Mohs Micrographic Surgery

Mohs micrographic surgery is a precise surgical technique used to remove skin cancer. It is usually performed by a dermatologist who has extended his training in the required surgical and laboratory techniques. This procedure enables your surgeon to remove the skin cancer completely, while preserving as much normal skin as possible and achieving the highest cure rate. In Mohs micrographic surgery, the skin cancer is removed in layers. Each layer of tissue is examined under the microscope to determine the location and extent of the skin cancer before more tissue is removed. While the procedure is time consuming, it produces a very high cure rate without an excessive loss of normal tissue. Mohs micrographic surgery is recommended for the treatment of skin cancer, such as basal cell carcinoma and squamous cell carcinoma. It is not routinely used for the treatment of malignant melanoma. This procedure offers many advantages, including the most precise and complete removal of the skin cancer, the highest cure rate for skin cancer treatment, maximum conservation of normal skin, and preservation of important structures.

Mohs micrographic surgery is also recommended for the following: (1) cancer of the face, nose, and eyelids or in cosmetically important areas; (2) cancer with indistinct borders; (4) cancer that has recurred after other treatments; (5) cancer with a high likelihood of recurrence; and (6) cancer that is larger than 1 inch in diameter. Before your surgery, you may have a preoperative visit. This visit gives you the opportunity to meet your dermatologist and the medical staff and to learn more about your surgery. Your dermatologist will examine the skin cancer, obtain your medical history, and discuss with you the reconstructive options that may be appropriate for you. Because it can be difficult to fully estimate the size and extent of the skin cancer, often, the best reconstructive option can only be determined at the actual time of your surgery, as the skin is removed and analyzed under the microscope.

In preparation of the surgery, the area surrounding the skin cancer will be cleansed and positioned with sterile drapes. A sticky pad will be placed on your arm or leg, or you will be given a grounding plate to hold, which “grounds” the electrosurgical machine used to stop any bleeding. The area containing the skin cancer will be numbed with a small local injection of anesthetic. Once the area is numb, the surgeon will cut a layer of skin and microscopic sections will be prepared in the pathology lab next to the operating room. You will remain in the office while the sections are processed and examined under a microscope. Depending upon the amount of skin removed, processing usually takes 30 to 45 minutes. If microscopic examination reveals the presence of additional skin cancer, additional layers of skin will be removed. Most skin cancer is removed in one to three surgical stages. After removal and the extent of the final skin defect is known, your dermatologist will discuss with you the most appropriate reconstructive option. The reconstruction is usually performed the same day. On occasion, other surgical specialists may perform the procedure because the skin cancer may be larger than anticipated. When the reconstruction is completed by other surgical specialists, it may take place on the same day or a subsequent day. There is no harm in delaying the reconstruction. Extensive reconstruction may require hospitalization. It is likely your surgical wound will require care during the weeks after surgery. Your dermatologist will provide you with detailed written instructions. You should also plan on wearing a bandage and avoid strenuous physical activity for 1 to 2 weeks after surgery. If the wound has been stitched, then nondissolvable stitches will be removed 1 to 2 weeks after surgery. Complete healing and maturation of the scar takes place over 12 to 18 months. The site may feel swollen or lumpy, especially during the first few months. Some redness may occur. Gently massaging of the area and keeping it lubricated with lotion, starting about 1 month after surgery, will speed the healing process. You may have minimal pain after surgery, which you can alleviate with over-the-counter pain medication. As your wound heals, you may also experience temporary tightness and itching across the surgical area. Significant blood loss is rare, but bleeding may occur after surgery. A follow-up visit will be scheduled after the surgery to ensure that the skin cancer is not recurring and that the healing process and maturation of the scar is taking a normal course.