Mohs surgery is a highly specialized treatment for the total removal of skin cancer. It is named in honor of Dr. Frederic Mohs, the physician who developed the technique. Mohs Surgery eliminates the guesswork used with all other methods of treating skin cancer. Other methods rely on a pathologist to sample the tissue removed by the surgeon and determine if the cancer has been removed. However, this method only samples less than 1% of the margins since the sugeon must take wide margins of normal skin to minimize the chance of leaving cancer cells behind. Mohs surgery differs by examining 100% of the edges of the tissue, giving the Mohs surgeon the ability to go back and remove all the cancer cells and leave the normal skin untouched.
What if I have more than one skin cancer? Usually we treat only one skin cancer site per visit. Each treatment site requires time and special attention. Most insurance companies limit reimbursement to a single skin cancer.
What are the advantages of Mohs Surgery?
By using detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic roots of cancer can be removed. The result is: 1) the removal of as little normal skin as possible, 2) the highest possibility for curing the cancer.
What are my chances for cure?
Using Mohs Surgery, the percentage of cure is more than 99% for most skin cancers, even when other forms of treatment have failed. Other methods of treatment offer only a 50% chance of success if previous treatments have failed.
Will I be hospitalized? No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day. Hospital facilities are available if necessary.
What happens the day of surgery?
Your appointment will be scheduled early in the day. Our staff will escort you into a surgical suite where the surgeon will numb the area around the skin cancer. Once it is numb, the visible cancer and a thin layer of tissue will be removed. This tissue is carefully mapped and coded by the surgeon and taken to the adjacent laboratory where the technician will immediately process the microscope slides. You will have a temporary dressing placed over the wound and you will be free to return to the reception area.
The surgical procedure alone takes 10-15 minutes. However, it takes a minimum of 1 1/2 to 2 hours to prepare and microscopically examine the tissues of each layer. Several surgical stages and microscopic examinations may be required, and you will be asked to wait in the patient reception area between stages. Although there is no way to tell before surgery how many stages will be necessary, most cancers are removed in three stages or less.
We would like to make the time you spend with us as pleasant and comfortable as possible. You may want to bring reading material to occupy your time while waiting for the microscope slides to be processed and examined. You may want to bring a sweater, as the temperature in our office varies. Magazines and beverages will be available in the reception area. If your visit extends through the lunch hour, your companion may visit the hospital cafeteria and bring you a snack or lunch since you are asked not to leave the reception area of our office.
The most difficult part of the procedure is waiting for the results from the laboratory. Since we do not know in advance how much time is necessary to remove the cancer and repair the wound, we ask that you plan to be in the office the entire day and that you make no other commitments. Please be sure to inform your companion and/or driver of this.
Will the surgery leave a scar?
Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose (1) to leave the wound to heal itself, (2) to repair the wound with stitches, or (3) to reconstruct the wound with a skin graft or flap. This decision is based on the safest method that will provide the best cosmetic result.
Will I have Pain after the surgery? Most patients do not complain of pain. If there is any discomfort, Tylenol is all that is usually necessary for relief.
How do I prepare for Surgery?
Medical History: Upon arrival at our office you will be asked to complete a medical history form. It may be helpful for you to bring a list of medications and illnesses. Please plan to arrive at least 15 minutes before your scheduled appointment to fill out your medical history form. Medications: Continue all medications prescribed by your doctor including blood thinners like Coumadin or aspirin. However, if you are taking aspirin, ibuprofen, or herbal supplements without your doctors orders for a medical condition, please discontinue them 10 days prior to your surgery appointment. These include Anacin, Bufferin, Excedrin, Alka Seltzer and Percodan, Advil, Aleve, Motrin, Oral Vitamin E & Ginko Biloba. You may take Tylenol if needed for pain. Alcohol will also promote bleeding, so avoid alcoholic beverages 48 hours before surgery. Please avoid wearing make-up, perfume, nail polish, and jewelry. Breakfast: The day of surgery, we suggest you eat your normal breakfast.
What can I expect after Mohs Surgery?
Will I need to come back? Usually one return visit is all that is needed to examine the healed surgical site or to remove your surgical dressings. Afterwards, you may return to your referring physician for routine check-ups. A follow-up period of four years for the treated cancer is essential. After having one skin cancer, statistics show that you have a higher chance of developing a second skin cancer. You should have your skin checked by your physician at least once each year for four years, not only to examine the treated skin cancer, but also to check for new skin cancers.
How can I protect myself from developing more skin cancer? The best protection from skin cancer is to avoid the harmful ultraviolet rays of the sun. Even if you tan easily, the sun can contribute to skin cancer in two ways. First, the sunlight damages the genes that control cell growth, and second, sunlight damages the body's immune system so that early cancers grow unchecked by normal immune defense.
Minimize your exposure by:
1) Using any sunscreen with a sun protective factor (SPF) of at least 30 and preferably with UVA/UVB protection when you spend any time in the sun.
2) Avoid sun exposure during mid-day hours (10:00 am - 4:00 pm)
3) Do not stay outdoors unprotected on cloudy days since the ultraviolet light penetrates easily through the clouds. If you follow this advice it may not be necessary to restrict your outdoor activities or change your lifestyle.
Where can I find additional information about skin cancer or other skin diseases?