Mohs Micrographic surgery is a safe and highly effective technique whereby skin cancers are removed under complete microscopic control. Dr. Fredric Mohs developed the specialized technique in the 1930’s. In Mohs surgery, a thin layer of skin is removed around the visible cancer. Detailed maps are then drawn of the area, and the tissue is completely examined under the microscope to be sure all the cancer and its roots are gone. If any cancer remains, additional tissue is removed from those areas and analyzed. This process is repeated until the cancer has been completely removed.
By using the mapping technique and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye and can sometimes be missed by a traditional excision. Therefore, even the smallest microscopic roots of cancer can be removed. Benefits of this meticulous technique include its ability to preserve as much normal skin as possible and offer the highest possibility for cure. Mohs surgery is the most effective treatment for most types of skin cancer.
You want your skin cancer treatment to be performed with the highest standards of quality and competency. The American College of Mohs Surgery is the only organization that requires its members, after their years of residency training, to successfully complete an extensive fellowship of at least one full year of hands-on training in the Mohs procedure under the supervision of a highly qualified instructor. Click here to learn more…
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Surgery begins in the morning and is performed in the office as an outpatient. A local anesthetic is injected into the skin to numb the area to be treated. Once the area is numb, the visible cancer is removed as well as a thin layer of tissue around the cancer. A temporary dressing is applied. The tissue is then mapped by the surgeon and taken to our laboratory where it is color coded, processed, and examined under the microscope. This part of the procedure takes about one hour while. If additional tumor is identified, the process is repeated until all of the cancer is removed. The number of stages or layers required varies for each patient and depends upon the size and depth of the tumor. On average, most patients have one or two layers of tissue removed. Since we cannot predict in advance the number of stages necessary to fully remove the tumor, you should plan on spending the entire day with us. Do not make any other appointments on this day.
Once the area is cancer free, the surgeon will discuss the options of wound healing and surgical repair. The reconstructive surgery may include suturing the wound together side to side or require a skin graft or flap. Sometimes the wound is left to heal on its own. Depending on the circumstance, the reconstruction may be coordinated by a plastic surgeon. Following surgery, a dressing is applied and you will be given instructions on wound care.
: Because the procedure is performed under local anesthesia, you may eat breakfast in the morning.
Medications: Please take your daily prescription medications prior to surgery, especially blood pressure medications. Also bring a list of your medications with you, including non-prescriptions drugs.
You may take Tylenol anytime before surgery if needed for pain.
If you have been prescribed Coumadin, Xarelto or Pradaxa, do not stop taking your medication. Continue as instructed. We can still perform your surgery. If you are on Aspirin and have any history of heart disease, stroke or TIA, do not stop this medication either. If you take Aspirin solely for “good measure” you may stop taking it seven days prior to surgery to decrease the risk of bleeding or bruising, as a result of your surgery.
Please stop Vitamin E and any fish oil one week prior to surgery as these can also contribute to bleeding.
Alcohol: Alcohol promotes bleeding. We ask that you avoid alcoholic beverages 24 hours before and after surgery.
Smoking: Smoking affects wound healing by diminishing blood supply at your surgery site and can lead to excess scarring. We ask that you discontinue smoking as soon as is possible prior to surgery. If you cannot stop completely, decreasing the amount you smoke will still be of benefit.
Transportation: You may want to make arrangements for someone to drive you to and from our office the day of surgery. This person may stay with you during the waiting period to keep you company between layers. Although you may be finished earlier, please plan on spending the entire day with us. If the area being treated is near your eye, the bandage that we apply may interfere with the positioning of your glasses or obstruct your vision. In these instances it will be necessary that you arrange transportation.
Passing Time: 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.
Lunch: We recommended you bring lunch or a snack with you. We can refrigerate your lunch when you arrive. Your companion may bring you a snack or lunch from several eateries that are located near our office. We ask that you not leave the office until the surgery has been completed.
Attire: Please dress comfortably the day of surgery.
If you have any problems at home after surgery, please do not hesitate to call our office. We will be glad to answer any questions. Instructions for wound care will be discussed at the completion of surgery and you will receive written instructions as well.
The surgical site may be sore for several days after surgery. If there is any discomfort, Tylenol is usually adequate for relief. Avoid taking aspirin or ibuprofen-containing medications as they may cause bleeding.
Bruising and swelling are common after surgery. This may not peak until 48 hours following the surgery. We do not recommend planning your surgery date around an engagement where physical appearance is important.
Activities, including exercise or heavy lifting, will be restricted until stitches are removed. The more activity you participate in after surgery, the more likely you may bleed from the surgery site.
A scar is formed after any form of surgery. Every effort will be made to decrease the appearance of this scar. Using the Mohs technique allows us to spare healthy tissue and this will help to minimize scarring.
Suture removal and wound evaluation is usually performed one week after surgery. Periodic visits at least once a year to your referring physician are advisable to monitor for new skin cancers or signs of recurrence from previous procedures. Since statistics show that a patient with skin cancer has a higher chance of developing another one, follow-up is very important.
Here are some helpful hints to avoid the damaging effects of the sun and protect your skin from more injury:
- Cover up with protective clothing, hats, beach umbrellas, etc. even on cloudy days, to minimize unnecessary exposure.
- Avoid the sun at its most intense hours from 10:00 am to 4:00 pm if possible.
- Regularly and liberally apply a board spectrum sunscreen (SPF 30 or greater with UVA and UVB coverage) on a daily basis. Re-apply every 2-3 hours during prolonged sun exposure.
Sun protection is extremely important to minimize further damage to your skin and the risk of developing additional skin cancers. Enjoy the outdoors, but do it wisely.