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Mohs Micrographic Surgery: The Gold Standard for Treating Skin Cancer

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Two surgeons with gloved hands perform stitches on a person's eyebrow with surgical tools, surrounded by blue surgical drapes.

Empowering You with Knowledge on the Most Advanced Skin Cancer Treatment

Mohs surgery removes skin cancer one layer at a time, preserving healthy tissue. It's the most precise way to treat common skin cancers.

What is Mohs Surgery?

A surgeon performs a delicate surgical procedure on a patient's face, using a pair of forceps and a scalpel. Both are dressed in surgical attire and gloves.
A surgeon performs a delicate surgical procedure on a patient's face, using a pair of forceps and a scalpel. Both are dressed in surgical attire and gloves.

Mohs surgery, developed by Dr. Frederic Mohs in the 1930s, is a specialized surgical technique that allows for the complete removal of skin cancer while sparing as much healthy tissue as possible. The procedure involves progressively removing thin layers of cancerous skin tissue and examining each layer microscopically until only cancer-free tissue remains.

This precise approach makes Mohs surgery ideal for treating skin cancers on cosmetically or functionally important areas like the face, scalp, hands, feet, and genitals. It offers the highest cure rates of any treatment - up to 99% for new skin cancers and 94-95% for recurrent cancers.

When is Mohs Surgery Recommended?

Your dermatologist may recommend Mohs surgery for skin cancers in cosmetically and functionally important areas like the face, ears, or lips. It's also the go-to treatment for recurrent skin cancers, those with ill-defined edges, or aggressive growth patterns. 

The goal is to remove the entire cancerous lesion while minimizing the removal of healthy tissue and scarring.

The Mohs Procedure Step-by-Step

So, what exactly happens during a Mohs dermatology procedure? Here's a breakdown of the process:

  1. Consultation and skin cancer mapping: Your surgeon will examine the area and map out the cancerous growth.
  2. Administering local anesthetic: The treatment area will be numbed with a local anesthetic to ensure your comfort.
  3. Removing the visible portion of the cancer: The surgeon will carefully remove the visible part of the skin cancer.
  4. Coding and color-coding layers for pathology tracking: Each layer removed is precisely coded and color-coded for examination under a microscope.
  5. Examining layers under a microscope: The surgeon will examine the layers under a powerful microscope to check for any remaining cancerous cells.
  6. Repeat process until all cancerous cells removed: This process is repeated layer by layer until no more cancer cells are detected.
  7. Repairing the wound: Once the cancer is completely removed, the surgeon will repair the wound with stitches, grafts, or flaps, depending on the size and location.

Who is a Candidate for Mohs Surgery?

Mohs surgery is most commonly used to treat basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer. It may also be used for certain melanomas, rare skin cancers like dermatofibrosarcoma protuberans, microcystic adnexal carcinoma, and sebaceous carcinoma.

The procedure is appropriate for various types of skin cancers, including basal cell carcinoma and squamous cell carcinoma. The location and size of the growth, as well as your overall health status, are also factors to consider.

You may be a good candidate for Mohs surgery if your skin cancer is:

  • Large, aggressive, or rapidly growing
  • Has ill-defined borders
  • Recurrent after previous treatment
  • Located in a critical area (face, ears, scalp, hands, feet, genitals)

The best way to determine if you're a suitable candidate is to consult with a Mohs surgeon. They will evaluate your specific case and provide a professional recommendation on the most appropriate treatment approach.

What to Expect During and After Mohs Surgery

A patient lying in a hospital bed with an IV line, while a healthcare worker in scrubs and a hair net stands beside her, adjusting the blanket.
A patient lying in a hospital bed with an IV line, while a healthcare worker in scrubs and a hair net stands beside her, adjusting the blanket.

You might be wondering, "How long does a Mohs dermatology procedure take?" and "Is it painful?" Let's address those concerns.

The procedure can take anywhere from 4 to 8 hours, depending on the size and complexity of the cancer. Don't worry, though – a local anesthetic is used to numb the area, so you'll experience minimal discomfort. After the surgery, you'll receive post-operative care instructions, such as how to care for the dressing and apply ointments.

It's normal to experience some swelling, bruising, and scarring, but these side effects are typically minimal compared to other skin cancer treatments. Your surgeon will advise you on when you can resume normal activities.

Benefits of Mohs Surgery

Mohs surgery offers several advantages over other skin cancer treatments:

  1. Highest success rate: It has a 97-99% cure rate for non-melanoma skin cancers like basal cell carcinoma and squamous cell carcinoma.
  2. Minimal disruption and scarring: By removing only the cancerous tissue layer by layer, Mohs surgery minimizes the impact on surrounding healthy tissue.
  3. Cost-effective: By removing cancers completely the first time, it avoids the need for additional treatments and their associated costs.
  4. Outpatient procedure: Mohs surgery is performed on an outpatient basis, so you can avoid an overnight hospital stay.

Potential Risks and Complications

While Mohs surgery is generally very safe, no procedure is without risks. Potential complications may include:

  • Bleeding, hematoma
  • Infection
  • Poor wound healing, skin necrosis
  • Scarring
  • Nerve damage causing numbness or muscle weakness

Recurrence of skin cancer after Mohs surgery is rare but possible. Regularly follow up with your dermatologist to monitor for any new suspicious lesions.

Who Performs Mohs Procedures?

Mohs procedures are performed by dermatologists who have completed specialized training and certification in this technique. 

Look for a dermatologist who is a "fellow of the American College of Mohs Surgery" – this credential indicates extensive experience and expertise in Mohs surgery, including complex reconstructions after the cancer is removed.

FAQs About Mohs Dermatology Procedures

A group of healthcare professionals, including 14 women and 1 man, are posing for a group photo in a dermatology clinic. They are wearing black scrubs. The logo "DSH" and clinic details are visible above them.
A group of healthcare professionals, including 14 women and 1 man, are posing for a group photo in a dermatology clinic. They are wearing black scrubs. The logo "DSH" and clinic details are visible above them.

Can I eat or drink before Mohs surgery?

Yes, you can eat a normal breakfast and take your regular medications on the day of Mohs surgery, unless your doctor instructs you otherwise. Avoiding caffeine may be advised as it can increase bleeding. Since the procedure is done under local anesthesia, fasting is not required.

Will Mohs surgery leave a hole in my skin?

After removing the skin cancer, there will be a surgical wound. However, Mohs surgeons are trained in reconstruction to repair the wound, often using stitches to close the incision. In some cases, a skin flap or graft may be used. The goal is to provide the best functional and cosmetic outcome.

Can I wear makeup to cover the scar?

It's best to avoid applying makeup directly on the surgical site for at least 1-2 weeks to prevent infection and allow proper healing. After this initial period, makeup can usually be applied to conceal redness or scarring. Your surgeon can advise you on when it's safe to use makeup based on your individual healing.

How will the surgery affect my daily activities?

Most people can return to work or normal activities the next day after Mohs surgery, depending on the extent and location of the procedure. However, you'll need to avoid strenuous exercise, heavy lifting, and swimming for 1-2 weeks. Your surgeon will provide specific activity guidelines to follow during recovery.

Can I drive myself home after the procedure?

It's usually recommended to have someone drive you home after Mohs surgery, especially if the wound is extensive or close to your eyes. The local anesthesia and bandaging may affect your vision and ability to drive safely. It's best to arrange for a ride to avoid putting yourself and others at risk.

Will I need to take antibiotics after Mohs surgery?

Typically, antibiotics are not necessary after Mohs surgery. The risk of infection is low when proper wound care instructions are followed. However, if you have certain medical conditions or develop signs of infection, your surgeon may prescribe preventive or therapeutic antibiotics on a case-by-case basis.

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