Mohs Surgery Explained

WHAT IS MOHS SURGERY? Mohs surgery was developed by Frederic E. Mohs, MD for the purpose of treating skin cancer and is now considered the best treatment for skin cancer removal for a variety of reasons. It’s a cost-effective treatment because it is a single-visit, outpatient surgery that requires only local anesthesia while lab work is done on site. All tumor margins are examined resulting in precise results while the maximum amount of healthy tissue is spared, leaving the smallest possible scar. It has the highest cure rate of any skin cancer treatment; up to 99% of skin cancers that have never been treated and up to 94% of recurring skin cancers are cured following a Mohs procedure.

WHAT CAN I EXPECT DURING THE PROCEDURE? When you arrive at our office, you will be directed to our surgical exam room. If a friend or family member accompanied you, he or she is invited to wait in our Mohs waiting room. Depending on the location on your body the surgery will be performed, you may be able to wear your own clothes, or you may need to put on a surgical gown. Dr. Hurst will examine the location where you had your biopsy and position you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you can’t see what’s happening, but Dr. Hurst will communicate with you throughout the procedure. A local anesthesia is then injected, which numbs the area completely so you should not experience pain during the surgery. You stay awake throughout the procedure. 

Using a scalpel, Dr. Hurst removes a thin layer of visible cancerous tissue. Some skin cancers may be much deeper, meaning they have roots or extensions that aren’t visible from the surface. The lab analysis, which comes next and which is performed in our office, will determine if the cancer is in fact beyond the initial tissue that was removed. Your wound is bandaged temporarily and you can relax in our Mohs waiting room while the lab work begins. If a friend or family member is waiting for you in our office, you will be able to sit with him or her during this time.

WHAT OCCURS WHILE I AM WAITING? After the tissue is removed, it is divided into sections, color coded with dyes and a map is drawn of the surgical site. In the lab, our technician freezes the divided tissue, then cuts very thin horizontal slices. The slices are placed on microscope slides, stained and covered.

Using a microscope, Dr. Hurst examines all the edges and underside of the tissue on the slides and, if any cancer cells remain, marks their location on the map. Our medical assistant will then let you know whether you need another layer of tissue removed.

WHAT HAPPENS IF CANCER CELLS ARE FOUND ON THE EDGES OR UNDERSIDE OF THE REMOVED TISSUE? Additional stages are required if cancer cells are found on the margins of the tissue that was removed. If more tissue needs to be removed, Dr. Hurst injects more anesthesia if needed and removes another layer of skin, precisely where the cancer cells remain, based on the map. Then, while you wait, the lab work begins again. This entire process is repeated as many times as needed until there are no more cancer cells.

WHAT HAPPENS WHEN ALL THE NECESSARY TISSUE HAS BEEN REMOVED? Once the site is clear of all cancer cells, the wound may be left open to heal or Dr. Hurst may close it with stitches. This depends on its size and location. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a skin graft. In some cases, Dr. Hurst may coordinate the repair of your wound with another specialist such as a plastic surgeon. In most instances, however, Dr. Hurst will repair the wound immediately after obtaining clear margins.

HOW LONG DOES THE SURGERY TAKE? If more than one or two rounds are needed, the entire process can take up to several hours, so be prepared for that. It’s worth it, though, because this precise technique has the highest cure rate of any treatment method and can save the greatest amount of healthy tissue, leaving the smallest scar possible. 

WHAT CAN I EXPECT FOLLOWING THE PROCEDURE? You may experience some pain and irritation in the area where your Mohs procedure was performed. Most patients find the pain to be very minor though. You will be given detailed instructions for wound care, scar care and follow-up. It’s important that you follow the instructions to achieve the best outcome. Please don’t hesitate to call our office if you have any questions following your procedure - we are here to help.

Candace Hurst

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