What Is Mohs Surgery and Is It Right for You?

August 29, 2016

A technical and highly specialized procedure, Mohs surgery removes skin cancers under precision, microscopic control. The doctor who first developed this technique approximately 50 years ago was Dr. Frederick Mohs, professor of surgery at the University of Wisconsin.

Removal of certain types of cancer under continuous microscopic control results in the smallest possible wound and highest rate of cure: 95% to 99% in some cases.

Generally recognized as a defined skin cancer treatment,  Mohs has proven exceptionally effective in the treatment of cancers located in sensitive areas of the neck and face, hands and fingers, neck and scalp.

What is Mohs Micrographic Surgery?

Mohs is the preferred procedure for removing skin cancers that may recur after treatment. Although skin cancers may be clearly seen by the patient, tiny cancer cells that are microscopic and not removed can make the cancer recur. It’s possible that the tumor goes past the external areas with groups of cells extending into other areas.

With the Mohs technique, these cells can be identified and removed with a high degree of accuracy and extremely high cure rates from 95% to 99%. A board-certified dermatologist who is expertly trained in the Mohs procedure should be the one to decide if the procedure is your best option.

“Mohs surgery helps thousands of people lessen the fear of skin cancer. It is safe and effective. We encourage early diagnosis and treatment for optimum results.”
Jessica Scruggs Dorsey, M.D., Board-Certified Dermatologist, Fellow of the American College of Mohs Surgery, Dermatology Associates of Central Texas

How is Mohs Surgery Performed?

Not all tumors grow symmetrically.  At the surface level, the tumor may actually be only a portion with more that exists under the skin. Because there are several different modes of tumor growth that are best treated using the Mohs technique, it is important to understand the details of the surgery. The Mohs technique includes the following:

  • Excising a tumor using strict anatomical orientation.
  • Close examination of tissue using a microscope.
  • Mapping the exact location of the residual tumor for complete removal of skin cancer.

First, multiple thin, layers of the excised tissue are analyzed. Tumors may send appendages of malignancy below the skin surface, beyond visibility. The high level of microscopic control sets Mohs apart from other methods of removing skin lesions.

The precision removal of the tumor is performed with a margin of healthy tissue around and below the lesion. Each level of tissue is intensely reviewed and “plotted” by the surgeon, so its precise location can be noted and isolated. Layers of tissue that are removed are carefully inspected under the microscope for evidence of any cancer cells.

Any evidence of cancerous tissue within the specimen is identified and removed. The surgeon proceeds to take away tissue until there are no cancerous cells present in the extracted specimen. Because of the close microscopic examination of each layer, dermatologists can be certain of the cancer eradication. Only the cancerous cells are removed, preserving normal tissue at every turn.

Before and After Mohs Surgery

Mohs surgery does not require checking into a hospital. The procedure is most often done in your dermatologist’s facility using a local anesthetic in the area around the tumor. You get an early morning start and usually finish the same day unless there are complications. Because the precise removal done by layers is so delicate it requires utmost attention to detail and focused microscopic examination.

If you need more than one session, a bandage is applied, and your return visit is scheduled. Once your surgical area is declared cancer-free, your surgeon will discuss options of wound healing or reconstruction, whichever is needed.

You will have intermittent visits so your dermatologist can monitor your progress and any possible reoccurrence of cancer. Patients who have a skin cancer are more likely to develop another one within a few years, so following up with your doctor is imperative.

Why Mohs Surgery?

Cure rates for skin cancer after treatment with Mohs micrographic surgery are as high as 95% to 99%. The technique produces the smallest possible wound in the removal of any given tumor. The smaller the wound, the greater the chances are for a good cosmetic result after the wound has completely healed. This is particularly important on the face, where a good appearance after surgery is of concern to the patient.

An overwhelming majority of tumors can be totally removed in one treatment session, due to the preciseness of the surgery and microscopic inspection. While the Mohs surgery is a technically demanding procedure, it is also highly cost-effective, because fewer return visits to the dermatologist are needed for treatment of a recurring lesion.

Are You a Good Candidate for Mohs?

Are you able to tolerate local anesthesia? Do you have extreme anxiety? Do you have a surgical phobia? Are you in very poor health? If you answered yes to any of these questions, you may be unable to undergo Mohs surgery.

Factors such as the location and type of skin cancer you have, past treatments, your overall health, and your comfort level with the procedure will all contribute to your decision. Ask your Mohs surgeon to help you understand the various treatments and share in your decision-making.

Do You Have Implants or Health Issues?

Discuss with your Mohs surgeon any medical conditions that may affect your surgery or healing. He needs to know if you have any artificial parts or implants or if you require antibiotics prior to special procedures or dental work – all of these things must be disclosed to your Mohs surgeon.

Let your doctor know if you have a recent history of skin infections, drug allergies or a tendency to bruising or bleeding easily.

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