What is Mohs surgery?
Mohs Surgery is a complex procedure combining surgical excision with immediate microscopic examination, offering the highest cure rate available for certain common skin cancers. This unique and highly specialized approach significantly increases the chance of complete cure, while minimizing the damage to the healthy and normal surrounding skin. This provides the best cosmetic outcome possible.
The Mohs Surgery technique allows your physician to examine 100% of the surgical margin (superficial and deep areas within the dermis) and pinpoint the exact location of the residual cancer. Since many of the skin cancers removed with Mohs Surgery are complicated, your physician will revisit the area of concern in multiple stages. Each stage includes surgical excision, where your physician will selectively remove a layer of skin, cutting only the ‘positive’ cancer area. The thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.
- Mohs has the highest cure rate available for nonmelanoma skin cancer
- The smallest amount of healthy skin tissue necessary is removed
- The entire procedure, from start to finish, is performed by a board-certified, skin cancer surgeon with highly specialized training
- Mohs surgery results in the smallest possible scar and the best cosmetic outcome
Am I a candidate for Mohs surgery?
You may be a candidate for Mohs if you:
- have aggressive or large basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)
- have a BCC or SCC in an area with little tissue beneath, such as the eyelid, nose, ear, scalp, hand, foot, or genitals
- have a BCC or SCC that has returned after being treated
Regardless of the skin cancer that you have, Mohs is only recommended for certain patients. You must have one skin cancer or a few skin cancers that are very close together.
What can I expect during Mohs surgery?
In most cases, the Mohs procedure will take place over a few hours. Since it is challenging to know how extensive a skin cancer is at first look, your physician will most likely recommend reserving the entire day for the surgery.
To prepare for this in-office surgery, your physician, surgeon, or nurse will cleanse your skin, then outline the affected area with a surgical marker. Next, small injections of local anesthetic are made, which will numb the skin, so you won’t feel any discomfort during the procedure.
During the procedure
Once the anesthetic has taken effect, the first stage of your procedure begins with your surgeon using a scalpel to remove the visible portion of the cancer along with a thin, underlying layer of tissue that’s slightly larger than the visible tumor. A temporary bandage is placed on the incision while your surgeon sends the removed tissue to the specialized in-office laboratory for analysis.
This portion of the procedure typically takes the longest amount of time and you are encouraged to relax, read a book, watch your iPad, or chat in the room with a friend or family member who may have accompanied you. You will be need to stay in the office during this waiting period between stages.
While you are relaxing, the Mohs technician will cut the tissue sample into sections and prepare slides for your surgeon to then examine under a microscope. Your surgical team will take great care to keep track of the exact spot where each piece of tissue was removed by making a map. This ensures that if a small area of cancer is found in one piece of tissue, your surgeon knows precisely where to return for the next stage of the procedure.
If cancer remains, your Mohs surgery will continue. Your surgeon will return and excise, or remove, another layer of tissue, with dedicated attention to cut only cancerous tissue, while leaving as much healthy skin tissue as possible. While you head back to the waiting room, your tissue sample is sent to the laboratory again for processing then to your surgeon for analysis.
This process is repeated until your surgeon finds the last tissue sample is cancer-free.
After the procedure
After all of the cancer has been removed, your surgeon will present options on how the wound can be repaired. Depending on the extent of the affected tissue, options presented might include:
- Letting the wound heal on its own
- Using stitches to close the wound (sometimes referred to as a primary closure)
- Placing a skin flap, which entails shifting skin from an adjacent area to cover the wound
- Using a skin graft from another part of the body to cover the wound
Follow-up exams to look for additional skin cancer
People who have been diagnosed with skin cancer have an increased risk of developing it again, compared with people who have never had skin cancer. As many as half the people diagnosed with the most common types of skin cancer will develop another skin cancer again within five years.
It is incredibly important to schedule regular follow-up visits. The frequency of your follow-up schedule is a conversation to have with your physician, as it is dependent on the type of skin cancer diagnosis you received. Your surgeon will give recommendations for post-care follow up, however expect to have an annual skin check at the bare minimum. If your cancer was aggressive, the recommendation may be for multiple visits per year.
Request an appointment
If you have skin cancer, schedule an appointment with DermPhysicians of New England. During your initial consultation, we will determine if Mohs surgery is the best treatment option for you. To get started, give us a call at (781) 272-7022 or request an appointment online using the form below.