Mohs

Mohs Surgery

Mohs surgery is the most effective and advanced treatment for skin cancer today. It offers the highest potential for cure – even if the skin cancer has been previously treated by another method.

Originally developed in the 1930s, Mohs micrographic surgery has been refined into the most advanced, precise, and effective treatment for an increasing variety of skin cancer types. With the Mohs technique, physicians can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed.

Success Rate of Mohs Surgery Mohs surgery is the most effective treatment for most types of skin cancer.

The Mohs Procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Our Gardens Dermatology, board certified dermatologists are trained as a cancer surgeons, pathologists, and reconstructive surgeons, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.

Advantages of Mohs Surgery

Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on site by the Mohs surgeon, who is specially trained in the reading of these slides and is best able to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include:

  • Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back
  • Minimizing the amount of healthy tissue lost - Maximizing the functional and cosmetic outcome resulting from surgery
  •  Repairing the site of the cancer the same day the cancer is removed, in most cases
  • Curing skin cancer when other methods have failed.

Other skin cancer treatment methods blindly estimate the amount of tissue to treat, which can result in the unnecessary removal of healthy skin tissue and tumor re-growth if any cancer is missed. The Mohs Procedure It's helpful to know what to expect before you undergo any surgical procedure. Because the Mohs surgery procedure for skin cancer removal is somewhat complex, it can be reassuring to become familiar with the treatment process ahead of time. Here, you can learn what to expect before, during, and after your procedure.

Before Your Surgery

Once you have set an appointment for surgery, you receive a detailed list of instructions to follow beforehand. You may be asked to:

  • Temporarily stop the use of certain medications, including some over-the-counter pain relievers, supplements, and other medicines
  • Stop consuming certain foods or beverages a number of hours before your procedure
  • Stop smoking
  • Clear a full day for your procedure, because it is difficult to predict how long it may take.

Your Gardens Dermatology board certified Mohs surgeon and his or her team will give you more information about these and other considerations before your surgery, and it's important to follow this advice as closely as you can to ensure a successful outcome. Your Mohs Procedure Surgeons usually perform Mohs skin cancer surgery as an outpatient procedure in the office, which has an on-site surgical suite and a laboratory for microscopic examination of tissue. Typically, surgery starts early in the morning and is completed the same day, depending on the extent of the tumor and the amount of reconstruction necessary.

You receive local anesthesia around the area of the tumor, so you are awake during the entire procedure. The use of local anesthesia versus general anesthesia provides numerous benefits, including preventing a lengthy recovery and possible side effects from general anesthesia. You are completely numb in the area of the surgery, though, so the procedure is comfortable.

After the area has been numbed, your Gardens Dermatology surgeon removes the visible tumor, along with a thin layer of surrounding tissue. A technician then prepares this tissue and puts it on slides for your surgeon to examine under a microscope. If the surgeon sees evidence of cancer around the outer edges of the removed tissue, he or she takes another layer of tissue from the area where the cancer was detected. This ensures that only cancerous tissue is removed during the procedure, minimizing the loss of healthy tissue. Your surgeon repeats these steps until all samples are free of cancer. Although there are always exceptions to the rule, most tumors require 1 to 3 stages for complete removal.

After Your Surgery

When your surgery is complete, your Mohs surgeon assesses the wound and discusses your options for ideal functional and cosmetic reconstruction. Your surgeons understand that a good cosmetic result is an important part of the recovery process, and that's why they work so hard to leave as little tissue damage as possible. If reconstruction is necessary, the Mohs surgeon usually repairs the area the same day as the tumor removal.

Post-Operative CareAfter a Mohs surgery procedure, most patients find the recovery process simple and easy thanks to the streamlined surgical approach that leaves surrounding tissue unharmed. Nonetheless, it's common for patients to wonder what they can expect after a Mohs skin cancer surgery. It's also important to use the post-operative period to plan an ongoing skin cancer detection strategy for the future.

This page is intended to help you understand what to expect in the short and long term.

Immediate Aftercare After a Mohs surgical procedure, you may or may not undergo a repair process to mend the wound left by the surgery. A number of different reconstruction options exist, and instructions for aftercare are different depending on which approach the surgeon takes.

The surgeon and his or her medical team will provide you with detailed instructions to follow at home, and it's important you do so in order to enhance your healing and final outcome. These instructions will include:

Information about when to change bandages and how to clean the surgical site Medication information about prescription or over-the-counter pills or a schedule of follow-up appointments to remove any stitches and monitor your healing.

Recommendations for treating your Mohs surgery scar to ensure it heals and fades quickly because our dermatologists perform the procedure in an outpatient setting using only local anesthesia, immediate recovery generally involves little more than resting and simple wound care. Some patients may experience mild discomfort, bleeding, redness, or inflammation, but these are typically temporary and easily manageable.

Long-Term Care

Although Mohs micrographic surgery has an extremely high success rate that frequently prevents skin cancer from recurring at the same site, monitoring is still very important for Mohs patients. Once you discover that you are prone to skin cancer, diligence is crucial for detecting any new lesions that may form elsewhere on your body.

Your surgeon arranges a schedule of post-surgical checkups that may extend many years into the future. He or she also gives you specific strategies for recognizing skin cancer symptoms so you can develop good detection habits at home.The Mohs surgery procedure seems simple: the surgeon removes the cancer, carefully checks to be sure that he or she got it all, then repairs the wound. Your board certified Gardens Dermatology Dermatologists, however, train in and practice the complex nuances of this process for years so they are prepared to handle any situation they may encounter. This page describes the steps they follow for each Mohs surgical procedure.

Mohs skin cancer surgery is the most effective treatment for most types of skin cancer.

Step 1

The Mohs Step-by-Step Process: Step 1

The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur. A surgery starts with your dermatologist examining the visible lesion and planning what tissue to remove. The patient then receives local anesthesia, and the Mohs surgery begins.

Step 2

The Mohs Step-by-Step Process: Step 2

The surgeon removes the visible portion of the tumor using careful surgical techniques.

Step 3

The Mohs Step-by-Step Process: Step 3

The Gardens Dermatology surgeon next removes a deeper layer of skin and divides it into sections. With the help of technicians, the surgeon then color-codes each of these sections with dyes and makes reference marks on the skin to show the source of the sections. A map of the surgical site is then drawn to track exactly where each small portion of tissue originated.

Step 4

The Mohs Step-by-Step Process: Step 4

In a laboratory, the surgeon uses a microscope to examine the undersurface and edges of each section of tissue in search of evidence of remaining cancer.

Step 5

The Mohs Step-by-Step Process: Step 5

If the surgeon finds cancer cells under the microscope, he or she marks their location on the "map" and returns to the patient to remove another deeper layer of skin — but only from precisely where the cancer cells originated. This method ensures that the Mohs surgery results in the smallest scar possible.

Step 6

The removal process stops when there is no longer any evidence of cancer in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

At this point, the surgeon discusses reconstruction options, should they be required, and then post-operative care. Mohs surgery recovery tends to be easily manageable because of the use of local anesthesia and the careful surgical techniques.

Immediate Aftercare

After a Mohs surgical procedure, you may or may not undergo a repair process to mend the wound left by the surgery. A number of different reconstruction options exist, and instructions for aftercare are different depending on which approach the surgeon takes.

The surgeon and his or her medical team will provide you with detailed instructions to follow at home, and it's important you do so in order to enhance your healing and final outcome. These instructions will include:

  • Information about when to change bandages and how to clean the surgical site
  • Medication information about prescription or over-the-counter pills or topical ointments
  • A timeline for when you can return to certain activities, such as wearing makeup or exercising
  • A schedule of follow-up appointments to remove any stitches and monitor your healing
  • Recommendations for treating your Mohs surgery scar to ensure it heals and fades quickly

Because American Academy of Dermatology board certified members perform the procedure in an outpatient setting using only local anesthesia, immediate recovery generally involves little more than resting and simple wound care. Some patients may experience mild discomfort, bleeding, redness, or inflammation, but these are typically temporary and easily manageable.

Your surgeon arranges a schedule of post-surgical checkups that may extend many years into the future. He or she also gives you specific strategies for recognizing skin cancer symptoms so you can develop good detection habits at home

Long-Term Care

Although Mohs micrographic surgery has an extremely high success rate that frequently prevents skin cancer from recurring at the same site, monitoring is still very important for Mohs patients. Once you discover that you are prone to skin cancer, diligence is crucial for detecting any new lesions that may form elsewhere on your body.