Mohs Micrographic Surgery

Mohs micrographic surgery is an advanced surgical technique designed specifically for the removal of cancers of the skin. Its name is derived from the inventor of the technique, Dr. Frederick Mohs. Mohs surgery is based upon the principle of using a microscope to trace skin cancer roots so that the cancer may be completely removed. This surgical technique provides the highest cure rate for the most common types of skin cancer, namely basal cell carcinoma and squamous cell carcinoma. Additionally, it allows the entire tumor to be removed with the smallest possible defect, which potentially results in less scarring at the site.

In Mohs micrographic surgery, the Mohs surgeon first removes a small piece of tissue just around the visible tumor on the skin surface. This tissue is immediately examined with a microscope to identify any cancerous roots that extend beyond the visible boundaries of the tumor. If any remaining cancerous cells are identified by microscope, their location will be mapped out with the aid of the microscope. The Mohs surgeon will then return to area of the remaining tumor cells as indicated by the map, and remove another thin layer of tissue just from the specific section where cancer cells were detected. This tissue will then be examined by microscope for any additional cancer cells. This process continues until no further cancerous cells are identified. By taking the tissue in thin layers and examining each with the microscope, the Mohs technique ensures that all the cancerous tissue is removed and prevents the unnecessary removal of healthy tissue.

Once the tumor has been removed by Mohs micrographic surgery, reconstructive surgery will be performed to repair the resulting defect. Because Mohs surgery minimizes the amount of healthy tissue that is removed, this defect will be the smallest possible wound that removes the cancer in its entirety. In the majority of cases, reconstructive surgery will require the placement of sutures to achieve the optimal cosmetic appearance.

What are the advantages of Mohs micrographic surgery?

• The Mohs technique provides the highest cure rate for the treatment of basal cell carcinoma and squamous cell carcinoma. These rates are approximately 99% if Mohs surgery is the initial form of treatment. Mohs surgery is also the treatment of choice for cancers that have recurred after other forms of treatment.
  
  
• Mohs micrographic surgery minimizes the amount of healthy tissue removed so that the resulting wound is as small as possible. This decreases the potential for scarring or disfigurement at the site.
  
  
• The Mohs procedure is performed on an outpatient basis under local anesthesia. You will not be put to sleep for the procedure, which results in less potential health risk.
  
  
• The entire procedure, including cancer removal and reconstruction, is performed in a single morning. You may also be required to return to the office for suture removal or evaluation of wound healing.

What are the disadvantages of Mohs micrographic surgery?

• There is some mild discomfort with the injection of the local anesthetic. This will be similar to that of the skin biopsy performed at the site.
  
  
• The procedure usually takes between two to three hours. However, the majority of this time is spent waiting while the tissue is being examined with the microscope. During this time, you may read or have some refreshments.

There is hardly anything left visible on my skin. Do I really need any more treatment?

Yes. It is important to recognize that the tumor that is visible to you - even to your physician - may be just the "tip of the iceberg". Many times after the initial biopsy is performed, there is little or no visible evidence of remaining skin cancer on the surface of the skin. This can be misleading as skin cancers often have roots that continue to grow underneath the skin if not adequately removed. Mohs micrographic surgery relies on evaluation of the skin tissue with a microscope to identify any remaining roots of the skin cancer. This allows the skin cancer to be removed in its entirety.

Will I be put to sleep for the procedure?

No. The Mohs procedure is performed under local anesthesia on an outpatient basis in an office-based setting.

Will I have a scar after the procedure?

Yes, there will be a scar present at the site of the removed skin cancer. The amount of scarring depends upon the size and location of the skin cancer. Every effort will be made to make the scar as small as possible. The Mohs technique also minimizes the degree of scarring by limiting the amount of healthy tissue that is removed with the cancer.

What risks are associated with the procedure?

Mohs micrographic surgery is usually a well-tolerated procedure; however, with any medical procedure there are potential risks. As each patient and case is unique, it is impossible to list every potential risk in this pamphlet. The following is a list of potential risks associated with the procedure. It should be noted that the occurrence of any of these is considered the exception rather than the rule.

• Infection at the surgical site which may require an oral antibiotic
• Excessive bleeding during or after surgery
• Scar formation resulting in an unsatisfactory cosmetic result
• Poor wound healing
• Allergic reaction to the local anesthetic or other medications
• Damage to nerves near the cancer resulting in loss of sensation or loss of muscle movement
• Damage to normal tissue surrounding the cancer

How should I prepare for the procedure?

• On the morning of surgery, eat a normal breakfast and take all your regular medications as scheduled.
• If you are on doctor-prescribed aspirin or Coumadin, please continue to take it - including the day of surgery.
• If not doctor-prescribed, please avoid aspirin, aspirin-containing medications (Alka-Seltzer, Anacin, Bufferin, Ecotrin, Empirin, Excedrin, Goody's Powder), ibuprofen, naproxen, Advil, Aleve, and Motrin for two weeks prior to surgery and five days following surgery. Failure to do so could result in excessive bleeding. Tylenol or acetaminophen are acceptable to take during this time period.
• Wear comfortable loose-fitting clothing.
• Do not apply make-up if the surgery is to be performed on your face.
• If you have been given an antibiotic to take before the surgery, please take it as directed one hour prior to the procedure. Failure to do so could result in the delay or cancellation of the procedure.
• Prepare to spend at least two to three hours at the office. Since most of the time will be spent waiting while we study the tissue under the microscope, it is helpful to bring a book to read. You may also want to bring one other person to stay with you during the wait.
• Plan to avoid strenuous exercise, sports activities, heavy lifting, bending, twisting or straining in the week following the surgery. Failure to do so may cause bleeding at the surgery site leading to poor healing and an unsatisfactory cosmetic result.