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Skin Surgery

Mohs Micrographic Surgery

Mohs micrographic surgery is a specialized, highly effective technique for the removal of skin cancer. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancerous tissue so that all “roots” and extensions of the skin cancer can be eliminated.

How is Mohs surgery different from other surgeries?

Due to the methodical manner in which tissue is removed and examined, Mohs surgery has been recognized as the skin cancer treatment with the highest reported cure rate. In fact, Mohs micrographic surgery has been shown to be a highly effective treatment for certain types of skin cancer, with a cure rate of up to 99% for certain tumors.

Mohs micrographic surgery procedure is micrographically controlled, meaning it can provide the most precise method for removal of the cancerous tissue while sparing the greatest amount of healthy tissue. For this reason, Mohs may result in a significantly smaller surgical defect and less noticeable scarring as compared to other methods of skin cancer treatment.

The Mohs surgery procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes. It may also be indicated for lesions that have recurred following prior treatment, or for lesions which have the greatest likelihood of recurrence.

When is Mohs surgery used?

It is important to note that Mohs surgery is not appropriate for the treatment of all skin cancers. As mentioned above, Mohs surgery typically is reserved for those skin cancers that have recurred following previous treatment or for cancers that are at high risk for recurrence.

Mohs surgery also is indicated for cancers located in areas where maximum preservation of healthy tissue is critical, whether for cosmetic or functional purposes. Areas of the body Mohs surgery is indicated for include the nose, ears, eyelids, lips, hairlines, hands, feet, and genitals.

What happens during Mohs surgery?

Using a local anesthetic, the doctor removes thin layers of the malignant growth, checking each layer under a microscope for the presence of a tumor. The excision is repeated as necessary until the tissue is tumor free. This method sacrifices the minimum amount of healthy tissue, traces cancer to its roots, and achieves the highest cure rate.

Options for Post-Surgical Reconstruction

After the skin cancer has been removed, your doctor will your post-surgical reconstruction options with you. These include:

  1. Allowing the wound to heal naturally on its own; no further surgeries or sutures
  2. Re-arranging skin from other areas surrounding cancer to repair the wound (graft, flap or complex closures)
  3. Refer to another surgeon for wound repair

The best course of action for you can only be decided once the cancer is removed and the final wound is evaluated. If a wound can be closed from side to side without adversely affecting the nearby anatomy, this may be the course of action. For some wounds, the tissue simply cannot be stretched far and it requires skin adjacent to the surgical defect to be partially cut free and rotated or moved forward to cover the surgical area (called a flap).

Alternatively, skin from an area that has similar skin is removed and placed over the surgical defect, called a graft. Stitches (sutures) are placed to hold either flaps or grafts in place.

You will be given daily instructions on how to take care of the wound, as well as when to return for suture removal.

Wound Healing, Scarring and Scar Revision

As with any surgery, there will be a scar associated with Mohs surgical removal of skin cancers. Mohs surgery will leave the smallest possible surgical defect and scar, however! Scars take up to one year to mature to their final appearance. There are many techniques to improve the appearance of these scars. Cosmetic aspects of such a wound can be addressed with you in detail during your follow up appointments with the doctor.

Potential Complications

It is important to know that no procedure is an absolute guarantee for total removal of every skin cancer cell. Recurrence is always a possibility. However, recurrence rates are the lowest with Mohs surgery. The potential complications associated with Mohs include a risk of bleeding and infection. Additionally, during surgery, small nerve endings are cut, which may result in temporary or permanent numbness in and around the area of surgery. With larger or deeper tumors, larger nerves controlling the movement of muscles could be cut, which may result in weakness in a portion of the face. (This is a very rare complication, however.) Another possible side effect is some itching or minor pain in the surgical area.

If poor healing takes place on your body, additional repairs may be needed. Your doctor will be with you every step of the way to assure a smooth healing and recovery process.

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