Mohs Micrographic Surgery
Updated July 08, 2014.
What is Mohs surgery:
Mohs micrographic surgery was developed in the 1930’s by Dr. Frederic Mohs at the University of Wisconsin. It is now practiced throughout the world as a highly-effective method of removing skin cancer. The procedure involves surgically removing the skin cancer layer by layer. Immediately upon removal, each layer is examined under a microscope by the surgeon until only healthy, cancer-free skin remains.
Reasons to have Mohs surgery:
There are several potential reasons for undergoing Mohs surgery for skin cancer removal. Your personal case should be discussed with your dermatologist. For basal cell carcinoma (the most common type of skin cancer), Mohs surgery cure rates typically exceed 98-99% for new cancers, and 94-96% for recurrent cancers (Leibovitch, et al. 2005; Rowe, et al. 1989a; Rowe, et al. 1989b). Mohs surgery removes all of the cancer cells visible under the microscope, while sparing as much healthy tissue as possible. While all surgical procedures may cause some degree of visible scarring, the tissue-sparing nature of the Mohs technique may result in the smallest scar possible.
Skin cancers that might require Mohs surgery include those that:
Preparing for the surgery:
Most insurance policies cover the costs of Mohs surgery, but it is advisable to contact your insurance company and the billing department of your Mohs surgeon to confirm your coverage or to see if you first need a referral from your primary care doctor.
Your doctor may have specific preoperative instructions. If not given to you, please ask your surgeon for the instructions and for things to avoid in the days before surgery. Follow these instructions closely. Finally, Mohs surgery on certain areas may impair your ability to safely operate a motor vehicle, so if your surgeon tells you this, you would need to arrange for transportation after your surgery.
What to let your surgeon know beforehand:
You should provide your doctor with a complete list of all medications (prescription, over-the-counter, vitamins, herbal medicines, and supplements). It is especially important to note blood thinners, such as aspirin. You should also discuss with your surgeon any concerns or questions you have regarding the procedure. If you have ever been told to take antibiotics before a surgical procedure, you should inform your surgeon so that the appropriate precautions can be taken.
What to expect on the day of surgery:
Surgeons usually perform Mohs micrographic surgery as an outpatient procedure in their office, which will have an on-site surgical suite and a laboratory for immediate preparation and microscopic examination of removed skin tissue. General anesthesia is not used, so you will be awake during the entire procedure.
Mohs surgery involves five steps:
1. Injection of local anesthesia to numb your skin.
2. Surgical removal of the visible tumor.
3. Examining skin tissue under a microscope for evidence of remaining cancer cells.
4. Removal of additional layers of skin as necessary until no cancer cells remain.
5. If necessary, reconstruction of the surgical site using sutures, skin grafts, or flaps.
Although the surgery is a multistep process, most surgeries require less than four hours for completion. However, because it is not possible to predict how extensive a cancer will be, more time may be necessary.
Post-surgery care:
After the surgery, you may experience bruising, swelling and small amounts of bleeding around the wound. Your surgeon should give you instructions for taking care of the wound at home. Full recovery may take 2-4 weeks.
Most patients do not have significant pain after the surgery, but if there is discomfort, an over-the-counter pain reliever such as Tylenol can be used. If necessary, stronger pain medications may be prescribed by your surgeon.
Warning signs to look out for after surgery:
If any of the above symptoms, such as pain, bruising, swelling, or bleeding, are severe, you should contact your surgeon immediately for further guidance.
Sources:
“Mohs Micrographic Surgery for Nonmelanoma Skin Cancer.” WebMD. http://D109/cancer/mohs-micrographic-surgery-for-nonmelanoma-skin-cancer
“Patient Information: Mohs Micrographic Surgery in the Treatment of Skin Cancer.” American Society for Mohs Surgery. http://www.mohssurgery.org/files/public/patient_information_brochure.pdf
“Patient FAQs.” American Society for Mohs Surgery. http://www.mohssurgery.org/i4a/pages/index.cfm?pageid=3313
“Overview of Mohs Micrographic Surgery.” American College of Mohs Surgery. http://www.skincancermohssurgery.org/mohs-surgery/overview.php
Leibovitch, I., S. C. Huilgol, et al. (2005). "Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up." J Am Acad Dermatol 53(3): 452-457.
Rowe, D. E., R. J. Carroll, et al. (1989). "Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up." J Dermatol Surg Oncol 15(3): 315-328.
Rowe, D. E., R. J. Carroll, et al. (1989). "Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma." J Dermatol Surg Oncol 15(4): 424-431.
What is Mohs surgery:
Mohs micrographic surgery was developed in the 1930’s by Dr. Frederic Mohs at the University of Wisconsin. It is now practiced throughout the world as a highly-effective method of removing skin cancer. The procedure involves surgically removing the skin cancer layer by layer. Immediately upon removal, each layer is examined under a microscope by the surgeon until only healthy, cancer-free skin remains.
Reasons to have Mohs surgery:
There are several potential reasons for undergoing Mohs surgery for skin cancer removal. Your personal case should be discussed with your dermatologist. For basal cell carcinoma (the most common type of skin cancer), Mohs surgery cure rates typically exceed 98-99% for new cancers, and 94-96% for recurrent cancers (Leibovitch, et al. 2005; Rowe, et al. 1989a; Rowe, et al. 1989b). Mohs surgery removes all of the cancer cells visible under the microscope, while sparing as much healthy tissue as possible. While all surgical procedures may cause some degree of visible scarring, the tissue-sparing nature of the Mohs technique may result in the smallest scar possible.
Skin cancers that might require Mohs surgery include those that:
- Are located in an area where it is important to preserve healthy skin for normal functioning or cosmetic appearance (e.g. eyelids, nose, ears, lips, hands)
- Have come back after being previously removed
- Are at high risk for coming back
- Have irregular borders
- Are large or growing rapidly
Preparing for the surgery:
Most insurance policies cover the costs of Mohs surgery, but it is advisable to contact your insurance company and the billing department of your Mohs surgeon to confirm your coverage or to see if you first need a referral from your primary care doctor.
Your doctor may have specific preoperative instructions. If not given to you, please ask your surgeon for the instructions and for things to avoid in the days before surgery. Follow these instructions closely. Finally, Mohs surgery on certain areas may impair your ability to safely operate a motor vehicle, so if your surgeon tells you this, you would need to arrange for transportation after your surgery.
What to let your surgeon know beforehand:
You should provide your doctor with a complete list of all medications (prescription, over-the-counter, vitamins, herbal medicines, and supplements). It is especially important to note blood thinners, such as aspirin. You should also discuss with your surgeon any concerns or questions you have regarding the procedure. If you have ever been told to take antibiotics before a surgical procedure, you should inform your surgeon so that the appropriate precautions can be taken.
What to expect on the day of surgery:
Surgeons usually perform Mohs micrographic surgery as an outpatient procedure in their office, which will have an on-site surgical suite and a laboratory for immediate preparation and microscopic examination of removed skin tissue. General anesthesia is not used, so you will be awake during the entire procedure.
Mohs surgery involves five steps:
1. Injection of local anesthesia to numb your skin.
2. Surgical removal of the visible tumor.
3. Examining skin tissue under a microscope for evidence of remaining cancer cells.
4. Removal of additional layers of skin as necessary until no cancer cells remain.
5. If necessary, reconstruction of the surgical site using sutures, skin grafts, or flaps.
Although the surgery is a multistep process, most surgeries require less than four hours for completion. However, because it is not possible to predict how extensive a cancer will be, more time may be necessary.
Post-surgery care:
After the surgery, you may experience bruising, swelling and small amounts of bleeding around the wound. Your surgeon should give you instructions for taking care of the wound at home. Full recovery may take 2-4 weeks.
Most patients do not have significant pain after the surgery, but if there is discomfort, an over-the-counter pain reliever such as Tylenol can be used. If necessary, stronger pain medications may be prescribed by your surgeon.
Warning signs to look out for after surgery:
If any of the above symptoms, such as pain, bruising, swelling, or bleeding, are severe, you should contact your surgeon immediately for further guidance.
Sources:
“Mohs Micrographic Surgery for Nonmelanoma Skin Cancer.” WebMD. http://D109/cancer/mohs-micrographic-surgery-for-nonmelanoma-skin-cancer
“Patient Information: Mohs Micrographic Surgery in the Treatment of Skin Cancer.” American Society for Mohs Surgery. http://www.mohssurgery.org/files/public/patient_information_brochure.pdf
“Patient FAQs.” American Society for Mohs Surgery. http://www.mohssurgery.org/i4a/pages/index.cfm?pageid=3313
“Overview of Mohs Micrographic Surgery.” American College of Mohs Surgery. http://www.skincancermohssurgery.org/mohs-surgery/overview.php
Leibovitch, I., S. C. Huilgol, et al. (2005). "Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up." J Am Acad Dermatol 53(3): 452-457.
Rowe, D. E., R. J. Carroll, et al. (1989). "Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up." J Dermatol Surg Oncol 15(3): 315-328.
Rowe, D. E., R. J. Carroll, et al. (1989). "Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma." J Dermatol Surg Oncol 15(4): 424-431.
Source...