How Long Does Mohs Surgery for Superficial Melanoma Take?

Worried About Undergoing Mohs Surgery for Skin Cancer? Here’s What to Expect

The time for Mohs surgery on superficial melanoma depends on the size and place of the cancer. Smaller, surface-level melanomas may take a few hours, but bigger or deeper cancers can make it last much longer.

Imagine noticing a new irregular mole on your skin that seems to be growing larger week by week. You finally get it checked out and your dermatologist determines it’s a superficial melanoma skin cancer measuring about 3 square centimeters. 

They recommend Mohs surgery to remove it layer by layer and minimize recurrence risk. Now you’re worried - how long will this procedure actually take?

Mohs micrographic surgery is commonly used to treat various types of skin cancer including superficial melanomas limited to the outermost skin layer. This specialized surgical technique involves meticulous removal of cancerous tissue in layers, with each layer examined under a microscope to check for residual cancer cells.

If you or a loved one is facing Mohs surgery for early stage melanoma, it’s normal to have questions about what the procedure entails and how long it will take. 

In this article, we provide a step-by-step overview of Mohs surgery for superficial melanoma and discuss the factors that determine its duration.

Speak with Dr. Mendese at Dermatology and Skin Health for a personalized estimate of Mohs surgery duration based on your unique case. Book a consultation now

What is Mohs Surgery?

Mohs surgery, named after Dr. Frederic Mohs, who developed the technique in the 1930s, involves surgically removing skin cancer tissue layer by layer. The Mohs procedure involves the following steps:

• Initial Removal
• Mapping and Processing
• Microscopic Examination
• Repeat Removal if Necessary
• Repairing the Surgical Defect

Compared to other skin cancer treatments, Mohs surgery has high cure rates—up to 99% for certain types of skin cancer. It minimizes the removal of healthy tissue while ensuring all cancerous cells are eliminated, resulting in smaller wounds and better cosmetic outcomes.

The Mohs technique allows the surgeon to precisely map and examine 100% of surgical margins to verify that no roots or extensions of the skin cancer remain, significantly minimizing the risk of recurrence.

How Long Does Mohs Surgery for Superficial Melanoma Typically Take?

For superficial melanoma lesions limited to the outermost skin layer (epidermis), Mohs surgery is usually quick. The procedure time varies case by case based on several factors:

Size and Depth of the Melanoma

The size and depth of invasion are key factors affecting Mohs surgery duration. Smaller, more superficial melanoma lesions have a shorter Mohs surgery time than larger, deeper lesions.

• For a small superficial melanoma lesion of about 3 square centimeters, Mohs surgery may take 1-2 hours. 
• Larger superficial melanomas of 6 or more square centimeters may require 3-4 hours.

Deeper infiltrating melanoma extending into the dermis or subcutaneous tissue generally necessitates longer Mohs surgery, even with small tumor sizes. Deep infiltrating melanoma may take 4 hours or more depending on individual circumstances.

Location of the Lesion

The location of the melanoma lesion also impacts how long Mohs surgery takes. Tumors on the face, ears, eyelids, lips and other delicate areas often demand extra precision and care during removal.

Mohs surgery around the eyes, nose and mouth may take longer, as the surgeon carefully protects nerves, muscles and other vital structures. Lesions on the trunk or extremities can usually be removed quicker.

Experience of the Surgeon

An experienced Mohs surgeon who has performed numerous cases may operate faster than less experienced surgeons. Their extensive knowledge and muscle memory helps optimize the coordination of steps like tissue removal, mapping, microscopic analysis and reconstruction.

Number of Stages

The number of stages directly relates to the total Mohs surgery duration. Each new stage adds time for additional tissue removal, mapping, microscopic slide preparation and examination.

Some melanoma cases may require only a single stage if clear margins are achieved right away. But certain melanomas are intricate and demand multiple stages to fully clear. This extends the Mohs surgery time considerably.

Overall Time Frame

Given these variables, total Mohs surgery time for superficial spreading melanoma can range widely. Smaller superficial lesions may take 1-3 hours, while larger or tricky cases could take 4 hours or more. Mohs for complicated facial tumors could even extend up to 6-8 hours in some instances.

It’s important to have an individualized discussion with your dermatologist about expected Mohs duration based on your unique situation. Don’t rely on general averages alone. Get a personalized time estimate from your surgeon.

Get Mohs surgery from an expert you can trust - schedule with Dr. Mendese at Dermatology and Skin Health today.

What to Expect During Mohs Surgery

Knowing what to expect during the step-by-step Mohs procedure can help ease anxiety over its duration:

1. Anesthesia

The first step is administering local anesthesia to numb the area around the skin cancer for comfortable treatment. General anesthesia is typically not required for Mohs surgery.

2. Initial Layer Removal

The visible tumor is excised along with a thin margin of clear skin surrounding it. The removal is carefully mapped to indicate orientation, ensuring precise tracking of tissue samples.

3. Tissue Preparation and Analysis

The removed tissue layer is color-coded and processed into thin slices for microscopic examination. This meticulous preparation allows for thorough analysis of the surgical margins.

4. Additional Layer Removals

If cancer cells are detected at the margins during microscopic examination, the surgeon removes another thin tissue layer from the specific area where the cancer cells were found. This process continues until all cancerous cells are cleared.

5. Wound Closure

Once all margins are confirmed to be cancer-free, the surgical defect is repaired. This may involve stitches, a skin graft, or a reconstructive flap depending on the size and location of the wound.

During the procedure, patients are given ample opportunities for restroom breaks and can have snacks or entertainment devices to help ease waiting times between stages.

Recovery After Mohs Surgery: Post-Procedure Care

Following Mohs surgery, it is important to properly care for the wound site to promote healing and minimize scarring. Here are some key tips:

1. Keep the wound area clean by gently washing around it daily with mild soap and water. Avoid soaking the wound directly.
2. Gently pat the area dry after washing. Do not rub.
3. Apply a thin layer of prescribed antibiotic ointment if recommended by your doctor.
4. Cover the wound with a sterile non-stick bandage and change the dressing as directed.
5. Take over-the-counter pain medication as needed for discomfort.
6. Use any prescribed medications exactly as directed.
7. Avoid direct sun exposure on the healing skin for at least 6 months.
8. Wear protective clothing, wide-brimmed hats, and use broad spectrum SPF 30+ sunscreen.
9. Watch for signs of infection like increasing pain, redness, fever or drainage. Notify your doctor promptly if these occur.
10. Attend all follow-up appointments as recommended by your dermatologist.

With proper wound care and sun protection, patients can expect good healing results and minimal scarring after Mohs surgery. Be diligent about continuing skin self-exams as well.

Choosing Your Mohs Surgeon: Optimal Outcomes Start Here

While Mohs surgery itself is a highly effective treatment, optimal results depend greatly on the skill and experience of your surgeon. When selecting a Mohs specialist:

• Look for a board-certified dermatologist who has completed advanced fellowship training in Mohs surgery. This intensive training ensures expertise.
• Choose a high-volume Mohs surgeon who performs the surgery routinely for melanoma and other skin cancers. Focused experience leads to precision.
• Verify that the surgeon has excellent cure rates and cosmetic outcomes for complex cases. View before-and-after photos when possible.
• Opt for a Mohs specialist affiliated with a major medical center, academic institution or cancer center. Access to comprehensive care matters.
• Consider logistics like location and operating room facility. Your comfort and convenience impact the experience.

Dermatology and Skin Health’s Dr. Gary Mendese is a fellowship-trained Mohs surgery specialist with over 15 years of experience achieving remarkable cure rates and cosmetic results. He provides care through our dermatology offices conveniently located in:

• Dover, New Hampshire
• Portsmouth, New Hampshire
• Peabody, Massachusetts
• Londonderry, New Hampshire
• Bedford, New Hampshire

Schedule a consultation about Mohs surgery or any skin health concern with Dr. Mendese today. Your optimal outcome begins here.

Conclusion

The duration of Mohs surgery for superficial melanoma removal varies substantially based on the size, location, depth and complexity of the lesion. While smaller superficial lesions may take only 1-3 hours, larger or intricate cases can extend 4 hours or longer in experienced hands.

Consult your board-certified dermatologist for an individualized estimate of expected Mohs surgery time based on your specific melanoma and medical history. Get advice on preparing for the procedure, recovery and beyond for optimal treatment success.

Get individualized advice on Mohs surgery time frames and care from melanoma specialists at Dermatology and Skin Health. Schedule your consultation with us!