancer with the microscope, we remove as little normal tissue as possible.

Our doctors and your referring physician, are happy to further explain the risks, benefits and alternatives for treatment of your skin cancer, and why we believe Mohs surgery is the best treatment option for you.

Mohs micrographic surgery is performed under local anesthesia so there is some pain from local anesthetic injections. Also, since the process may involve several surgical stages, the time for this procedure may take several hours and the procedure may last all day.

• We may ask to see you in consultation prior to your surgery, or we may perform the consultation on the same day as your surgery. The night before the surgery, get a good night’s rest, eat a light breakfast and come to the office at your scheduled appointment time.
• As the surgery can take several hours with some downtime, we recommend that you bring a book, newspaper, laptop computer or something else to help pass the time. Many patients bring a snack or lunch to eat during the day.
• You should wear comfortable, loose-fitting clothing for the day of the surgery. It is a good idea to also bring a sweater with you to make you more comfortable. We ask that you have someone available to drive you home after the surgery.

You should continue to take all of your regular medications, unless specifically instructed by our office staff. If your doctor has prescribed a blood thinner such as Coumadin®, Plavix®, heparin, aspirin, we recommend that you continue taking these medications as prescribed.

• After taking a brief history, we will perform a limited skin exam, and mark the site of your skin cancer with you. We will then inject a local anesthetic to numb the skin and prevent discomfort for you. Our surgeon will then remove the affected area with a thin layer of tissue. We will stop the bleeding and place a large bandage over the area.
• We will then take your skin and prepare the tissue for microscopic examination. This is unfortunately, the most time-consuming part of the process, as it can take 1-2 hours for the tissue and slides to be prepared. We will then examine the slides of your skin under a microscope, in order to determine if there is any skin cancer still remaining.
• If there is skin cancer seen on your slides, it means that there is still skin cancer at the edges of the tissue. We must remove more tissue (“another layer of tissue”), and we will repeat the above process until all of the skin cancer is removed. Depending on your skin cancer, it may take several stages of this process in order to completely remove the skin cancer. We cannot predict how many stages of surgery will be necessary to remove your skin cancer.
• Once the skin cancer is completely removed, we will then discuss the different options to help the wound heal. Depending on the size and location of your skin cancer wound, we will discuss all of the different surgical reconstructive options with you and recommend the best option in our opinion. Typically, this reconstruction is performed the same day as your Mohs surgery, but it may be necessary to perform the reconstruction on a separate day.

Unfortunately, all surgeries result in scars. When we remove your skin cancer, the procedure will result in a scar. We have great expertise in reconstructing skin cancer wounds in all locations as a result of our specialized training in Mohs surgery. In some cases, a minor revision to the scar may be necessary in the future to result in the best cosmetic outcome. We refer few cases out for reconstruction. We do work with colleagues in plastic, head and neck, and oculoplastic surgery, and we are happy to refer you to them for reconstruction after Mohs surgery if you desire.

After your surgery, we will see you back to observe the wound and to make sure that the incision has healed well. You may also need to have sutures removed at that time. In the future, we recommend that you have regular visits with your dermatologist for full skin checks in order to maintain skin health.

You should continue to take all of your regular medications, unless specifically instructed by our office staff. If your doctor has prescribed a blood thinner such as Coumadin®, Plavix®, heparin, aspirin, we recommend that you continue taking these medications as prescribed.