Mohs Surgery: The Gold Standard for Skin Cancer Removal

Mohs surgery is a highly effective treatment for certain types of skin cancer. This precise technique allows surgeons to remove all cancerous cells while minimizing damage to the surrounding healthy skin.

What is Mohs Surgery?

Mohs surgery, also called Mohs micrographic surgery, is a specialized procedure for removing skin cancer. Developed in the 1930s by Dr. Frederick Mohs, it is considered the gold standard for treating basal cell carcinoma and squamous cell carcinoma, the two most common types of skin cancer. Mohs surgery may also be used to treat rare skin cancers.

Mohs surgery is unique because it allows surgeons to examine 100% of the surgical margin. This means that the surgeon can see exactly where the cancer cells are and remove them, while leaving as much healthy tissue as possible. Other skin cancer treatments only examine a small portion of the surgical margin.

Mohs surgery has the highest cure rate of any skin cancer treatment, up to 99% for certain tumors. Mohs surgery also results in minimal scarring and disfigurement and offers a shorter healing time.

How Mohs Surgery Works

The Mohs procedure is performed in stages:

1. The visible tumor is removed with a scalpel.
2. The tissue is divided into sections and color-coded.
3. A frozen section of each portion is examined under a microscope to check for remaining cancer cells.
4. If cancer cells are present, the surgeon removes another layer of tissue and repeats the microscopic examination.
5. This process continues until the margins are completely clear of cancer.
6. The wound is then closed with stitches.

The Mohs procedure is performed in the dermatologic surgeon's office under local anesthesia, meaning you will remain awake during the procedure. You will wait about an hour between each stage as your surgeon analyzes the removed tissue. Most procedures require one to two stages, but complex cases can take five or more. The total procedure can take three to six hours.

When is Mohs Surgery Recommended?

Mohs surgery is often recommended for skin cancers that:

• Are located in areas where it is important to preserve healthy tissue, such as the face, ears, hands, feet, and genitals.
• Are large or aggressive.
• Have recurred after previous treatment.

Mohs Surgery Above the Eyebrow

The skin above the eyebrow presents unique challenges for skin cancer treatment because of the delicate structures in this area. These structures include hair follicles, sebaceous glands, and intricate nerves and blood vessels that feed the eye and forehead.

Skin cancers above the eyebrow can also extend delicate roots along nerve paths, making it difficult to ensure complete removal with other methods. Because Mohs surgery allows for comprehensive analysis of the entire surgical margin, it is often the preferred treatment for skin cancer in this area.

What to Expect During Mohs Surgery Above the Eyebrow

Mohs surgery above the eyebrow is performed in the same way as Mohs surgery in other areas of the body. Because the procedure is performed under local anesthesia, you will be awake during the surgery, but you should not feel any pain.

Recovery After Mohs Surgery Above the Eyebrow

After your Mohs surgery, your surgeon will close the surgical site with stitches. You may have a pressure dressing or bandage over the site.

• You can expect some mild to moderate pain, swelling, bruising, and oozing from the surgical site. Your surgeon will provide instructions on how to care for your wound, including how to change the dressing and when you can get the site wet.
• Most patients heal within two to three weeks. You will need to avoid strenuous activity and sun exposure for one to two months.

Results and Appearance

One of the biggest concerns with surgery near the eyes is the resulting appearance and scarring. However, Mohs surgery is designed to minimize scarring. Several factors can influence how visible your scar will be, including:

• Proper wound care: Following your surgeon’s post-operative instructions will help your wound heal properly and minimize scarring.
• Surgical technique: A skilled Mohs surgeon will close the wound carefully in natural creases and ridges to help the scar blend in.
• Reconstructive methods: Your surgeon may use a variety of techniques to minimize the appearance of the scar.
• Time: Scars naturally fade over time.

Most patients experience excellent functional and cosmetic outcomes with Mohs surgery above the eyebrow.

Risks and Complications

Mohs surgery is a safe and effective procedure, but like any surgery, there are some risks and potential complications. These risks are rare but can include:

• Bleeding
• Infection
• Poor wound healing
• Nerve damage
• Eye injury
• Recurrence of skin cancer

It is important to contact your surgeon immediately if you experience any signs of infection, such as increasing pain, swelling, redness, or pus drainage.

Cost and Insurance Coverage

The cost of Mohs surgery varies depending on several factors, such as the size and location of the tumor, the number of stages required, the surgeon’s fees, and the facility fees.

The average cost of Mohs surgery is $2,575. The cost per stage typically ranges from $500 to $1,500. Simple cases may cost as little as $1,500, while complex cases can cost over $12,000.

Most health insurance plans cover Mohs surgery when it is considered medically necessary. However, coverage varies depending on your specific plan. You may need to meet a deductible or copay.

It is important to contact your insurance company to verify your coverage before undergoing Mohs surgery. Dermatology & Skin Health’s staff can also help you verify your insurance benefits and understand your potential out-of-pocket costs.

Alternatives to Mohs Surgery

While Mohs surgery is considered the gold standard for treating certain types of skin cancer, there are other treatment options available. These include:

• Excisional surgery: This involves surgically cutting out the tumor and a margin of healthy tissue. Excisional surgery has a slightly higher risk of recurrence than Mohs surgery because the surgical margins are not examined microscopically.
• Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. It can be a good option for people who are not candidates for surgery, but it can also cause side effects such as skin damage.
• Photodynamic therapy: This treatment uses a light-sensitive medication and a special light to kill cancer cells. It is typically used for superficial skin cancers.
• Topical creams: Topical creams can be used to treat some early-stage skin cancers. However, they are not as effective as surgery or radiation therapy.
• Curettage and electrodesiccation: This technique involves scraping away the tumor and then cauterizing the area to stop bleeding and kill any remaining cancer cells. It can be a good option for small, superficial skin cancers, but it can cause scarring.

The best treatment option for you will depend on the type, size, and location of your skin cancer, as well as your overall health and preferences. Your doctor will discuss the risks and benefits of each treatment option with you and help you choose the best course of treatment.

Schedule a Consultation with Derm Skin Health

If you have been diagnosed with skin cancer or are concerned about a suspicious spot on your skin, please schedule a consultation at Dermatology & Skin Health. We will work with you to develop a personalized treatment plan.

Contact Dermatology & Skin Health today to get started.