Mohs surgery also referred to as Mohs micrographic surgery, is a precise surgical technique used to treat skin cancer. Mohs surgery has a high cure rate and allows dermatologists to preserve as much healthy skin as possible by only removing the cancerous skin.
Mohs surgery is considered a highly effective type of surgery to treat the most common types of skin cancer. The surgery can be technically challenging as it is carried out by an experienced dermatologist (skin doctor), fellowship-trained in skin cancer surgery.
The dermatologist performs the surgery in stages and works by progressively removing and analyzing thin layers of skin containing the cancer cells, until only cancer-free tissue remains. Unlike conventional excision surgery that involves removing the visible cancer along with a small margin of surrounding healthy tissue, Mohs surgery aims to remove as much of the cancerous skin as possible, while doing minimal damage to the surrounding healthy skin. This can be particularly effective when treating skin cancer that developed in an area with little tissue beneath, such as the ear, eyelid, or hand.
Why is Mohs Surgery Done
Mohs surgery is used to treat the two most common skin cancers, basal cell carcinoma (BCCs) and squamous cell carcinomas (SCCs). It is usually recommended when the skin cancer:
- Is large or aggressive
- Is in an area with little tissue beneath it, such as the nose, ear, around the eyes, scalp, genitals, hand, or foot)
- Was treated and returned, or has a high risk of recurrence
- Has a border that is hard to define
How Does the Procedure Work?
Your surgeon will explain how you can prepare for surgery and may request you stop taking certain medications or supplements prior to the procedure. You should wear comfortable clothing, and bring some entertainment along, such as a book or magazine, as there can be some waiting during surgery.
Mohs surgery is an outpatient procedure. It requires a local anesthetic at the site of the cancer. Most procedures are completed within 1 to 5 hours, depending on the extent of the skin tumor. Surgery is typically performed with a lab area onsite. This allows the surgeon to examine each small layer of tissue to check for cancer cells. Most skin tumors require 1-4 stages for complete removal and as much as a 1-2 hour wait between each stage for analysis.
The visible tumor is removed using special surgical instruments. A thin layer of tissue with a small margin around the tumor site is removed gradually in stages, one tissue layer at a time. Once the layer of tissue has been removed, the surgeon takes it to the lab for analysis. The staff makes you comfortable while you wait, with a simple bandage in place.
Each layer of tissue is cut into small sections and examined thoroughly under a microscope. The surgeon carefully maps out the tissue sample to identify the exact location of any cancer cells. The surgeon repeats the process, layer by layer, to check for evidence of remaining cancer cells. And the process continues until the last tissue sample is cancer-free. Once the surgeon removes all the cancer cells successfully, the surgical site is evaluated to determine the best option for the area to heal.
Will I Need Reconstruction for The Wound?
Once the surgeon removes all of the cancerous tissue, he discusses with you how best to repair the wound to achieve the best possible cosmetic and functional results. Reconstruction is typically done the same day as the cancer removal. However, it depends on the extent of surgery. There are several options for reconstruction including:
- Allowing the wound to heal on its own (healing by second intention).
- Using sutures to close the wound (a primary closure).
- Using a skin flap from a nearby area to cover the wound.
- Using a skin graft from another area of the body to cover the wound.
For more complex surgical procedures, the wound may be closed temporarily. Then the surgeon may refer you to another reconstructive surgical specialist to repair the wound.
What Risks Are Involved?
Complications associated with this type of surgery are rare and are usually only temporary. However, as with any kind of surgical procedure, there can be risks involved which may include:
- Pain/tenderness/bruising at the surgical site
- Itching/shooting pains in the affected area
Mohs surgery is an outpatient procedure and only uses local anesthesia, which ensures a quicker recovery period. Therefore, in most cases, you can drive yourself home after your procedure.
Due to this type of surgical approach, Mohs surgery offers the highest chance of complete removal of the cancer, while sparing normal healthy tissue. This type of surgery has a high rate of cure for skin cancer. But there is always a small chance of cancer recurrence or developing another skin cancer in the future. If you have been diagnosed with skin cancer, you are at an increased risk of developing skin cancer again. You should, therefore, have regular follow-up visits with your doctor to check for any new skin cancer.
Mohs Surgery in Miami, FL
The Dermatology and Skin Cancer Center offers high-quality dermatologic services in the Miami area. We specialize in Mohs Micrographic Surgery for the treatment of high-risk skin cancers. We also perform skin cancer and full body screenings. We offer a variety of treatment options for skin cancer, and other skin surgical procedures.
If you would like to find out more about Mohs surgery or our other services, call us at (305) 461-2000. Alternatively, you can contact us using our convenient online request form.