Mohs Micrographic Surgery (MMS)

Precise, Effective, and Scar-Minimizing Treatment for Skin Cancer

If you've been diagnosed with skin cancer, you're likely exploring your treatment options. One highly effective method you may have heard of is Mohs Micrographic Surgery (MMS). This blog post will delve into what Mohs surgery is, how it works, and why it might be the right choice for you. 

We'll cover everything from the procedure itself to recovery, advantages, potential risks, and how it compares to other skin cancer treatments. This is all from the perspective of a medical spa that offers Mohs surgery as a service.

What is Mohs Micrographic Surgery?

Mohs Micrographic Surgery, often referred to as MMS, is a specialized surgical technique primarily used to treat non-melanoma skin cancers, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). 

Named after Dr. Frederic Mohs, who developed the technique, MMS is renowned for its precision and high cure rates, often exceeding 99% for certain skin cancers.

Why is Mohs Surgery So Effective?

The key to Mohs surgery's success lies in its meticulous approach. Unlike traditional surgery, which removes the visible tumor along with a margin of surrounding tissue, Mohs surgery is performed in stages. The surgeon removes cancerous tissue layer by layer, examining each layer under a microscope in real-time. This process continues until no cancer cells are detected, ensuring complete removal of the cancer while preserving as much healthy tissue as possible.

The Mohs Surgery Procedure: A Step-by-Step Overview

Understanding the Mohs surgery procedure can help alleviate anxiety and prepare you for what to expect. Here's a breakdown of the process:

Pre-Surgical Examination and Preparation

Before the surgery begins, your surgeon will examine the area where the biopsy confirmed the presence of skin cancer. This area is marked for reference. You will be positioned comfortably, and a surgical drape will be used to maintain a sterile environment. Local anesthesia is then administered to numb the area, ensuring you remain awake and pain-free throughout the procedure.

Surgical Steps: Precision in Action

Step 1: Initial Removal

Once the anesthesia takes effect, the surgeon carefully removes the visible portion of the tumor, along with a thin layer of surrounding tissue. This typically only takes a few minutes. A temporary bandage is then placed over the wound.

Step 2: Lab Analysis - The Heart of Mohs Surgery

This is where Mohs surgery differs from other methods. The excised tissue is immediately taken to an on-site laboratory. Here, it undergoes a process called frozen section preparation. This allows the tissue to be quickly frozen, sliced into thin sections, and examined under a microscope.

The pathologist meticulously examines the margins (edges) of the tissue to check for any remaining cancer cells. This crucial step usually takes about an hour. During this time, you'll wait in a comfortable area.

Step 3: Additional Layers - Ensuring Complete Removal

If cancer cells are found at the margins, the surgeon knows precisely where they are located. You'll be brought back to the surgical room, and another thin layer of tissue will be removed, but only from the area where cancer cells were detected. This process (anesthesia, removal, lab analysis) is repeated until the margins are clear, indicating that all cancerous cells have been removed.

Wound Treatment and Final Steps: Completing the Procedure

Once the cancer is completely removed, the surgeon will discuss the best way to manage the wound. Depending on the size and location of the wound, options may include:

• Letting the wound heal naturally: This is often suitable for smaller wounds.
• Stitching the wound closed: This is common for slightly larger wounds.
• Reconstruction with a skin flap or graft: For larger or more complex wounds, a skin flap (moving adjacent tissue to cover the wound) or a skin graft (taking skin from another part of the body) may be necessary. In some cases, your surgeon may collaborate with a plastic surgeon to achieve the best cosmetic outcome.

Postoperative Care: Ensuring a Smooth Recovery

After the procedure, you'll receive detailed instructions on how to care for your wound. This may include keeping the area clean and dry, applying antibiotic ointment, and changing bandages. 

You may experience some mild pain or discomfort, which can typically be managed with over-the-counter pain relievers. Most patients will have a bandage over the wound for at least a week.

One of the advantages of Mohs surgery is that you often receive immediate results regarding the status of your cancer removal. This can provide significant peace of mind.

Why Choose Mohs Surgery? The Advantages

Mohs surgery offers several compelling advantages that make it a preferred choice for treating certain types of skin cancer:

High Cure Rate: Maximizing Your Chances of Success

Mohs surgery boasts an impressive cure rate, often exceeding 99% for many non-melanoma skin cancers. This is due to the meticulous layer-by-layer removal and microscopic examination, which ensures complete removal of cancerous tissue.

Tissue Preservation: Minimizing Scarring and Optimizing Appearance

Because Mohs surgery only removes tissue where cancer is present, it preserves as much healthy skin as possible. This is particularly important in cosmetically sensitive areas like the face, where minimizing scarring is a priority.

Outpatient Procedure: Convenience and Comfort

Mohs surgery is typically performed on an outpatient basis under local anesthesia. This means you can return home the same day, avoiding a hospital stay.

Single-Session Treatment: Streamlined Care

In most cases, Mohs surgery is completed in a single session. While the process may take several hours due to the lab analysis, you usually leave the office knowing whether the cancer has been completely removed.

Low Risk of Recurrence: Long-Term Peace of Mind

The thoroughness of Mohs surgery significantly reduces the risk of cancer recurrence compared to other treatment methods.

Minimal Side Effects: A Gentler Approach

Compared to treatments like chemotherapy or radiation therapy, Mohs surgery has fewer side effects. Most patients tolerate the procedure well and experience minimal postoperative discomfort.

Are There Risks? Understanding Potential Complications

While Mohs surgery is generally safe and effective, like any surgical procedure, it carries some potential risks:

Infection and Scarring: Managing Common Concerns

There is a small risk of infection at the surgical site. Following your surgeon's wound care instructions carefully can help minimize this risk. Some scarring is inevitable, but Mohs surgery aims to minimize tissue removal, resulting in smaller scars compared to traditional excision.

Delayed Healing: Factors to Consider

Some patients may experience delayed healing, especially those with underlying health conditions. Following post-operative instructions and maintaining a healthy lifestyle can promote healing.

Cancer Recurrence: Staying Vigilant

Although rare, there is a small chance of cancer recurrence even after Mohs surgery. Regular follow-up appointments with your dermatologist are crucial to monitor for any signs of recurrence.

Anesthetic Reactions: A Rare Possibility

While general anesthesia is not used, there is a very small risk of an allergic reaction to the local anesthetic. Be sure to inform your surgeon of any known allergies.

Other Potential Complications

Other less common complications may include pain, tenderness, bleeding, swelling, and nerve damage.

Specific Recovery Considerations: Tailoring Your Care

Patients with a history of skin infections or other medical conditions should discuss these with their surgeon to ensure appropriate precautions are taken during and after the procedure.

Monitoring for Complications: Staying Proactive

It's important to be aware of potential complications and contact your surgeon immediately if you experience persistent pain, fever, or any unusual changes at the surgical site.

Mohs Surgery vs. Other Skin Cancer Treatments

How does Mohs surgery stack up against other common skin cancer treatments?

Mohs Surgery vs. Traditional Excision

• Precision: Mohs surgery is more precise because it examines 100% of the tissue margins in real-time, ensuring complete cancer removal. Traditional excision removes a larger margin of healthy tissue and may not achieve the same level of accuracy.
• Cosmetic Outcomes: Mohs surgery typically results in smaller scars due to its tissue-sparing approach.
• Immediate Results: With Mohs surgery, you often know the results immediately. Traditional excision may require further surgery if the margins are not clear.

Mohs Surgery vs. Radiation Therapy

Treatment Approach: Mohs surgery is a surgical procedure, while radiation therapy uses high-energy beams to kill cancer cells.

Indications: Mohs surgery is often preferred for primary skin cancers, while radiation therapy may be used as an adjuvant treatment or when surgery is not feasible.

Side Effects: Mohs surgery generally has fewer side effects and allows for quicker recovery. Radiation therapy can cause skin irritation, fatigue, and other side effects.

Other Treatment Options

Other treatments include topical creams, cryotherapy (freezing), and chemotherapy. These may be suitable for certain types of skin cancer but often lack the precision and high cure rates of Mohs surgery.

Outcomes and Success Rates: What to Expect

Mohs surgery is known for its high success rates. Studies have shown cure rates exceeding 99% for certain skin cancers. The meticulous nature of the procedure, with its real-time evaluation of excised tissue, contributes to these impressive results.

Recovery and Follow-Up: Your Journey to Healing

Recovery time varies depending on the size and location of the wound. Some patients heal within a few weeks, while others may take longer. Regular follow-up appointments are important to monitor healing and address any concerns.

Patient Satisfaction: A Positive Experience

Patient satisfaction rates for Mohs surgery are very high. The combination of high cure rates, minimal scarring, and a streamlined treatment process contributes to a positive patient experience.

Conclusion: Is Mohs Surgery Right for You?

Mohs Micrographic Surgery offers a highly effective and precise treatment option for many non-melanoma skin cancers. Its high cure rates, tissue-sparing approach, and excellent cosmetic outcomes make it a preferred choice for many patients, especially those with cancers in cosmetically sensitive areas.

If you've been diagnosed with skin cancer, discuss your treatment options with your dermatologist. They can help you determine if Mohs surgery is the right choice for your specific situation.

Disclaimer: This blog post is intended for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your treatment.

Remember, early detection and treatment are crucial for successful skin cancer outcomes. Regular skin exams and prompt medical attention for any suspicious lesions are essential for maintaining your skin health.