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Explaining Mohs Surgery

Mohs Surgery

Mohs Surgery is a microscopically controlled surgery used to treat the most common types of skin cancer – basal cell carcinoma (most common) and squamous cell carcinoma (more aggressive) This surgical technique, which is designed to completely remove the tumor, is named after its founder Dr. Frederic Mohs.

Ideal Candidates for Mohs Surgery

Mohs Surgery is most commonly used for people who have skin cancers on the face, neck, or hands (high-risk locations), recurrent cancer at any site, a predisposition to multiple skin cancers, or rapidly growing or large tumors.

The Procedure

During Mohs surgery, layers of cancer-containing skin are progressively removed and examined by the surgeon under the microscope until all the cancer is gone. Once the cancer is removed, the area is typically repaired with stitches.

Mohs Surgery is performed under local anesthetic, adding to the safety of this procedure. The four steps are:

(1) Tumor removal: After the skin has been numbed, the visible tumor is removed with a curette (a surgical instrument)

(2) Mapping: Once the layer of tissue has been removed, a “map” or drawing of it will be made, in relation to local landmarks (i.e., cheeks, eyes). The sections of tissue are processed and then will be examined by the physician, in which he or she will evaluate if there is evidence of any remaining cancer cells.

(3) Microscopic Analysis: Should any of the tissue sections demonstrate that additional cancer cells exist at the margin during the microscopic analysis (interpretation of microscope slides), the physician will return to that specific area of the tumor and remove an additional thin layer. The mapping process, in which the excised tissue will again be color-coded, processed, and examined for additional cancer cells, will take place. This entire process will continue as needed until all cancer cells are completely removed.

(4) Reconstruction: The reconstruction of skin defects is an individualized procedure for every patient, which is designed to properly repair the wound and provide optimal aesthetic results.  The best repair technique is discussed between the patient and physician after the cancer is completely removed. The method chosen will depend on the patient’s repair needs, preference, and physician’s recommendation. Options include: natural healing, stitches, or a skin flap or graft.

It is difficult to predict exactly how long this procedure takes, due to the fact that it is impossible to know prior to surgery just how extensive the cancer is; several stages may be required for complete tumor removal. Due to the unpredictable amount of time involved in the processing and examination of the tissue it is likely that patients will spend a few hours in the doctor’s clinic.

The Recovery Period

Patients will receive complete wound care instructions from their physician that should be followed closely. In general, regardless of the reconstruction or repair method, it is important to not let the wound dry up and scab. Typically it is required that the patient applies an antibacterial ointment or Vaseline on a daily basis.  Most of the time, however, wound care is not needed.

If the wound is allowed to heal naturally, the tissue will grow back slowly in four to six weeks. In regards to repairing with stitches or a graft, the wound should heal in about one to two weeks, and over a period of months continuing cosmetic improvement will be apparent.

The Most Common Risks

This includes scarring, infection, bleeding, bruising and swelling, pain, numbness, opening of the wound, keloid scarring, and recurrence of the tumor.

Mohs Surgery: The Highest Cancer Cure Rate

Mohs Surgery offers the highest cancer cure rate while minimizing removal of the surrounding healthy tissue. It has been cited that the cure rate for Mohs Surgery is between 97 percent and 99 percent for basal cell carcinoma, with a lower cure rate for squamous cell carcinoma. An annual full-skin exam can help to catch cancerous tissue in its early, most treatable stages.

At Dermatology Consultants, we specialize in Mohs surgery; however, we will determine which type of skin cancer treatment will appropriately treat your particular condition.   Some of the other cancer treatments are cryotherapy (deep freezing), radiation therapy, and excision.

Insurance Coverage

Because Mohs Surgery is a medical procedure, rather than a cosmetic procedure, most insurances plans provide coverage. However, because insurance plans may change over time, it is important for a candidate to make contact with his or her insurance carrier first to learn about eligibility and benefits.

For more information, visit the American College of Mohs Surgery patient education website. Patients can Learn More About Mohs Surgery, including what the Mohs Procedure is, see the Mohs step-by-step process, and get answers to the most-asked questions about the procedure.

Please schedule your appointment with one of our highly skilled Mohs surgeons today by calling (651) 209-1600! 

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